Diagnostic efficacy of preoperative ultrasound in cervical lateral lymph nodes metastasis of thyroid cancer
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摘要:
目的 探讨颈部超声对于甲状腺癌颈侧各区淋巴结转移的诊断价值。 方法 选取2020年8月~2021年11月于本院行甲状腺癌根治术的932例患者进行回顾性分析。所有患者均由我院经验丰富的超声医师进行至少两次颈部超声检查（分别为入院前与术前颈部超声检查）。收集患者两次颈部超声及颈部增强CT检查的影像学资料，以术后颈侧各区淋巴结组织的病理结果为金标准，采用SPSS 26.0和MedCacl 19.0.4软件进行统计学分析，计算并比较两次颈部超声、颈部增强CT检查在颈侧各区淋巴结转移的诊断效能指标及曲线下面积（AUC）。 结果 术前超声在颈侧Ⅲ、Ⅳ区淋巴结诊断的准确率、敏感度、特异性、假阳性率及假阴性率均优于入院前超声与颈部增强CT检查。术前超声在颈侧各区淋巴结的诊断AUC值均高于入院前超声与颈部增强CT检查。术前超声在颈侧Ⅲ、Ⅳ区淋巴结的AUC值均在0.80以上（分别为0.89、0.85），且与入院前超声与颈部增强CT检查的AUC值对比，差异有统计学意义（P < 0.05）。术前超声在颈侧Ⅲ、Ⅳ区淋巴结的诊断价值优于其在颈侧Ⅱ、Ⅴ区淋巴结的诊断价值（AUC值分别为0.67、0.54）。 结论 术前由经验丰富的超声医师对甲状腺癌患者再次进行颈侧区淋巴结检查是重要且必要的。 Abstract:Objective To investigate the diagnostic value of cervical ultrasonography in the cervical lymph node metastasis of thyroid carcinoma. Methods A total of 932 patients who underwent radical thyroidectomy in our hospital from August 2020 to November 2021 were analyzed retrospectively. All patients were examined at least twice by experienced sonographers (pre-admission and pre-operation respectively). The imaging data of cervical ultrasound and cervical enhanced CT were collected. According to the pathological results of cervical lymph nodes as the gold standard. SPSS 26.0 and MedCacl 19.0.4 were used statistical analysis and compare the diagnostic efficacy index and AUC value of cervical ultrasound and cervical enhanced CT in cervical lymph node metastasis. Results The diagnostic accuracy, sensitivity, specificity, false-positive rate and false-negative rate of pre-operation ultrasound in cervical lateral Ⅲ and Ⅳ lymph nodes were superior to those of pre-admission ultrasound and cervical enhanced CT. The AUC value of pre-operation ultrasound in cervical lateral lymph nodes was better than that of pre-admission ultrasound and cervical enhanced CT. The AUC values of pre-operation ultrasound in cervical lateral Ⅲ and Ⅳ lymph nodes were above 0.80 (0.89 and 0.85, respectively), and the difference with the AUC values of pre-admission ultrasound and cervical enhanced CT was significant (P < 0.05). The diagnostic value of pre- operation ultrasound in cervical lateral Ⅲ and Ⅳ lymph nodes was better than that in cervical lateral Ⅱ and Ⅴ lymph nodes (AUC value was 0.67 and 0.54, respectively). Conclusion It is important and necessary for patients with thyroid cancer to undergo cervical lateral lymph nodes exploration again by experienced sonographers before operation. -
Key words:
- thyroid cancer /
- cervical lymph nodes metastasis /
- ultrasound /
- cervical enhanced CT
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图 1 66岁男性患者影像学表现
Figure 1. Imaging findings of a 66-year-old male patient. There were no found about abnormal lymph nodes in the lateral cervical region by pre-admission ultrasound. However, 2 lymph nodes were found in area Ⅳ of the left neck by pre-operation ultrasound, the smaller one was about 1.38 cm×0.37 cm (A), the lymphatic hilum was unclear, the larger one had isoechoic masses in the hilar, the internal echo was uneven and the blood flow was abundant. Pathological diagnosis of lymph node in left region Ⅳ showed cancer metastasis (2/4) (HE staining, ×100) (B)
图 2 55岁女性患者影像学表现
Figure 2. Imaging findings of a 55-year-old female patient. There were no found about abnormal lymph nodes in the lateral cervical region by pre-admission ultrasound. However, multiple lymph nodes were found in area Ⅳ of the left neck by pre- operation ultrasound, the larger one was about 1.2 cm × 1.3 cm (A), the lymphatic hilum was unclear, the internal echo was uneven and some of them showed strong echo like sand, blood flow increased and uneven distribution. Pathological diagnosis of lymph node in right region Ⅳ showed no cancer metastasis (HE staining, ×100) (B).
