甲状腺乳头状癌颈部淋巴结转移的超声、CT特征及联合诊断应用分析
肖倩 罗富欢 胡小丽▲
贵州医科大学附属医院超声中心,贵州贵阳 500081
Application analysis of ultrasonic, CT features and combined diagnosis in papillary thyroid carcinoma cervical lymph node metastasis
XIAO Qian LUO Fuhuan HU Xiaoli▲
Ultrasound Center, Affiliated Hospital of Guizhou Medical University, Guizhou Province, Guiyang 500081, China
摘要 目的 探讨甲状腺乳头状癌(PTC)发生颈部淋巴结转移的超声、CT特征及联合应用的诊断价值。 方法 选取贵州医科大学附属医院2019年1月至2021年12月确诊的139例PTC患者,根据颈部淋巴结穿刺结果将患者分为颈部淋巴结转移患者66例(转移组)、颈部淋巴结未发生转移的患者73例(非转移组)。对两组术前超声、CT检查影像学资料进行回顾性分析,比较两组PTC病灶及转移淋巴结影像学特征,并计算两种方式单独及联合应用诊断PTC发生颈部淋巴结转移的价值。 结果 两组淋巴结边缘缺损、纵横径之比、淋巴结门部回声、淋巴结形状、回声特征比例比较,差异有统计学意义(P<0.05)。两组淋巴结内囊变坏死、颗粒状钙化灶、淋巴结边缘强化、淋巴结形态、淋巴结与周围组织、淋巴结长径线比例比较,差异有统计学意义(P<0.05)。 结论 PTC发生颈部淋巴结转移后,超声、CT具有明显的特征,二者联合应用可以提高诊断效能。
关键词 :
甲状腺乳头状癌 ,
淋巴结转移 ,
超声 ,
CT ,
诊断
Abstract :Objective To investigate the diagnostic value of ultrasonography, CT features and combined application of cervical lymph node metastasis in papillary thyroid carcinoma (PTC). Methods A total of 139 PTC patients diagnosed in the Affiliated Hospital of Guizhou Medical University from January 2019 to December 2021 were selected and divided into 66 patients with cervical lymph node metastasis (metastatic group) and 73 patients with no cervical lymph node metastasis (non-metastatic group) according to the results of cervical lymph node puncture. Preoperative ultrasound and CT imaging data of the two groups were retrospectively analyzed, the imaging features of PTC lesions and metastatic lymph nodes were compared between the two groups, and the value of the two methods in the diagnosis of cervical lymph node metastasis of PTC was calculated. Results The difference between the two groups was statistically significant (P<0.05) in the ratio of lymph node margin defect, vertical and horizontal diameter, portal echo, lymph node shape, and echo feature ratio. There were significant differences between the two groups in lymph node internal capsular necrosis, granular calcification, lymph node margin enhancement, lymph node morphology, lymph node and surrounding tissue, and lymph node elongated diameter line ratio(P<0.05). Conclusion After cervical lymph node metastasis of PTC, ultrasound, and CT have obvious characteristics, and the combined application of the two can improve the diagnostic efficiency.
