Department of Ultrasonography, Haian People's Hospital of Jiangsu Province, Haian, Jiangsu, China.
Medicine (Baltimore). 2022 Mar 4;101(9):e28909. doi: 10.1097/MD.0000000000028909.
Preoperative screening of potential risk of lymph node metastasis is necessary for thyroidectomy plus lymph node dissection. The 2015 American thyroid association management guidelines do not recommend prophylactic cervical lymph node resection without clinical evidence of metastasis. Ultrasound is recommended imaging method and routine computed tomography is not recommended by the 2015 American thyroid association management guidelines for screening of lymph node metastasis. The objective of the study was to compare the diagnostic performance of ultrasound against that of computed tomography for screening cervical lymph node metastasis of patients with papillary thyroid cancer before thyroidectomy plus lymph node dissection.Data regarding preoperative neck ultrasound, neck computed tomography, and physical examination of the head and neck and postoperative pathological results of a total of 185 patients (age > 18 years) with a diagnosis of papillary thyroid cancer who had suspicious lymph nodes on preoperative imaging and treated by thyroidectomy plus lymph node dissection for the therapeutic purpose were collected and analyzed.Sensitivity (78.09% vs 75.28%, P < .0001) and accuracy (77.29% vs 75.13%, P = .0004) of neck computed tomography scanning to detect cervical lymph node metastasis were higher than those of neck ultrasound scanning. Sensitivity, accuracy, positive clinical utility, and negative clinical utility for neck ultrasound scanning plus neck computed tomography scanning to detect cervical lymph node metastasis were higher among all index tests (P < .05 for all) and were statistically the same as those of surgical pathology (P > .05 for all). The working areas for decision-making of thyroidectomy plus lymph node dissection of the physical examination, neck ultrasound, the neck computed tomography, and the neck ultrasound scanning plus the neck computed tomography scanning were 0 to 0.691 diagnostic confidence/lesion, 0 to 0.961 diagnostic confidence/lesion, 0 to 0.944 diagnostic confidence/lesion, and 0 to 0.981 diagnostic confidence/lesion, respectively.Besides the neck ultrasound, the neck computed tomography scanning can be used as a complementary imaging method to detect cervical lymph node metastasis of patients with papillary thyroid cancer before thyroidectomy plus lymph node dissection.Level of evidence: III.Technical efficacy stage: 2.
术前筛查甲状腺切除术加淋巴结清扫术的潜在淋巴结转移风险是必要的。2015 年美国甲状腺协会管理指南不建议在没有临床转移证据的情况下预防性颈淋巴结切除术。超声是推荐的影像学方法，2015 年美国甲状腺协会管理指南不建议常规 CT 用于筛查淋巴结转移。本研究的目的是比较超声与 CT 对甲状腺切除术加淋巴结清扫术治疗前甲状腺乳头状癌患者颈部淋巴结转移的诊断性能。收集并分析了 185 例（年龄>18 岁）诊断为甲状腺乳头状癌的患者的术前颈部超声、颈部 CT、头颈部体格检查以及术后病理结果，这些患者术前影像学检查均提示可疑淋巴结，且行甲状腺切除术加淋巴结清扫术治疗。CT 扫描对检测颈部淋巴结转移的敏感性（78.09%比 75.28%，P<.0001）和准确性（77.29%比 75.13%，P=.0004）均高于超声扫描。超声加 CT 扫描检测颈部淋巴结转移的敏感性、准确性、阳性临床效用和阴性临床效用在所有检测指标中均较高（所有 P<.05），与手术病理相同（所有 P>.05）。体格检查、颈部超声、颈部 CT 以及颈部超声加颈部 CT 对甲状腺切除术加淋巴结清扫术的决策工作区分别为 0 至 0.691 诊断置信度/病变、0 至 0.961 诊断置信度/病变、0 至 0.944 诊断置信度/病变、0 至 0.981 诊断置信度/病变。除颈部超声外，颈部 CT 扫描可作为甲状腺切除术加淋巴结清扫术治疗前检测甲状腺乳头状癌患者颈部淋巴结转移的补充影像学方法。证据水平：III。技术效能分期：2。
