南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (2): 219-224.doi: 10.12122/j.issn.1673-4254.2023.02.09

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经淋巴管超声造影可提高甲状腺癌中央区转移淋巴结的检出率

张 艳，赵佳航，王 冰，林轶群，孟书玉，罗渝昆   

  1. 解放军总医院第一医学中心超声诊断科，普通外科，北京 100853
  • 出版日期:2023-02-20 发布日期:2023-03-16

Contrast-enhanced ultrasonography with intra-glandular contrast injection can improve the diagnostic accuracy of central compartment lymph node metastasis of thyroid cancer

ZHANG Yan, ZHAO Jiahang, WANG Bing, LIN Yiqun, MENG Shuyu, LUO Yukun   

  1. Department of Ultrasound, Department of Surgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Online:2023-02-20 Published:2023-03-16

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摘要： 目的 探讨通过腺体内注射实现的经淋巴管超声造影（LCEUS）对甲状腺癌颈部中央区转移淋巴结的诊断价值。方法 2020年11月~2022年5月期间，对怀疑为甲状腺癌并拟行超声引导下穿刺活检的患者行颈部中央区淋巴结常规超声及LCEUS检查，所有患者均行外科手术清扫淋巴结，根据淋巴结的造影剂灌注特点将其分为：均匀增强、不均匀增强、规则或不规则环状增强及无增强，以病理结果为金标准，将中央区淋巴结分为转移组与未转移组，比较常规超声及LCEUS对转移淋巴结的诊断能力。结果 最终纳入49例甲状腺癌患者，共60个淋巴结，病理证实34个为转移淋巴结，26个为良性。以不均匀增强，不规则环状增强及无增强为恶性诊断标准，则LCEUS诊断转移淋巴结的灵敏度，特异度，准确度分别为：97.06%，92.31%，95%，均高于常规超声（P<0.001）。ROC曲线分析结果显示LCEUS诊断转移淋巴结的曲线下面积明显高于常规超声（94.7% [0.856~0.988] vs 78.2%[0.656~0.878]，P=0.003)。结论 LCEUS可提高中央区淋巴结的显示及诊断准确率，对临床治疗决策的制定有重要指导意义。

关键词: 甲状腺癌；超声；超声造影；淋巴结

Abstract: Objective To investigate the value of lymphatic contrast-enhanced ultrasound (LCEUS) with intra-glandular injection of contrast agent for diagnosis of central compartment lymph node metastasis of thyroid cancer. Methods From November, 2020 to May, 2022, the patients suspected of having thyroid cancer and scheduled for biopsy at our center received both conventional ultrasound and LCEUS examinations of the central compartment lymph nodes before surgery. All the patients underwent surgical dissection of the lymph nodes. The perfusion features in LCEUS were classified as homogeneous enhancement, heterogeneous enhancement, regular/irregular ring, and non-enhancement. With pathological results as the gold standard, we compared the diagnostic ability of conventional ultrasound and LCEUS for identifying metastasis in the central compartment lymph nodes. Results Forty-nine patients with 60 lymph nodes were included in the final analysis. Pathological examination reported metastasis in 34 of the lymph nodes, and 26 were benign lymph nodes. With ultrasound findings of heterogeneous enhancement, irregular ring and non-enhancement as the criteria for malignant lesions, LCEUS had a diagnostic sensitivity, specificity and accuracy of 97.06%，92.31% and 95% for diagnosing metastatic lymph nodes, respectively, demonstrating its better performance than conventional ultrasound (P<0.001). Receiver-operating characteristic curve analysis showed that LCEUS had a significantly greater area under the curve than conventional ultrasound for diagnosing metastatic lymph nodes (94.7% [0.856-0.988] vs 78.2% [0.656-0.878], P=0.003). Conclusion LCEUS can enhance the display and improve the diagnostic accuracy of the central compartment lymph nodes to provide important clinical evidence for making clinical decisions on treatment of thyroid cancer.

Key words: thyroid carcinoma; ultrasound; contrast-enhanced ultrasound; lymph nodes