彩色超声、FNA-C、FNA-Tg在诊断甲状腺乳头状癌（PTC）颈部淋巴结转移中的价值

曹亚; 张辉; 孟林; 倪焕然; 赵一; 王光彦; 刘志莹; 杨晓梅; 杨丽春

doi:10.12259/j.issn.2095-610X.S20211119

彩色超声、FNA-C、FNA-Tg在诊断甲状腺乳头状癌（PTC）颈部淋巴结转移中的价值

doi: 10.12259/j.issn.2095-610X.S20211119

曹亚¹,
张辉²,
孟林²,
倪焕然³,
赵一⁴,
王光彦⁵,
刘志莹¹,
杨晓梅¹,
杨丽春^6, ,

1.
楚雄彝族自治州人民医院/大理大学第四附属医院超声医学二科
2.
肝胆外二科
3.
全科医学科
4.
病理科
5.
检验科，云南楚雄　675000
6.
云南省肿瘤医院超声医学科，云南昆明　650118

基金项目: 云南省器官移植临床医学中心开放课题（2020SYZ-F-007）

详细信息

作者简介:
曹亚（1972～），女，云南楚雄人，医学硕士，副主任医师，主要从事腹部、小器官超声诊断工作

通讯作者:
杨丽春，E-mail：yn_ylc@163.com

中图分类号: R445.1
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出版历程
- 收稿日期: 2021-09-25
- 网络出版日期: 2021-11-16
- 刊出日期: 2021-11-30

Value of Color Doppler Ultrasonography, Fine Needle Aspiration Cytology, and the Level of Thyroglobulin in the Diagnosis of Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma

1.
Dept. of Ultrasound Medicine
2.
Dept. of Hepatobiliary Surgery
3.
Dept. of General Practice
4.
Dept. of Pathology
5.
Dept. of Laboratory，The People’s Hospital of Chuxiong Yi Autonomo CDU Prefecture/The 4th Affiliated Hospital of Dali University，Chuxiong Yunnan 675000
6.
Dept. of Ultrasound Medicine， Yunnan Cancer Hospital，Kunming Yunnan 650118，China

摘要

摘要: 目的探讨颈部淋巴结彩色超声征象（CDU）、淋巴结细针穿刺细胞学检查（FNA-C）、淋巴结细针穿刺洗脱液中甲状腺球蛋白含量（FNA-Tg）在诊断甲状腺乳头状癌（PTC）颈部淋巴结转移中的价值。方法回顾性分析甲状腺乳头状癌（PTC）患者颈部淋巴结CDU、FNA-C、FNA-Tg、术前血清Tg、术后病理结果，并分析其特异性和阳性预测率。确定FNA-Tg的受试者工作特征(ROC)曲线和最佳诊断阈值。然后分析术前血清Tg、促甲状腺激素(TSH)、血清Tg抗体(TGAB)与淋巴结FNA-Tg的相关性。结果 CDU典型转移超声征象的淋巴结中，FNA-Tg的准确率为100%；CDU非典型转移超声征象（淋巴结皮质厚度不均匀，皮质厚度≥2 mm）的淋巴结，FNA-Tg准确率为88.9%,优于CDU和FNA-C；淋巴结FNA-Tg诊断PTC颈淋巴结转移的阈值为2.57 ng/mL；淋巴结FNA-Tg与血清Tg、TGAB无相关性(P > 0.05)，而与TSH有相关性(P < 0.05)。结论 CDU显示颈部淋巴结典型转移征象PTC患者结合CDU征象、淋巴结FNA-C、FNA-Tg，可准确诊断甲状腺乳头状癌（PTC）颈部淋巴结转移。CDU显示颈部淋巴结非典型转移征象（皮质厚度不均匀≥2 mm）的PTC患者应引起注意，淋巴结检查FNA-C和FNA-Tg可明显提高诊断率，形成临床治疗PTC患者颈淋巴转移的重要依据。
- 颈部淋巴结 /
- 彩色超声征象 /
- FNA-C检查 /
- FNA-Tg
Abstract: Objective To explore the value of color Doppler ultrasonography （CDU） signs, fine needle aspiration cytology （FNA-C） of lymph nodes, and the level of thyroglobulin in lymph node fine needle aspiration eluate （FNA-Tg） in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma （PTC）. Methods Firstly, CDU signs of cervical lymph nodes, FNA-C, FNA-Tg level, preoperative serum Tg level, and postoperative pathological results of patients with PTC were retrospectively analyzed and the specificity and positive prediction rate of them were also analyzed. Then, the receiver operating characteristic （ROC） curve and the optimal diagnostic threshold of FNA-Tg levels were determined. After that, the correlation between preoperative serum Tg, thyroid-stimulating hormone （TSH）, serum Tg antibody （TGAB） and lymph node FNA-Tg level were analyzed. Results As a result, in patients with typical ultrasound signs of cervical lymph node metastasis, the diagnostic rate of FNA-Tg was 100%, which is better than CDU and FNA-C. the cortical thickness of cervical lymph nodes is uneven and is ≥ 2mm, the diagnostic rate of FNA-Tg was 88.9%. The threshold value of FNA-Tg level in lymph nodes for diagnosing cervical lymph node metastasis of PTC was 2.57 ng/ml. There was no correlation between lymph node FNA-Tg and serum Tg level, serum TGAB （P > 0.05）, while there was a correlation between lymph node FNA-Tg and TSH （P < 0.05）. Conclusions For PTC patients with typical signs of cervical lymph node metastasis showed by CDU, the combination of CDU signs, lymph node FNA-C and FNA-Tg can accurately diagnose cervical lymph node metastasis. Attention should be paid to PTC patients with atypical signs of cervical lymph node metastasis （uneven cortical thickness ≥ 2 mm） showed by CDU, Lymph node lymph node FNA-C and FNA-Tg can significantly improve the diagnostic rate and form an important basis for clinical treatment of cervical lymph node metastasis in PTC patients.
- Cervical lymph node /
- Color Doppler ultrasonography /
- Fine needle aspiration cytology /
- FNA-Tg