图 3 超声、增强CT检查在颈侧区淋巴结转移的ROC曲线
Figure 3. The ROC curve of lymph node metastasis in the lateral cervical region by ultrasound, enhanced CT. Comparison of ROC curves of cervical lymph nodes in regions Ⅱ (A), Ⅲ (B), Ⅳ (C) and Ⅴ (D) by pre-admission ultrasound, pre-operation ultrasound and enhanced CT.
表 1 颈部超声及颈部增强CT检查在颈侧各区淋巴结的诊断效能分析（%）
Table 1. Analysis of the diagnostic efficacy of ultrasound and enhanced CT in lymph node metastasis in the lateral cervical region (%)
Lymph node classification Coincidence rate with pathology examination Sensitivity Specificity False-positive rate False-negative rate Pre-admission ultrasound Ⅱ 95.49 15.56 99.55 0.45 84.44 Ⅲ 90.88 32.11 98.66 3.28 67.89 Ⅳ 91.42 43.90 98.61 2.39 56.10 Ⅴ 89.70 4.00 100.00 0.00 96.00 Pre-operation ultrasound Ⅱ 95.82 35.56 98.87 1.13 64.44 Ⅲ 94.96a 81.65a 96.72a 1.22a 18.35a Ⅳ 94.42a 73.17a 97.65 2.35 26.83a Ⅴ 90.13 8.00 100.00 0.00 92.00 Cervical enhanced CT Ⅱ 96.03 22.22 99.77b 0.23b 77.78 Ⅲ 91.85b 39.45b 98.78b 1.98b 60.55b Ⅳ 92.38b 62.60ab 96.91a 3.09 37.40b Ⅴ 90.02 7.00 100.00 0.00 93.00 aP < 0.05 vs Pre-admission ultrasound, bP < 0.05 vs Pre-operation ultrasound. 
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表 2 超声、增强CT检查在颈侧区淋巴结转移的AUC值对比
Table 2. Comparison of AUC values of lymph node metastasis in the lateral cervical region by ultrasound, enhanced CT
Lymph node classification AUC Standard deviation 95% CI Pre-admission ultrasound Ⅱ 0.58 0.03 0.54-0.61 Ⅲ 0.65 0.02 0.62-0.68 Ⅳ 0.71 0.02 0.68-0.74 Ⅴ 0.52 0.01 0.49-0.55 Pre-operation ultrasound Ⅱ 0.67a 0.04 0.64-0.70 Ⅲ 0.89a 0.02 0.87-0.91 Ⅳ 0.85a 0.02 0.83-0.88 Ⅴ 0.54 0.01 0.51-0.57 Cervical enhanced CT Ⅱ 0.61 0.03 0.58-0.64 Ⅲ 0.69b 0.02 0.66-0.72 Ⅳ 0.80ab 0.02 0.77-0.82 Ⅴ 0.53 0.01 0.50-0.57 aP < 0.05 vs Pre-admission ultrasound, bP < 0.05 vs Pre-operation ultrasound.
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