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 ›› 2017, Vol. 39 ›› Issue (5): 675-681.doi: 10.3881/j.issn.1000-503X.2017.05.013

• 论著 • 上一篇    下一篇

甲状腺乳头状癌原发转移性与复发/持续转移性颈部淋巴结超声特征的比较

徐景竹1,2, 梁智勇3, 王兴华4, 李小毅2, 刘洪枫2, 吴琼5, 刘如玉5, 杨筱5, 朱沈玲5, 赵瑞娜5, 赖兴建5, 张晓燕5, 席雪华5, 张波5()   

  1. 1山西医科大学医学影像学系,太原 030000
    2中国医学科学院 北京协和医学院 北京协和医院,基本外科,北京 100730
    3中国医学科学院 北京协和医学院 北京协和医院,病理科,北京 100730
    4山西医科大学第二附属医院超声科,太原 030000
    5中国医学科学院 北京协和医学院 北京协和医院超声医学科,北京 100730
  • 收稿日期:2016-12-15 出版日期:2017-10-30 发布日期:2017-10-30
  • 作者简介:

    通信作者:张 波 电话:010-69159318,电子邮件:zora19702006@163.com

  • 基金资助:
    国家自然科学基金(81541131)、国家国际科技合作专项项目(2015DFA30440)和首都卫生发展科研专项基金(2016-2-40110)

Comparison of Ultrasound Features of Primary Metastatic Papillary Thyroid Carcinoma and Recurrent/Persistent Metastatic Cervical Lymph Nodes

Jingzhu XU1,2, Zhiyong LIANG3, Xinghua WANG4, Xiaoyi LI2, Hongfeng LIU2, Qiong WU5, Ruyu LIU5, Xiao YANG5, Shenling ZHU5, Ruina ZHAO5, Xingjian LAI5, Xiaoyan ZHANG5, Xuehua XI5, Bo ZHANG5()   

  1. 1Department of Medical Imaging,Shanxi Medical University,Taiyuan 030000,China
    2Department of General Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
    3Department of Pathology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
    4Department of Ultrasound,the Second Affiliated Hospital of Shanxi Medical University,Taiyuan 030000,China
    5Department of Ultrasound,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
  • Received:2016-12-15 Online:2017-10-30 Published:2017-10-30
  • Supported by:
    Supported by the National Natural Sciences Foundation of China(81541131),the International Science and Technology Cooperation Program of China (2015DFA30440),and the Special Fund for Research on Health Development of the Capital (2016-2-40110)

摘要:

目的 比较甲状腺乳头状癌(PTC)原发与复发/持续转移性颈部淋巴结的声像图特征及分区差异。方法 回顾性分析2015年1月1日至2016年1月1日在北京协和医院行颈部淋巴结清扫术的2181例连续甲状腺癌患者的临床资料,根据纳入与排除标准,选择418例PTC患者的622个转移性淋巴结为研究对象,将前期未接受任何治疗(手术或131I治疗)的患者定义为原发组(352例527个转移性淋巴结),接受治疗(手术及/或131I治疗)的患者定义为复发/持续组(66例95个转移性淋巴结)。以手术病理结果为金标准,对手术清扫的淋巴结通过区-区对应评价超声诊断的结果。结果 原发组和复发/持续组转移性淋巴结的平均最短径线分别为(6.7±3.6)和(6.6±3.1)mm,差异无统计学意义(U=0.180,P=0.857)。原发组中央区转移比例为40.0%,明显高于复发/持续组的12.6%;侧方区转移比例为60.0%,明显低于复发/持续组的87.4%(χ2=26.288,P<0.001)。原发组与复发/持续组的侧方转移性淋巴结均在Ⅲ区发生率最高,在Ⅴ区发生率最低。复发/持续组出现强回声(63.1%比48.2%;χ2=7.207,P=0.007)和边缘型血流信号的比例(81.1%比59.4;χ2=16.147,P<0.001)明显高于原发组,其他声像图征象两组间差异均无统计学意义(P均>0.05)。结论 原发组转移性淋巴结常发生于中央区淋巴结,而复发/持续组转移性淋巴结常发生于侧方区淋巴结。在转移性淋巴结的声像图中,皮质内钙化及边缘型血流信号更多见于复发/持续组。

关键词: 甲状腺乳头状癌, 淋巴结, 超声, 淋巴结分区, 转移

Abstract:

Objective To explore the ultrasound features and levels of cervical lymph node metastases in primary and recurrent/persistent papillary thyroid cancer (PTC).Methods We retrospectively analyzed the clinical data of 2181 patients who underwent cervical lymph nodes dissection for PTC from January 1st 2015 to January 1st 2016.Totally 418 PTC patients (with 622 lymph nodes) who met the inclusion criteria entered the final analysis.Patients who had not received any prior thyroid treatment (surgery with or without radioactive iodine) were categorized as the primary group (352 patients with 527 metastatic lymph nodes),and patients who had received prior treatment (thyroidectomy with or without radioactive iodine) for PTC were categorized as recurrent/persistent group (66 patients with 95 metastatic lymph nodes).Pathological results from lymph node dissections were used as the gold standards by means of level-to-level analysis.Results The mean of the minimum axis diameter of the lymph nodes in the primary group was (6.7±3.6)mm,and that of the recurrent/persistent group was (6.6±3.1)mm (U=0.180,P=0.857).The proportion of metastasis in the central area of primary group was 40.0%,which was significantly higher than that in the recurrent/persistent group (12.6%);the proportion of metastasis in the lateral area was 60.6% in the primary group,which was significantly lower than that in the recurrent/persistent group (87.4%)(χ2=26.288,P<0.001).In lateral metastatic lymph nodes,Ⅲ level was the most common place in both groups.Level Ⅴ metastatic lymph was rare in both primary group and recurrent/persistent group.Calcifications (63.1% vs. 48.2%;χ2=7.207,P=0.007) and peripheral vascularity (81.1% vs. 59.4%;χ2= 16.147, P<0.001) were more common in the recurrent/persistent group.The round shape,absence of an echogenic hilum,hyperechogenicity,and cystic aspects were not significantly different between these two groups (all P>0.05).Conclusions Primary metastatic lymph nodes often occur in the central area of lymph nodes,while lateral metastatic lymph nodes are more common in recurrent/persistent PTC.For metastatic lymph nodes,calcifications and peripheral vascularity are more common in recurrent/persistent PTC.

Key words: papillary thyroid carcinoma, lymph nodes, ultrasound, lymph node levels, metastasis

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