Diagnostic effect of cervical contrast-enhanced CT on occurrence of cervical lymph node metastasis in patients with thyroid cancer
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摘要:
目的 分析颈部增强CT对甲状腺癌颈部淋巴结转移的诊断效能。 方法 回顾性分析76例甲状腺乳头状癌患者的临床资料。以病理诊断结果为金标准，分析增强CT检查对甲状腺癌颈部淋巴结转移的诊断价值。 结果 病理学检查确诊本组患者颈部淋巴结转移153枚，未转移533枚，中央区淋巴结转60.13%；以病理诊断结果为金标准，增强CT诊断颈部中央区淋巴结转移准确率为83.61%，诊断颈侧区淋巴结转移准确率为89.26%；增强CT显示本组患者颈部转移淋巴结平均短径高于未转移淋巴结（8.91±2.62 mm vs 8.02±2.51 mm），转移与未转移淋巴结短径>10 mm、明显增强、明显不均匀强化、囊变、病灶内钙化及周围组织侵犯数目的差异有统计学意义（P < 0.05）。 结论 增强CT对甲状腺癌颈部中央区淋巴结转移的诊断效能低于颈侧区淋巴结，建议结合超声或MRI检查综合评估。 Abstract:Objective To analyze the diagnostic efficiency of cervical contrast-enhanced CT on cervical lymph node metastasis in thyroid cancer. Methods The clinical data of 76 patients with papillary thyroid carcinoma were retrospectively analyzed. Taking the pathological diagnosis result as the gold standard, the diagnostic value of contrast-enhanced CT examination on cervical lymph node metastasis in thyroid cancer was analyzed. Results Pathological examination confirmed 153 cervical lymph node metastases and 533 non-metastases, with 60.13% central lymph node metastasis. Taking pathological diagnosis as the gold standard, the accuracy rate of contrast-enhanced CT was 83.61% in diagnosing central cervical lymph node metastasis and was 89.26% in the diagnosis of lateral cervical lymph node metastasis. Contrast-enhanced CT showed that the average short diameter of cervical metastatic lymph nodes in patients was significantly higher than that in non-metastatic lymph nodes (8.91±2.62 mm vs 8.02±2.51 mm). There were significant differences between metastatic and non-metastatic lymph nodes in terms of short diameter >10 mm, obvious enhancement, obvious heterogeneous enhancement, cystic degeneration, calcification in the lesion and surrounding tissue invasion (P < 0.05). Conclusion The diagnostic efficiency of contrast-enhanced CT for central cervical lymph node metastasis in thyroid cancer is lower than that in the lateral cervical lymph node metastasis. It is recommended to combine ultrasound or MRI for comprehensive evaluation. -
图 1 增强CT诊断甲状腺癌颈部转移淋巴结的影像学资料
A: 增强CT见右侧食管旁小淋巴结, 手术病理证实为转移性淋巴癌; B: 增强CT见气管前小淋巴结, 手术病理证实为转移性淋巴癌.
Figure 1. Imaging data of cervical metastatic lymph nodes in thyroid cancer diagnosed by contrast-enhanced CT.
表 1 76例患者一般资料情况分布
Table 1. Distribution of general data of 76 patients
资料 例数（n） 构成比（%） 病理类型 乳头状癌 42 55.26 滤泡状癌 25 32.89 髓样癌 6 7.89 未分化癌 3 3.95 文化水平 小学 12 15.79 初中 35 46.05 高中及以上 29 38.16 手术类型 全切+双中央 9 11.84 全切+单中央 10 13.16 全切+双中央+双侧区 2 2.63 全切+双中央+单侧区 7 9.21 全切+单中央+单侧区 2 2.63 右叶+右中央 24 31.58 左叶+左中央 18 23.68 左叶+双中央+双侧区 2 2.63 左右+左中央+左侧区 1 1.32 右叶+右中央+右侧区 1 1.32 TNM分期 Ⅰ期 58 76.32 Ⅱ期 14 18.42 Ⅲ期 3 3.95 Ⅳ期 1 1.32 
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表 2 本组转移及未转移淋巴结的颈部各区分布情况
Table 2. Distribution of metastatic and non-metastatic lymph nodes in the cervical regions [n(%)]
分类 数量 颈部淋巴结分区 Ⅱ Ⅲ Ⅳ Ⅴ Ⅵ+Ⅶ 转移淋巴结 153(22.30) 12(7.84) 23(15.03) 21(13.73) 5(3.27) 92(60.13) 未转移淋巴结 533(77.70) 60(11.26) 101(18.95) 71(13.32) 33(6.19) 268(50.28) 总计 686(100.00) 72(10.50) 124(18.08) 92(13.41) 38(5.54) 360(52.48)
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表 3 增强CT对甲状腺癌颈部中央区淋巴结转移的诊断效能
Table 3. Diagnostic efficiency of contrast-enhanced CT on central cervical lymph node metastasis in thyroid cancer
结果 病理组织学诊断（n） 合计（n） 敏感度(%) 特异性(%) 准确率(%) Kappa值 转移 未转移 转移 73 40 113 79.35 85.07 83.61 0.599 未转移 19 228 247 合计 92 268 360
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表 4 增强CT对甲状腺癌颈侧区淋巴结转移的诊断效能
Table 4. Diagnostic efficiency of contrast-enhanced CT on lateral cervical lymph node metastasis in thyroid cancer
结果 病理组织学诊断（n） 合计（n） 敏感度(%) 特异性(%) 准确率(%) Kappa值转移 转移 未转移 转移 51 25 76 83.61 90.57 89.26 0.678 未转移 10 240 250 合计 61 265 326
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表 5 甲状腺癌颈部转移淋巴结及未转移淋巴结的增强CT影像学特征比较
Table 5. Comparison of contrast-enhanced CT imaging features of cervical metastatic lymph nodes and non-meta-static lymph nodes in thyroid cancer [n(%)]
增强CT表现 转移淋巴结(n=153) 未转移淋巴结(n=533) t/χ2 P 淋巴结短径(mm, Mean±SD) 8.91±2.62 8.02±2.51 3.828 0.001 淋巴结短径 > 10 mm 76(49.67) 186(34.90) 10.995 0.001 明显增强 105(68.63) 154(28.89) 79.863 0.001 明显不均匀强化 39(25.49) 27(5.07) 57.031 0.001 囊变 23(15.03) 0(0.00) 82.904 0.001 淋巴结内钙化 30(19.61) 0(0.00) 109.289 0.001 侵犯周围组织 12(7.84) 0(0.00) 42.548 0.001
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