摘要
目的:探讨剪切波弹性成像(shear wave elastography,SWE)与细针穿刺洗脱液甲状腺球蛋白(fine-needle aspiration washout thyroglobulin,FNA-Tg)对甲状腺乳头状癌侧颈部淋巴结转移的诊断价值。方法:回顾性分析159例经病理证实为甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的患者资料,对颈部211枚可疑淋巴结进行常规超声、SWE参数平均值(E_(mean))、FNA-Tg检查,以术后病理结果为金标准,比较各检测方法的诊断效能。结果:(1)SWE E_(mean)转移组[(50.96±27.66)kPa]高于非转移组[(32.20±17.34)kPa],差异有统计学意义(t=8.761,P<0.01)。受试者工作特征(receiver operating characteristic,ROC)曲线分析表明,SWE E_(mean)最佳诊断阈值为40.42 kPa时对PTC颈部淋巴结转移预测价值较高,曲线下面积(area under the curve,AUC)为0.849(95%CI=0.795~0.902,P<0.01)。(2)与SWE E_(mean)比较,联合法敏感度、特异度、准确度、阳性预测值及阴性预测值均显著提高(χ^(2)=7.724、28.230、35.094、21.731、9.890,P=0.005、<0.000、<0.000、<0.000、0.002)。与FNA-Tg比较,联合法敏感度、特异度、准确度、阳性预测值及阴性预测值也显著提高(χ^(2)=7.724、6.014、13.526、6.137、7.602,P=0.005、0.014、<0.000、0.013、0.006)。(3)在淋巴结有囊性变和无囊性变时,SWE E_(mean)的准确度分别为53.8%和79.8%,差异有统计学意义(χ^(2)=4.819,P=0.028);FNA-Tg的准确度分别为92.3%和87.4%,差异无统计学意义(χ^(2)=0.275,P=0.600)。结论:FNA-Tg诊断PTC转移淋巴结的准确度较高,且不受淋巴结有无囊性变的影响,与SWE E_(mean)联合后可显著提高诊断效能。
Objective:To investigate shear wave elastography(SWE)and fine-needle aspiration washout thyroglobulin(FNA-Tg)in the diagnosis of cervical lymph node metastasis of thyroid papillary carcinoma.Methods:The data of 159 patients with papillary thyroid carcinoma(PTC)confirmed by pathology were analyzed retrospectively,and 211 suspected lymph nodes in the neck were examined by ultrasonic examination,SWE E_(mean)and FNA-Tg.The diagnostic efficacy of each method was compared with the postoperative pathological results as the gold standard.Results:①The SWE E_(mean)metastasis group[(50.96±27.66)kPa]was significantly higher than the non-metastasis group[(32.20±17.34)kPa],with a statistically significant difference(t=8.761,P<0.01).The receiver operating characteristic(ROC)curve analysis showed that SWE E_(mean)optimal diagnostic threshold of 40.42 kPa had a higher predictive value for cervical lymph node metastasis of PTC,with an area under the curve(AUC)of 0.849(95%CI=0.795-0.902,P<0.01).②Compared with SWE E_(mean),the sensitivity,specificity,diagnostic value,positive predictive value and negative predictive value were significantly increased(χ^(2)=7.724,28.230,35.094,21.731,9.890;P=0.005,<0.000,<0.000,<0.000,0.002).Compared with FNA-Tg,the sensitivity,specificity,diagnostic value,positive predictive value and negative predictive value of the combined method were significantly increased(χ^(2)=7.724,6.014,13.526,6.137,7.602;P=0.005,0.014,<0.000,0.013,0.006).③The accuracy of SWE E_(mean)was 53.8%with and 79.8%without cystic changes in lymph nodes,respectively,with a statistical significance(χ^(2)=4.819,P=0.028).The accuracy of FNATg was 92.3%and 87.4%,respectively,with no significant difference(χ^(2)=0.275,P=0.600).Conclusion:FNA-Tg has a high accuracy in the diagnosis of PTC metastatic lymph nodes,and is not affected by the presence or absence of cystic changes in lymph nodes.The combination of SWE E_(mean)and FNA-Tg can significantly improve the diagnostic efficiency.
作者
韩云霞
刘丽云
欧阳向柳
王艳滨
Han Yunxia;Liu Liyun;Ouyang Xiangliu;Wang Yanbin(Department of Ultrasound,Tangshan Gongren Hospital;Department of Pathology,Tangshan Gongren Hospital)
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2023年第4期462-466,共5页
Journal of Chongqing Medical University
基金
河北省2020年度医学科学研究课题计划资助项目(编号:20201517)
关键词
超声检查
剪切波弹性成像
细针穿刺洗脱液甲状腺球蛋白
甲状腺乳头状癌
淋巴结转移
ultrasonic examination
shear wave elastography
fine-needle aspiration washout thyroglobulin
papillary thyroid carcinoma
lymph node metastasis
