剪切波弹性成像与FNA-Tg对甲状腺乳头状癌侧颈部淋巴结转移的诊断价值

Diagnostic value of shear wave elastography and FNA-Tg in cervical lymph node metastasis of thyroid papillary carcinoma

摘要:

目的 探讨剪切波弹性成像（shear wave elastography，SWE）与细针穿刺洗脱液甲状腺球蛋白（fine-needle aspiration washout thyroglobulin，FNA-Tg）对甲状腺乳头状癌侧颈部淋巴结转移的诊断价值。方法 回顾性分析159例经病理证实为甲状腺乳头状癌（papillary thyroid carcinoma，PTC）的患者资料，对颈部211枚可疑淋巴结进行常规超声、SWE参数平均值（E_mean）、FNA-Tg检查，以术后病理结果为金标准，比较各检测方法的诊断效能。结果 ①SWE E_mean转移组[（50.96±27.66） kPa]高于非转移组[（32.20±17.34） kPa]，差异有统计学意义（t=8.761，P<0.01）。受试者工作特征（receiver operating characteristic，ROC）曲线分析表明，SWE E_mean最佳诊断阈值为40.42 kPa时对PTC颈部淋巴结转移预测价值较高，曲线下面积（area under the curve，AUC）为0.849（95％CI=0.795~0.902，P<0.01）。②与SWE E_mean比较，联合法敏感度、特异度、准确度、阳性预测值及阴性预测值均显著提高（χ²=7.724、28.230、35.094、21.731、9.890，P=0.005、<0.000、<0.000、<0.000、0.002）。与FNA-Tg比较，联合法敏感度、特异度、准确度、阳性预测值及阴性预测值也显著提高（χ²=7.724、6.014、13.526、6.137、7.602，P=0.005、0.014、<0.000、0.013、0.006）。③在淋巴结有囊性变和无囊性变时，SWE E_mean的准确度分别为53.8%和79.8%，差异有统计学意义（χ²=4.819，P=0.028）；FNA-Tg的准确度分别为92.3%和87.4%，差异无统计学意义（χ²=0.275，P=0.600）。结论 FNA-Tg诊断PTC转移淋巴结的准确度较高，且不受淋巴结有无囊性变的影响，与SWE E_mean联合后可显著提高诊断效能。

Abstract:

Objective To investigate shear wave elastography（SWE）and fine-needle aspiration washout thyroglobulin（FNA-Tg）in the diagnosis of cervical lymph node metastasis of thyroid papillary carcinoma.Methods The data of 159 patients with papillary thyroid carcinoma（PTC） confirmed by pathology were analyzed retrospectively，and 211 suspected lymph nodes in the neck were examined by ultrasonic examination，SWE E_mean and FNA-Tg. The diagnostic efficacy of each method was compared with the postoperative pathological results as the gold standard.Results ①The SWE E_mean metastasis group [（50.96±27.66） kPa] was significantly higher than the non-metastasis group [（32.20±17.34） kPa]，with a statistically significant difference（t=8.761，P<0.01）. The receiver operating characteristic（ROC） curve analysis showed that SWE E_mean optimal diagnostic threshold of 40.42 kPa had a higher predictive value for cervical lymph node metastasis of PTC，with an area under the curve（AUC） of 0.849（95%CI=0.795-0.902，P<0.01）. ②Compared with SWE E_mean，the sensitivity，specificity，diagnostic value，positive predictive value and negative predictive value were significantly increased（χ²=7.724，28.230，35.094，21.731，9.890；P=0.005，<0.000，<0.000，<0.000，0.002）. Compared with FNA-Tg，the sensitivity，specificity，diagnostic value，positive predictive value and negative predictive value of the combined method were significantly increased（χ²=7.724，6.014，13.526，6.137，7.602；P=0.005，0.014，<0.000，0.013，0.006）. ③The accuracy of SWE E_mean was 53.8% with and 79.8% without cystic changes in lymph nodes，respectively，with a statistical significance（χ²=4.819，P=0.028）. The accuracy of FNA-Tg was 92.3% and 87.4%，respectively，with no significant difference（χ²=0.275，P=0.600）.Conclusion FNA-Tg has a high accuracy in the diagnosis of PTC metastatic lymph nodes，and is not affected by the presence or absence of cystic changes in lymph nodes. The combination of SWE E_mean and FNA-Tg can significantly improve the diagnostic efficiency.