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目的:探讨甲状腺乳头状癌转移性淋巴结的特征性灰阶超声表现及其临床应用价值。方法 :回顾分析512例甲状腺乳头状癌患者,共发现483个淋巴结,采用灰阶超声评估其淋巴结的分区、形态、边界、淋巴门及内部回声。结果:①病理证实为转移性淋巴结217个,非转移性淋巴结266个;淋巴结转移率为31.3%。②217个转移性淋巴结经灰阶超声检查显示,143个淋巴结的最大径>10 mm,163个淋巴结纵横比(A/T)≤2,62个淋巴结边界不清;大部分淋巴门消失,其余偏心或狭窄;淋巴结内见微钙化的有56个,囊性变的有22个,内部高回声55个。③灰阶超声综合评价转移性淋巴结的灵敏度为65.0%,特异度为92.9%,微钙化、囊性变、高回声评估转移性淋巴结的灵敏度分别为25.8%、10.1%和25.3%,特异度分别为98.1%、99.2%和98.5%。④颈侧区与中央区淋巴结间的超声特征中微钙化、囊性变及高回声差异均有统计学意义。结论:微钙化、囊性变、高回声作为甲状腺乳头状癌转移性淋巴结评估指标具有很高的特异性,颈侧区与中央区的转移性淋巴结灰阶超声特征间存在差异。
Objective: To investigate the characteristic gray scale ultrasonographic findings of metastatic lymph nodes in thyroid papillary carcinoma and its clinical value. Methods: A retrospective analysis of 512 cases of thyroid papillary carcinoma, a total of 483 lymph nodes were found, using gray scale ultrasound to assess the division of lymph nodes, morphology, border, lymph nodes and internal echo. Results: ① The pathological findings were 217 metastatic lymph nodes and 266 non-metastatic lymph nodes; the lymph node metastasis rate was 31.3%. ② 217 metastatic lymph nodes by grayscale ultrasonography showed that the maximum diameter of 143 lymph nodes> 10 mm, 163 lymph node aspect ratio (A / T) ≤2, 62 lymph node border is unclear; most of the lymphatic glands disappear, the remaining eccentric Or stenosis; there were 56 microcalcifications in the lymph nodes, cystic degeneration in 22, and 55 intrahepatic echoes. The sensitivity of gray scale ultrasound in the evaluation of metastatic lymph nodes was 65.0% and the specificity was 92.9%. The sensitivity of microcalcifications, cystic degeneration and hyperechoic lymph node metastasis were 25.8%, 10.1% and 25.3%, respectively 98.1%, 99.2% and 98.5%. ④ There was significant difference in the characteristics of micro-calcifications, cystic degeneration and hyperechoic in the ultrasonic features between the cervical lateral region and the central lymph nodes. CONCLUSIONS: Microcalcifications, cystic degeneration and hyperechoic have high specificity as metastatic lymph nodes in papillary thyroid carcinoma. There are differences in gray scale ultrasound features between metastatic lymph nodes in the lateral and medial regions.