US-FNAC及穿刺洗脱液...淋巴结清扫的安全性及有效性_刘丽.pdf

色效果观察 J 临床与实验病理学杂志，2018，34(4):461 463 15 殷晓敏，余光银 两种骨髓活检标本脱钙方法比较J 实用医技杂志，2017，24(8):911 912 16 刘伟，周小鸽，滕孝静，等 原位荧光杂交检测在骨髓活检切片中的方法建立及优化 J 临床和实验医学杂志，2018，17(6):655657(收稿日期:2022 12 06)DOI:10 3969/j issn 1671 4695 2023 07 025文章编号:1671 4695(2023)07 0766 05US FNAC 及穿刺洗脱液 Tg 水平指导下甲状腺癌颈淋巴结清扫的安全性及有效性刘丽许荣波叶新华谢晴晴朱颖王南刘辉*(宿迁市第一人民医院超声医学科江苏宿迁223800)基金项目:江苏省青年医学重点人才项目(编号:QNC2016480)*通讯作者:刘辉，E mail:lh13812406087163 com【摘要】目的探讨超声引导下细针穿刺活检(US FNAC)联合穿刺后洗脱液中甲状腺球蛋白(Tg)检测术前诊断甲状腺乳头状癌发生淋巴结转移及制定清扫方案的价值。方法采用回顾性研究方案，选取2021 年1 月至2022 年9月在宿迁市第一人民医院实施手术治疗且接受中央区+侧区淋巴结清扫的 90 例甲状腺乳头状癌患者，所有患者术前均接受中央区、侧颈区淋巴结 US FNAC 检查，并对穿刺针洗脱液中 Tg 进行检查，以手术后病理学结果作为金标准，计算 US FNAC、Tg 单独及联合应用情况下诊断患者中央区、侧颈区发生淋巴结转移的价值。结果共 90 例接受甲状腺全切及单侧叶切除术或者甲状腺手术+中央区+侧区淋巴结清扫术的甲状腺乳头状癌患者，术后病理学检查共计确诊56 例患者中央区淋巴结转移阳性，60 例侧颈区淋巴结转移阳性;以病理学结果作为金标准，US FNAC 诊断甲状腺乳头状癌患者中央区淋巴结转移的敏感度为 76 79%，特异度为 91 18%，受试者工作特征(OC)曲线下面积(AUC)值为0 840;Tg 诊断甲状腺乳头状癌患者中央区淋巴结转移的敏感度为 82 14%，特异度为 91 18%，OC AUC 值为 0 867;FNAC+Tg 诊断甲状腺乳头状癌患者中央区淋巴结转移的敏感度为 96 43%，特异度为 85 29%，OC AUC 值为 0 909;US FNAC 诊断甲状腺乳头状癌患者侧颈区淋巴结转移的敏感度为 71 67%，特异度为 93 33%，OC AUC 值为 0 840;Tg 诊断甲状腺乳头状癌患者侧颈区淋巴结转移的敏感度为 75 00%，特异度为 93 33%，OC AUC 值为 0 842;US FNAC+Tg 诊断甲状腺乳头状癌患者侧颈区淋巴结转移的敏感度为 95 00%、特异度为 86 67%、OC AUC 值为 0 908。结论US FNAC 与 Tg 单独应用时诊断甲状腺乳头状癌发生中央区和侧颈区淋巴结转移的敏感度较低，二者联合可显著提高诊断的敏感度，同时保证特异度，对于术前制定淋巴结清扫方案具有一定的参考价值。【关键词】超声引导下细针穿刺活检洗脱液甲状腺球蛋白甲状腺乳头状癌淋巴结转移Safety and effectiveness of neck lymph node dissection for thyroid cancer guided by FNAC and Tg levels of puncture eluent LIU Li，XUong bo，YE Xin hua，et al Department of Ultrasound Medicine，Suqian First Peoples Hospital，Suqian Jiangsu 223800，China【Abstract】ObjectiveTo investigate the value of ultrasound guided fine needle aspiration biopsy(US FNAC)combined with thyro-globulin(Tg)in the eluent after puncture in preoperative diagnosis of lymph node metastasis of papillary thyroid carcinoma and the development ofdissection plan MethodsIn this study，ninety patients with papillary thyroid carcinoma who underwent surgical treatment and underwent central+lateral lymph node dissection in Suqian First Peoples Hospital from January 2021 to September 2022 were selected by retrospective study proto-col All patients underwent US FNAC examination of central and lateral cervical lymph nodes before surgery，and Tg in the puncture needle elu-ent was examined Postoperative pathological results were used as the gold standard，the value of US FNAC and Tg alone and in combination inthe diagnosis of central and lateral cervical lymph node metastases was calculated esultsA total of 90 patients with papillary thyroid carcinomawho underwent total thyroidectomy，unilateral lobectomy or thyroid surgery+central zone+lateral zone lymphadenectomy，56 patients were con-firmed to be positive for central zone lymph node metastasis and 60 patients were positive for lateral cervical zone lymph node metastasis Pathologi-cal results were used as the gold standard，the sensitivity，specificity of US FNAC in the diagnosis of central lymph node metastasis in patients withpapillary thyroid carcinoma were 7679%，9118%，and the area under the curve(AUC)value of receiver operating characteristic(OC)curve was0 840 The sensitivity and specificity of Tg in the diagnosis of central lymph node metastasis in patients with papillary thyroid cancer were 8214%，91 18%，and the AUC value of OC curve was 0867 The sensitivity and specificity of FNAC+Tg in the diagnosis of central lymph node metasta-sis in patients with papillary thyroid carcinoma were 96 43%and 8529%，and the AUC value of OC curve was 0 909 The sensitivity and spe-cificity of US FNAC in the diagnosis of lateral cervical lymph node metastasis in patients with papillary thyroid cancer were 7167%，9333%，and the AUC value of the OC curve was 0840 The sensitivity and specificity of Tg in the diagnosis of lateral cervical lymph node metastasis inpatients with papillary thyroid cancer were 7500%，9333%，and the AUC value of the area under the OC curve was 0 842 The sensitivityand specificity of US FNAC+Tg in the diagnosis of lateral cervical lymph node metastasis in patients with papillary thyroid cancer were 9500%，86 67%，and the AUC value of OC curve was 0 908 ConclusionWhen US FNAC and Tg are used alone，the sensitivity of diagnosinglymph node metastasis in the central and lateral cervical regions of papillary thyroid carcinoma is low The combination of FNAC and Tg can signifi-667Journal of Clinical and Experimental Medicine Vol22，No7Apr2023cantly improve the diagnostic sensitivity and ensure specificity，which has certain reference value for formulating lymph node dissection plan beforeoperation【Key words】Ultrasound guided fine needle aspiration biopsy;Eluent;Thyroglobulin;Papillary thyroid carcinoma;Primary lymph nodemetastasis甲状腺癌是内分泌系统最常见的恶性肿瘤，预后较好。然而仍有患者发生颈部淋巴结转移，导致复发1。因而，准确的颈部淋巴结检查对术前诊断甲状腺乳头状癌发生淋巴结转移、制定清扫方案治疗策略和评估患者预后至关重要。虽然超声因其方便、经济、敏感度高而被广泛应用于甲状腺癌颈部淋巴结转移的诊断，但其仍无法识别直径小于 1 cm 的颈部淋巴结。同时，超声的诊断价值还受到淋巴细胞、可变坏死和上皮细胞密度差的影响2。超声引导下细针穿刺活检(ultrasound guided fine needle aspiration biopsy，US FNAC)在检测固体性颈部淋巴结方面具有较高的特异性，可识别囊性成分