高频二维超声及彩色多普勒超声声像图对甲状腺癌颈部淋巴结转移的诊断价值

摘要：目的 探讨高频二维超声及彩色多普勒超声声像图对甲状腺癌颈部淋巴结转移的诊断价值。方法
回顾性分析 65 例甲状腺癌伴颈部淋巴结转移患者的临床资料，所有患者术前均接受颈部二维超声及彩色多普勒
超声检查，探头频率为 9.0~14.0 MHz，观察患者的二维超声及彩色多普勒超声声像图特征，包括转移性淋巴结数
目、形态、纵横比、边界、回声、钙化、内部血流状况等，分析高频二维超声及彩色多普勒超声声像图对甲状腺癌颈
部淋巴结转移的诊断价值。结果 65 例患者经病理检出颈部转移性淋巴结 379 枚，其中单侧颈部淋巴结转移 52
例，双侧颈部淋巴结转移 13 例。二维超声检出颈部转移性淋巴结 347 枚，以病理结果为金标准，诊断符合率为
Diagnostic value of high-frequency two-dimensional and color Doppler ultrasonography on cervical lymph node metastasis of thyroid cancer
WANG Zhimin1 #, LIU Jian2, DU Yueming1, CAO Wei1
6.72）cm/s。结论 甲状腺癌颈部淋巴结转移较为常见，高频超声诊断颈部淋巴结转移与病理诊断的符合率较
高，可清晰显示转移性淋巴结的内部结构、形态及边界特征，同时可明确血流信号特征，为临床诊断提供依据。
关键词：二维超声；彩色多普勒超声；甲状腺癌；颈部淋巴结转移
中图分类号：R736.1
文献标志码：A
doi：10.11877/j.issn.1672-1535.2018.16.13.12
*论
著*
《 癌 症 进 展 》 2018 COLOGY PROGRESS, Nov 2018, Vol. 16, No. 13
1612
高频二维超声及彩色多普勒超声声像图对甲状腺癌颈部淋巴结 转移的诊断价值
王志民 1 #，刘剑 2，杜月明 1，曹伟 1 晋州市人民医院 1超声科，2甲状腺外科，河北 晋州 0522600
1Department of Ultrasonic, 2Department of Thyroid Surgery, Jinzhou People’s Hospital, Jinzhou 052260, Hebei, China
Abstract: Objective To investigate the diagnostic value of high-frequency two-dimensional and color Doppler ultrasonography on cervical lymph node metastasis of thyroid cancer. Method The clinical data of 65 patients with thyroid cancer and cervical lymph node metastasis were collected. All patients were examined with high-frequency two-dimensional ultrasound and color Doppler ultrasonography by probe with 9.0- 14.0 MHz frequency on neck before operation. The characteristics of patients on high-frequency two-dimensional ultrasound and color Doppler ultrasonography were observed, including the number, shape, aspect ratio, boundary, echo, calcification and internal blood flow of metastatic lymph nodes. The diagnostic value of high- frequency two- dimensional and color Doppler ultrasonography on cervical lymph node metastasis of thyroid cancer was analyzed. Result In the 65 patients, 379 cervical metastatic lymph nodes were detected by pathology, including 52 cases of unilateral cervical lymph node metastases and 13 cases of bilateral cervical lymph node metastases. There were 347 cervical metastatic lymph nodes detected by two-dimensional ultrasound, and the diagnose accordance rate was 91.56% compared to the pathologic findings as the golden standard. Sites of metastatic lymph nodes mainly included area III, area IV and area II. There were 280 metastatic lymph nodes with round or oval shape, and with aspect ratio smaller than 2. There were 338 cervical metastatic lymph nodes with hilar high echoes, 138 ones with internal punctiform high echoes and 216 ones with inhomogeneous internal echoes. There were 272 metastatic lymph nodes with irregular boundaries, 58 ones with internal cystic lesions and 132 ones with microcalcifications in lesions. Blood flow classification showed 22 ones of type I, 121 ones of type II and 236 ones of type III. There were 103 cervical metastatic lymph nodes of high-resistance type with RI of 0.70~1.00 (0.82±0.08), 69 of medium-resistance type with RI of 0.60~0.65 (0.62±0.01) and 207 of low-resistance type with RI of 0.33~0.60 (0.46±0.05). The peak systolic blood flow velocity was (35.26±6.72) cm/s. Conclusion Cervical lymph node metastasis of thyroid cancer is common. The diagnostic accordance rate of high-frequency ultrasound on cervical lymph node metastasis compared with pathological diagnosis is high. It can clearly show the internal structure, shape and boundary of metastatic lymph nodes, and can also identify the characteristics of blood flow signals, so as to provide evidence for clinical diagnosis.
91.56%。转移性淋巴结位置主要分布于Ⅲ区、Ⅳ区及Ⅱ区；280 枚转移性淋巴结呈圆形或椭圆形，纵横比﹤2；颈
部转移性淋巴结门部高回声 338 枚，内部见点状高回声 138 枚，内部回声不均 216 枚；边缘不规则 272 枚；58 枚转
移性淋巴结内部伴囊性病变；病灶内见微钙化 132 枚；血流分型为Ⅰ型 22 枚，Ⅱ型 121 枚，Ⅲ型 236 枚。103 枚颈
部转移性淋巴结呈高阻型，血流阻力指数（RI）为 0.70~1.00，平均（0.82±0.08）；69 枚为中等阻力型，RI 为 0.60~
0.65，平 均（0.62±0.01）；207 枚 呈 低 阻 型 ，RI 为 0.33~0.60，平 均（0.46±0.05）。 收 缩 期 峰 值 血 流 速 度 为（35.26±