HTML全文

图 1 CDU、FNA-C、FNA-Tg的ROC曲线

Figure 1. ROC curves of CDU, FNA-C and FNA-Tg

下载: 全尺寸图片幻灯片

图 2 患者淋巴结病理切片

A：HE染色（×8）；B、C：HE染色（×40）；D ：HE染色（×100）

Figure 2. Pathological section of lymph node of the patient

下载: 全尺寸图片幻灯片

表 1 CDU、FNA-C、FNA-Tg 及三者联合诊断淋巴结转移的评估

Table 1. Evaluation of CDU，FNA-C，FNA-TG alone and combination in diagnosis of Lymph node metastasis

项目	曲线下面积	敏感度（%）	特异度（%）	准确率（%）	阳性预测值（%）	阴性预测值（%）
FNA-Tg FNA-C CDU 三者联合	0.994 0.747 0.725 0.80	98.30 71.7 86.7 60	92.3 84.6 61.5 100	95.8 73.9 71.2 67.1	98.3 71.6 86.6 100	84.6 84.6 61.5 100

下载: 导出CSV

表 2 淋巴结CDU与FNA-Tg、FNA-C、病理学结果之间的关系

Table 2. The relationship between CDU signs of lymph node metastasis and FNA-TG, FNA-C and pathological results

CDU		FNA-Tg		FNA-C		总计（个）
CDU		FNA-Tg < 2.57 ng/mL	FNA-Tg≥2.57 ng/mL	阳性	阴性	总计（个）
典型CDU	病理（+）	0	51	36	15	55
典型CDU	病理（−）	4	0	0	4	55
非典型CDU	病理（+）	1	8	8	1	18
非典型CDU	病理（−）	8	1	1	8	18
总计（个）		14	59	45	28	73

下载: 导出CSV

参考文献(17)