Key words :
Thyroid papillary carcinoma
Lymph node metastasis
Ultrasound
CT
Diagnosis
基金资助: 贵州省卫生健康委员会科学技术基金项目(gzwkj 2023-068)。
通讯作者:
▲通讯作者
[1] Yan T,Qiu W,Song J,et al. ARHGAP36 regulates proliferation and migration in papillary thyroid carcinoma cells [J]. J Mol Endocrinol,2021,66(1):1-10. [2] Ohashi R. Solid variant of papillary thyroid carcinoma:an under- recognized entity [J]. Endocr J,2020,67(3):241-248. [3] Harries V,Wang LY,McGill M,et al. Should multifocality be an indication for completion thyroidectomy in papillary thyroid carcinoma [J]. Surgery,2020,167(1):10-17. [4] 栾梦琪,夏蜀珺,林琳,等.超声引导下细针穿刺洗脱液测定BRAF~(V600E)突变丰度预测甲状腺乳头状癌颈部淋巴结转移[J].中华医学超声杂志(电子版),2021,18(9):828-833. [5] 张续民,张恒刚.术前CT结合彩色多普勒超声对甲状腺乳头状癌颈部淋巴结转移的诊断价值[J].中国CT和MRI杂志,2020,18(1):88-90. [6] Mastronikolis N,Tsiambas E,Roukas D,et al. Micro-RNAs signatures in papillary thyroid carcinoma [J]. J BUON,2020, 25(5):2144-2146. [7] Donaldson LB,Yan F,Morgan PF,et al. Hobnail variant of papillary thyroid carcinoma:a systematic review and meta- analysis [J]. Endocrine,2021,72(1):27-39. [8] Sudoko CK,Jenks CM,Bauer AJ,et al. Thyroid Lobectomy for T1 Papillary Thyroid Carcinoma in Pediatric Patients [J]. JAMA Otolaryngol Head Neck Surg,2021,147(11):943-950. [9] Sur ML,Gaga R,Laz?觍r C,et al. Papillary thyroid carcinoma in children with Hashimoto’s thyroiditis-a review of the literature between 2000 and 2020 [J]. J Pediatr Endocrinol Metab,2020,33(12):1511-1517. [10] Shaha AR,Poorten VV,Tuttle RM. Multifocality in papillary thyroid carcinoma-An unresolved controversy [J]. Eur J Surg Oncol,2020,46(10 Pt A):1777-1778. [11] 王国涛,黎燕,梁瑾瑜,等.甲状腺乳头状癌BRAF V600E基因突变与临床及超声特征的相关性研究[J].中国超声医学杂志,2021,37(4):376-379. [12] 高鑫宇,刘慧楠,裴建国.增强CT纹理分析在老年甲状腺乳头状癌诊断和预测淋巴结转移中的价值[J].中国老年学杂志,2022,42(6):1361-1364. [13] 钟李长,谷丽萍,马方,等.甲状腺微小乳头状癌颈部淋巴结转移的原发灶超声与BRAF~(V600E)基因突变特征[J].中国医药导报,2020,17(32):92-95. [14] 吴晓恬,朱鹏飞,葛舒,等.基于超声特征构建甲状腺微小乳头状癌中央区淋巴结转移的预测模型研究[J].川北医学院学报,2022,37(12):1626-1630. [15] 李宁,阚艳敏,李晓松,等.基于多模态超声的甲状腺乳头状癌决策树模型的构建及其诊断效能评估[J].中国全科医学,2021,24(30):3821-3827. [16] 谭雯,肖伶俐,张诗文,等.甲状腺微小乳头状癌中央区淋巴结转移的超声与病理对照[J].中国超声医学杂志,2022,38(12):1325-1327. [17] 温雅,刘静静,刘利平,等.局灶性亚急性肉芽肿性甲状腺炎与甲状腺乳头状癌超声及术中特征鉴别研究[J].中国全科医学,2021,24(12):1512-1516. [18] 蔡小威,韩宜廷,杨冬,等.CT与超声在甲状腺乳头状癌患者术前淋巴结评估中的价值比较[J].中国肿瘤外科杂志,2022,14(4):352-356. [19] 李皓盈,王海燕,翁璐昕.高频超声联合CT用于诊断甲状腺微小乳头状癌淋巴结转移价值分析[J].中国CT和MRI杂志,2021,19(12):27-29,32. [20] 张明博,阎琳,李盈盈,等.甲状腺微小乳头状癌射频消融治疗的临床价值与展望[J].中华医学超声杂志(电子版),2022,19(1):78-81. [21] 闵蕊,韩丹,赵雯,等.甲状腺乳头状癌原发灶CT值联合形态学预测中央组淋巴结转移的价值[J].中国医学影像学杂志,2020,28(3):184-188. [22] 贾小瑞,张怡.超声联合CT诊断甲状腺乳头状癌颈部淋巴结转移的应用[J].影像研究与医学应用,2022,6(6): 191-193. [23] Tong Y,Li J,Huang Y,et al. Ultrasound-Based Radiomic Nomogram for Predicting Lateral Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma [J]. Acad Radiol,2021,28(12):1675-1684. [24] Azizi G,Mayo ML,Azizi Y,et al. Persistent Metastatic Thyroid Carcinoma [J]. J Med Ultrasound,2020,28(2):111- 113. [25] 陈凌云.CT联合超声诊断甲状腺乳头状癌的价值分析[J].影像研究与医学应用,2021,5(24):143-145.
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