中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2018, Vol. 40 ›› Issue (5): 680-684.doi: 10.3881/j.issn.1000-503X.10275

• 论著 • 上一篇    下一篇

超声弹性对比指数在淋巴结良恶性鉴别诊断中的应用价值

葛喜凤1,李磊2,崔立刚1(),薛恒1   

  1. 1北京大学第三医院,超声科,北京 100191
    2北京大学第三医院,普外科,北京 100191;
  • 收稿日期:2018-01-08 出版日期:2018-10-30 发布日期:2018-11-07
  • 通讯作者: 崔立刚 E-mail:cuiligang_bysy@126.com

Value of Elasticity Contrast Index of Ultrasonography in Differentiating Benign and Malignant Cervical Lymph Nodes

GE Xifeng1, LI Lei2, CUI Ligang1(), XUE Heng1   

  1. 1 Department of Ultrasound, Third Hospital,Beijing 100191,China
    2 Department of General Surgery,Peking University,Third Hospital,Beijing 100191,China;
  • Received:2018-01-08 Online:2018-10-30 Published:2018-11-07
  • Contact: Ligang CUI E-mail:cuiligang_bysy@126.com

摘要:

目的 评估超声弹性对比指数(ECI)在颈部淋巴结良恶性鉴别诊断中的应用价值。方法 2016年12月至2017年4月在北京大学第三医院超声科连续对48例患者的颈部淋巴结进行二维超声及ECI评估,根据是否需要手动加压分为两组。以淋巴结病理或临床随访结果为金标准,比较二维超声、ECI测值及两者联合在鉴别淋巴结良恶性的诊断价值。结果 最终纳入46例患者的138枚淋巴结,其中,良性淋巴结76枚,恶性淋巴结62枚;恶性淋巴结的平均ECI值为1.69±0.89,明显高于良性淋巴结的1.32±0.87(t=-2.46,P=0.015)。二维超声鉴别颈部良恶性淋巴结的ROC曲线下面积为0.899,最佳界值为≥7分,敏感度为93.5%,特异度为84.2%;ECI的ROC曲线下面积为0.649,最佳界值为1.25,敏感度为59.7%,特异度为60.5%;两者联合的ROC曲线下面积为0.724,敏感度为93.5%,特异度为51.3%。无需加压组恶性淋巴结的平均ECI值为1.77±0.94,明显高于良性淋巴结的1.26±0.81(t=-3.09,P=0.003);手动加压组恶性淋巴结的中位ECI值为1.33(1.01,1.44),与良性淋巴结的1.32(0.78,2.18)差异无统计学意义(z=-0.20,P=0.843)。结论 二维超声在颈部淋巴结良恶性鉴别诊断中的诊断效能优于ECI和二维超声与ECI联合。ECI在甲状腺以外器官中的应用尚待进一步研究。

关键词: 颈部淋巴结, 弹性成像, 弹性对比指数

Abstract:

Objective To investigate the diagnostic value of elasticity contrast index(ECI)in the differential diagnosis between benign and malignant cervical lymph nodes.Methods Cervical lymph nodes of 48 patients were examined by traditional ultrasound and ECI in Peking University Third Hospital between December 2016 and April 2017. Patients were further divided into free-hand group and non-free-hand group according to the use of manual compression or not. With pathological or clinical follow-up results as the gold standard,we compared the diagnostic values of traditional ultrasound,ECI,and their combination in the differential diagnosis between benign and malignant lymph nodes.Results Totally 138 lymph nodes were collected from 46 patients,among which 76 were benign and 62 were malignant. The ECI value of malignant lymph nodes(1.69±0.89)were significantly higher than that of benign lymph nodes(1.32±0.87)(t=-2.46,P=0.015).The area under receiver operating characteristic(ROC)curve for traditional ultrasound in discrimination of malignant cervical lymph nodes with benign ones was 0.899,with an optimal cut-off value of 7,which had a sensitivity of 93.5% and a specificity of 84.2%. The area under ROC curve for ECI was 0.649,with an optimal cut-off value of 1.25,which had a sensitivity of 59.7% and a specificity of 60.5%. For their combination,the area under ROC curve was 0.724,with a sensitivity of 93.5% and a specificity of 51.3%. In the group without using free-hand technique,the mean ECI value was 1.77±0.94 for malignant nodes,which was significantly higher than that(1.26±0.81)for benign nodes(t=-3.09,P=0.003). In the group requiring free-hand technique,the ECI value for malignant nodes was 1.33(1.01,1.44),showing no significant difference with benign ones[1.32(0.78,2.18);z=-0.20,P=0.843].Conclusions Conventional ultrasound has higher diagnostic value than ECI and their combination in differentiating benign and malignant lymph nodes. The role of ECI in evaluating other organs requires further investigations.

Key words: cervical lymph nodes, elastography, elasticity contrast index

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