Giuffrida D, Santonocito M G, Iurato M P, Freni V, Ippolito A, Squatrito S
Istituto di Medicina Interna, Malattie Endocrine e del Metabolismo, Ospedale Garibaldi, Università degli Studi, Catania.
Minerva Endocrinol. 1997 Sep;22(3):61-6.
In the diagnosis and follow-up of differentiated thyroid cancer (DTC) patients, a major clinical objective is to differentiate whether the cause of enlarged neck lymph nodes is either tumorous or inflammatory. High-frequency (7.5-10 MHz) ultrasound examination proved to be highly informative in this regard. An oval shape of the examined lymph node (longitudinal/anteroposterior diameter ratio, L/A > 1.5) and a central echogenic hilus indicate a benign lymphadenopathy. Roundness (L/A < or = 1.5), absence of the central echogenic hilus and a parenchymatous echogenicity are considered as signs of malignancy.
A series of 131 lymph nodes in DTC patients were examined at ultrasound and, on the basis of round shape (L/A < or = 1.5) in association with either one or both the other features (absence of central echogenic hilus, homogenous internal echo), 94 lymph nodes were classified a "malignant" and 37 "benign". The ultrasonographic diagnosis was evaluated with either cytologic or histologic diagnosis in all "malignant" nodes and in 7/30 "benign" nodes. In the other 30 "benign" nodes volume shrinkage or lymph node disappearance was observed during follow-up period.
According to the results obtained, the ultrasound features utilized provided a good diagnostic accuracy (87%) with only 5 false positive case.
High-frequency sonography, therefore, must be considered a useful and accurate method for evaluating suspected lymphadenopathy in DTC patients.
在分化型甲状腺癌（DTC）患者的诊断和随访中，一个主要的临床目标是区分颈部淋巴结肿大的原因是肿瘤性还是炎性。高频（7.5 - 10 MHz）超声检查在这方面已被证明具有很高的信息量。被检查淋巴结呈椭圆形（纵径/前后径比值，L/A > 1.5）且有中央强回声 hilus 提示为良性淋巴结病。圆形（L/A ≤ 1.5）、无中央强回声 hilus 以及实质回声增强被视为恶性征象。
对一系列131例DTC患者的淋巴结进行超声检查，并根据圆形（L/A ≤ 1.5）以及另外一个或两个特征（无中央强回声 hilus、内部回声均匀），将94个淋巴结分类为“恶性”，37个分类为“良性”。对所有“恶性”淋巴结以及7/30个“良性”淋巴结的超声诊断与细胞学或组织学诊断进行了评估。在另外30个“良性”淋巴结中，随访期间观察到体积缩小或淋巴结消失。
根据获得的结果，所采用的超声特征提供了良好的诊断准确性（87%），仅有5例假阳性病例。
因此，高频超声检查必须被视为评估DTC患者可疑淋巴结病的一种有用且准确的方法。
