基于超声和计算机断层扫描的甲状腺癌术前患者颈部淋巴结危险分层系统和活检标准的验证。

Validation of Ultrasound and Computed Tomography-Based Risk Stratification System and Biopsy Criteria for Cervical Lymph Nodes in Preoperative Patients With Thyroid Cancer.

机构信息

Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.

Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.

出版信息

Korean J Radiol. 2023 Sep;24(9):912-923. doi: 10.3348/kjr.2023.0215.

OBJECTIVE

This study aimed to validate the risk stratification system (RSS) and biopsy criteria for cervical lymph nodes (LNs) proposed by the Korean Society of Thyroid Radiology (KSThR).

MATERIALS AND METHODS

This retrospective study included a consecutive series of preoperative patients with thyroid cancer who underwent LN biopsy, ultrasound (US), and computed tomography (CT) between December 2006 and June 2015. LNs were categorized as probably benign, indeterminate, or suspicious according to the current US- and CT-based RSS and the size thresholds for cervical LN biopsy as suggested by the KSThR. The diagnostic performance and unnecessary biopsy rates were calculated.

RESULTS

A total of 277 LNs (53.1% metastatic) in 228 patients (mean age ± standard deviation, 47.4 years ± 14) were analyzed. In US, the malignancy risks were significantly different among the three categories (all < 0.001); however, CT-detected probably benign and indeterminate LNs showed similarly low malignancy risks ( = 0.468). The combined US + CT criteria stratified the malignancy risks among the three categories (all < 0.001) and reduced the proportion of indeterminate LNs (from 20.6% to 14.4%) and the malignancy risk in the indeterminate LNs (from 31.6% to 12.5%) compared with US alone. In all image-based classifications, nodal size did not affect the malignancy risks (short diameter [SD] ≤ 5 mm LNs vs. SD > 5 mm LNs, ≥ 0.177). The criteria covering only suspicious LNs showed higher specificity and lower unnecessary biopsy rates than the current criteria, while maintaining sensitivity in all imaging modalities.

CONCLUSION

Integrative evaluation of US and CT helps in reducing the proportion of indeterminate LNs and the malignancy risk among them. Nodal size did not affect the malignancy risk of LNs, and the addition of indeterminate LNs to biopsy candidates did not have an advantage in detecting LN metastases in all imaging modalities.

目的

本研究旨在验证韩国甲状腺放射学会（KSThR）提出的颈淋巴结（LNs）风险分层系统（RSS）和活检标准。

材料与方法

本回顾性研究纳入了 2006 年 12 月至 2015 年 6 月期间连续接受 LN 活检、超声（US）和计算机断层扫描（CT）检查的术前甲状腺癌患者。根据当前基于 US 和 CT 的 RSS 以及 KSThR 建议的颈部 LN 活检大小阈值，将 LNs 分为可能良性、不确定或可疑。计算了诊断性能和不必要活检率。

结果

共分析了 228 例患者（平均年龄 ± 标准差，47.4 岁 ± 14）的 277 个 LN（53.1%转移性）。在 US 中，三个类别之间的恶性风险差异有统计学意义（均 < 0.001）；然而，CT 检测到的可能良性和不确定 LNs 显示出相似的低恶性风险（ = 0.468）。联合 US + CT 标准将三个类别之间的恶性风险分层（均 < 0.001），并降低了不确定 LNs 的比例（从 20.6%降至 14.4%）和不确定 LNs 的恶性风险（从 31.6%降至 12.5%），与 US 相比。在所有基于图像的分类中，淋巴结大小不影响恶性风险（短径 [SD] ≤ 5 mm LNs 与 SD > 5 mm LNs， ≥ 0.177）。仅覆盖可疑 LNs 的标准在所有成像方式中均具有更高的特异性和更低的不必要活检率，同时保持敏感性。