Endocr Pract. 2019 Oct;25(10):1049-1055. doi: 10.4158/EP-2018-0567. Epub 2019 Jun 26.
The aim of this study was to assess and compare the diagnostic power of B-mode ultrasonography (US), power Doppler US (PD), and ultrasound elastography (USE) in detecting malignant lymph nodes (LNs) during follow-up of patients who were operated on for differentiated thyroid cancer (DTC). In this prospective study, a total of 103 cervical LNs having suspicious malignant features from 72 patients with DTC were examined using US, PD, and USE. USE scores were classified from 1 to 3 according to the presence of elasticity (1, soft; 2, intermediate; 3, hard). The strain ratios (SRs) of all LNs were calculated according to adjacent muscle tissue. The most-sensitive ultrasonographic features were hilum loss and hypoechogenicity, with 94.4% and 80.6% sensitivity and 93.5% and 84.4% negative predictive value, respectively. The most-specific feature was the presence of cystic component, with 98.5% specificity and 85.7% positive predictive value. Presence of diffuse/chaotic or irregular vascularity in PD had 47.2% sensitivity and 83.6% specificity in predicting metastasis. In USE, the sensitivity and specificity of score 3 were 56.7% and 74.2%, respectively. The median SR of metastatic LNs was higher than that of benign LNs (median SR [min-max], 3.0 [0.16 and 29] vs. 1.89 [0.26 and 37.9]), but the difference was not significant ( = .07). Multivariate logistic regression analyses revealed 4.9-, 6.6-, and 10-fold increases in metastasis risk for short/long axis ratio ≥0.5, nodal vascularity, and score 3 USE, respectively (<.05). While USE had higher sensitivity, PD had higher specificity in detecting malignant LNs, but none of these techniques was as sensitive and specific as gray-scale US features. = confidence interval; = differentiated thyroid cancer; = lymph node; = lymph node-thyroglobulin; = negative predictive value; = power Doppler; = positive predictive value; = region of interest; = strain ratio; = ultrasonography; = ultrasound elastography.
本研究旨在评估和比较 B 型超声（US）、能量多普勒超声（PD）和超声弹性成像（USE）在检测分化型甲状腺癌（DTC）患者术后随访中恶性淋巴结（LNs）的诊断能力。在这项前瞻性研究中，对 72 例 DTC 患者的 103 个具有可疑恶性特征的颈部 LNs 进行了 US、PD 和 USE 检查。根据弹性（1，软；2，中等；3，硬）对 USE 评分进行分类。根据相邻肌肉组织计算所有 LNs 的应变比（SR）。最敏感的超声特征是门部缺失和低回声，其灵敏度分别为 94.4%和 80.6%，阴性预测值分别为 93.5%和 84.4%。最特异的特征是存在囊性成分，特异性和阳性预测值分别为 98.5%和 85.7%。PD 中弥漫/杂乱或不规则血管的存在对转移的预测具有 47.2%的灵敏度和 83.6%的特异性。在 USE 中，评分 3 的灵敏度和特异性分别为 56.7%和 74.2%。转移性 LNs 的中位数 SR 高于良性 LNs（中位数 SR [最小值-最大值]，3.0 [0.16 和 29] vs. 1.89 [0.26 和 37.9]），但差异无统计学意义（ =.07）。多变量逻辑回归分析显示，短/长轴比≥0.5、LN 血管性和 USE 评分 3 的转移风险分别增加 4.9 倍、6.6 倍和 10 倍（<.05）。虽然 USE 的灵敏度较高，但 PD 的特异性较高，在检测恶性 LNs 时，这些技术均不如灰阶 US 特征敏感和特异。 = 置信区间； = 分化型甲状腺癌； = 淋巴结； = 淋巴结-甲状腺球蛋白； = 阴性预测值； = 能量多普勒； = 阳性预测值； = 感兴趣区； = 应变比； = 超声； = 超声弹性成像。