[1]	Zhu X,Yao J,Tian W. Microarray technology to investigate genes associated with papillary thyroid carcinoma[J]. Mol Med Rep,2015,11(5):3729-3733. doi: 10.3892/mmr.2015.3180
[2]	Jin S,Bao W,Yang Y T,et al. Establishing a prediction model for lateral neck lymph node metastasis in patients with papillary thyroid carcinoma[J]. Sci Rep,2018,8(1):17355.
[3]	Mulla M,Schulte K M. Central cervical lymph node metastases in papillary thyroid cancer:a systematic review of imaging-guided and prophylactic removal of the central compartment[J]. Clin Endocrinol (Oxf),2012,76(1):131-136. doi: 10.1111/j.1365-2265.2011.04162.x
[4]	Rotstein L. The role of lymphadenectomy in the management of papillary carcinoma of the thyroid[J]. J Surg Oncol,2009,99(4):186-188. doi: 10.1002/jso.21234
[5]	Grogan R H,Kaplan S P,Cao H,et al. A study of recurrence and death from papillary thyroid cancer with 27 years of median follow-up[J]. Surgery,2013,154(6):1436-1446. doi: 10.1016/j.surg.2013.07.008
[6]	Yang J,Gong Y,Yan S,et al. Risk factors for level V lymph node metastases in solitary papillary thyroid carcinoma with clinically lateral lymph node metastases[J]. Cancer Med,2016,5(8):2161-2168. doi: 10.1002/cam4.792
[7]	中国超声医学工程学会浅表器官及外周血管专业委员会. 甲状腺及相关颈部淋巴结超声若干临床常见问题专家共识(2018版)[J]. 中国超声医学杂志,2019,35(3):193-204.
[8]	Boi F,Baghino G,Atzeni F,et al. The diagnostic value for differentiated thyroid carcinoma metastases of thyroglobulin (Tg) measurement in washout fluid from fine-needle aspiration biopsy of neck lymph nodes is maintained in the presence of circulating anti-Tg antibodies[J]. J Clin Endocrinol Metab,2006,91(4):1364-1369. doi: 10.1210/jc.2005-1705
[9]	Song Y,Xu G,Wang T,Zhang B. Lateral neck multilevel fine-needle aspiration cytology and thyroglobulin estimation in papillary thyroid carcinoma[J]. Laryngoscope Investig Otolaryngol,2021,6(3):570-575.
[10]	Moon J H,Kim Y I,Lim J A,et al. Thyroglobulin in washout fluid from lymph node fine-needle aspiration biopsy in papillary thyroid cancer:large-scale validation of the cutoff value to determine malignancy and evaluation of discrepant results[J]. J Clin Endocrinol Metab,2013,98(3):1061-1068. doi: 10.1210/jc.2012-3291
[11]	Grani G,Fumarola A. Thyroglobulin in lymph node fine-needle aspiration washout:a systematic review and meta-analysis of diagnostic accuracy[J]. J Clin Endocrinol Metab,2014,99(6):1970-1982. doi: 10.1210/jc.2014-1098
[12]	Borel A L,Boizel R,Faure P,et al. Significance of low levels of thyroglobulin in fine needle aspirates from cervical lymph nodes of patients with a history of differentiated thyroid cancer[J]. Eur J Endocrinol,2008,158(5):691-698. doi: 10.1530/EJE-07-0749
[13]	Baskin H J. Detection of recurrent papillary thyroid carcinoma by thyroglobulin assessment in the needle washout after fine-needle aspiration of suspicious lymph nodes[J]. Thyroid,2004,14(11):959-963. doi: 10.1089/thy.2004.14.959
[14]	Duval M,Zanella A B,Cristo A P,et al. Impact of serum TSH and anti-thyroglobulin antibody levels on Lymph node fine-needle aspiration thyroglobulin measurements in differentiated thyroid cancer patients[J]. Eur Thyroid J,2017,6(6):292-297. doi: 10.1159/000479682
[15]	刘娜香,唐丽娜,沈友洪,等. 超声引导下细针抽吸活检联合洗脱液测定甲状腺球蛋白诊断甲状腺乳头状癌侧颈区淋巴结转移[J]. 中国介入影像与治疗学,2019,16(9):527-530.
[16]	Holting T,Duh O Y,Clark O H,et al. Growth and invasion in differentiated thyroid carcinoma. Function of different growth factors[J]. Chirurg,1994,65(12):1100-1106.
[17]	纪丽丽,姜双全,李守强,等. 穿刺洗脱液甲状腺球蛋白测定在诊断甲状腺乳头状癌转移淋巴结中的应用[J]. 中华超声影像学杂志,2019,28(4):313-317. doi: 10.3760/cma.j.issn.1004‐4477.2019.04.007

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