超声联合细针穿刺洗脱液甲状腺球蛋白测定在甲状腺乳头状癌 颈部淋巴结转移诊断中的应用.

陈瑞珠; 张欢; 郑立春; 刘丽云; 欧阳向柳

Objective To compare the diagnostic value of ultrasound, thyroglobulin measurement in fine-needle aspiration biopsy (FNATg), and their combination in the diagnosis of cervical lymph node metastasis in papillary thyroid carcinoma (PTC) . Methods The clinical data of 130 patients (144 lymph nodes in total) with PTC in Tangshan Gongren Hospital from January 2017 to March 2023 were retrospectively analyzed. Patients were divided into metastatic and non-metastatic groups according to the pathological findings of the cervical lymph nodes. The ultrasonic characteristics, serum Tg, and eluate Tg levels were compared between the two groups. The diagnostic efficacy of ultrasound, FNA-Tg, and the combination for cervical lymph node metastasis was assessed using the receiver operating characteristic (ROC) curve. Results Among 144 cervical lymph nodes, 64 comprised the metastatic group and 80 comprised the non-metastatic group. Compared with the non-metastatic group, the lymph nodes in the metastatic group had indistinct cortical-medullary demarcation, uneven echogenicity, cystic changes, microcalcifications, and abnormal blood flow, and the differences were statistically significant (all P 0.05) . Serum Tg in the metastatic and non-metastatic groups was 19.5 (1.9-70.7) ng/mL and 20.4 (8.9-38.3) ng/mL, respectively, and the difference between the two groups was not statistically significant (P > 0.05); eluate Tg in the metastatic and non-metastatic groups was 500.0 (49.4-500.0) ng/mL and 2.4 (0.6-6.5) ng/mL, and the difference between the two groups was statistically significant (P < 0.05), with an optimal FNA-Tg critical value of 11.7 ng/mL. FNA-Tg diagnosed cervical lymph node metastasis with the highest specificity, accuracy, and positive predictive value, whereas the combination of ultrasound and FNA-Tg diagnosed cervical lymph node metastasis with the highest sensitivity and negative predictive value. Conclusion Ultrasound manifestations of PTC cervical meta-static lymph nodes include poorly demarcated corticomedullary stroma, uneven echogenicity accompanied by cystic changes, microcalcifications, and abnormal blood flow and have high diagnostic efficacy for PTC metastatic lymph nodes. When PTC cervical lymph node abnormalities are suspected on ultrasound, further FNA-Tg should be performed. The combination of ultrasound with FNA-Tg could improve the diagnostic efficacy of PTC cervical lymph node metastasis.

LYMPHATIC metastasis; NEEDLE biopsy; DIAGNOSTIC ultrasonic imaging; RECEIVER operating characteristic curves; LYMPH nodes

Journal of China Medical University, 2024, Vol 53, Issue 11, p999

0258-4646

Academic Journal