摘要
目的探究超声引导下细针抽吸活检(US-FNA)对甲状腺癌临床诊断及颈部淋巴结转移评估中的临床价值。方法回顾性分析2018年10月至2021年4月舟山医院甲状腺病变患者90例的临床资料,所有患者术前行二维超声及US-FNA检查,以手术病理诊断为金标准,比较US-FNA与二维超声对甲状腺癌、颈部淋巴结转移的诊断效能及对良、恶性淋巴结的检出情况,多因素logistic回归分析不同超声征象与淋巴结阳性检出率的关联性。结果90例患者中病理检查诊断为甲状腺癌73例,良性病变17例;US-FNA诊断甲状腺癌70例,良性病变20例,其中漏诊4例,误诊2例,诊断敏感度为94.52%,特异度为88.24%,准确率为93.33%,Kappa值为0.79,与手术病理学检查具有较高的一致性(Kappa值>0.75);二维超声诊断甲状腺癌69例,良性病变21例,其中漏诊7例,误诊4例,诊断敏感度为90.41%,特异度为76.47%,准确率为87.78%,Kappa值为0.63;90例患者中病理检查转移12例,未转移78例;US-FNA诊断敏感度为83.33%,特异度为97.50%,准确率为95.65%,Kappa值为0.81,与手术病理学检查具有较高的一致性(Kappa值>0.75);二维超声诊断敏感度为75.00%,特异度为94.87%,准确率为92.22%,Kappa值为0.67;US-FNA检出淋巴结156枚,其中良性103枚,恶性53枚,诊断准确率分别为94.17%、96.22%;二维超声检出淋巴结173枚,其中良性111枚,恶性62枚,诊断准确率分别91.89%、91.93%,两组比较差异均无统计学意义(χ^(2)=0.42、0.92,均P>0.05);多因素logistic回归分析显示,高回声团、囊性病变、内部钙化与二维超声及US-FNA诊断淋巴结阳性检出率均具有显著关联性(OR=6.64、5.32、4.12、7.07、5.60、5.06,均P<0.05)。结论US-FNA对甲状腺癌及颈部淋巴结转移均具有较高的诊断效能,其中超声征象高回声团、囊性病变、内部钙化与淋巴结阳性检出率有显著相关性。
Objective To explore the clinical value of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of thyroid cancer and assessment of cervical lymph node metastasis.Methods The clinical data of 90 patients with thyroid cancer who received treatment in Zhoushan Hospital from October 2018 to April 2021 were retrospectively analyzed.All patients underwent a two-dimensional ultrasound examination and ultrasound-guided fine-needle aspiration biopsy before surgery.Taking surgical and pathological diagnosis as the gold standard,the efficiency of two-dimensional ultrasound examination versus ultrasound-guided fine-needle aspiration biopsy in the diagnosis of thyroid cancer and cervical lymph node metastasis and in the identification of benign and maligant lymph nodes were investigated.Multivariate Logistic regression analysis was performed to analyze the correlation between different ultrasound signs and the detection rate of lymph nodes.Results Pathological results showed that among the 90 patients,73 patients had thyroid cancer,and 17 patients had benign lesions.Ultrasound-guided fine-needle aspiration biopsy results showed that 70 patients had thyroid cancer,and 20 patients had benign lesions,including 4 cases of missed diagnosis and 2 cases of misdiagnosis.The diagnostic sensitivity,specificity,accuracy rate,and Kappa value were 94.52%,88.24%,93.33%,and 0.79,respectively.These were highly consistent with the surgical and pathological diagnosis(Kappa value>0.75).Two-dimensional ultrasound revealed 69 patients with thyroid cancer and 21 patients with benign lesions,including 7 cases of missed diagnosis and 4 cases of misdiagnosis.The diagnostic sensitivity,specificity,accuracy rate,and Kappa value were 90.41%,76.47%,87.78%,and 0.63,respectively.Pathological results revealed that cervical lymph node metastasis occurred in 12 patients,and it did not occur in 78 patients.The diagnostic sensitivity,specificity,accuracy rate,and Kappa value of ultrasound-guided fine-needle aspiration biopsy were 83.33%,97.50%,95.65%,and 0.81 respectively.These were highly consistent with surgical and pathological results(Kappa value>0.75).The diagnostic sensitivity,specificity,accuracy rate,and Kappa value of two-dimensional ultrasound examination were 75.00%,94.87%,92.22%,and 0.67,respectively.A total of 156 lymph nodes were detected by ultrasound-guided fine-needle aspiration biopsy,including 103 benign lymph nodes and 53 malignant lymph nodes,with a diagnostic accuracy rate of 94.17%and 96.22%,respectively.A total of 173 lymph nodes were detected by two-dimensional ultrasound,including 111 benign lymph nodes and 62 malignant lymph nodes,with a diagnostic accuracy rate of 91.89%and 91.93%,respectively.There were no significant differences in the diagnostic accuracy of benign and malignant lymph nodes between the two examination methods(χ^(2)=0.42,0.92,both P>0.05).Multivariate logistic regression analysis showed that hyperechoic masses,cystic lesions,and internal calcification were significantly correlated with the detection rate of lymph nodes diagnosed by two-dimensional ultrasound and ultrasound-guided fine-needle aspiration biopsy(OR=6.64,5.32,4.12,7.07,5.60,5.06,all P<0.05).Conclusion Ultrasound-guided fine-needle aspiration biopsy has high diagnostic efficiency for thyroid cancer and cervical lymph node metastasis.Ultrasound signs of hyperechoic mass,cystic lesions,and internal calcification are significantly correlated with the detection rate of lymph nodes.
作者
王昊
颜树宏
郑雷
郑笑娟
Wang Hao;Yan Shuhong;Zheng Lei;Zheng Xiaojuan(Ultrasound Diagnosis Center,Zhoushan Hospital,Zhoushan 316021,Zhejiang Province,China;Pathological Diagnosis Center,Zhoushan Hospital,Zhoushan 316021,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2023年第6期829-834,共6页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省医药卫生科技计划(sbba20111014142747)
舟山医院2019院级科研项目(2019YB021)。
关键词
甲状腺疾病
甲状腺肿瘤
活组织检查
细针
超声检查
淋巴转移
诊断效能
病理诊断
恶性病变
相关性
Thyroid diseases
Thyroid neoplasms
Biopsy,fine-needle
Ultrasonography
Lymphatic metastasis
Diagnostic efficiency
Pathological diagnosis
Malignant lesions
Correlation
