【摘要】 目的探讨超声引导下细针抽吸活检(FNA)细胞学检查结合细针抽吸洗脱液测定甲状腺球蛋白(FNA-Tg)术前诊断甲状腺乳头状癌(PTC)侧颈区淋巴结转移的价值。方法选择111例经甲状腺细针穿刺细胞学证实为PTC且颈部超声显示侧颈区可疑肿大淋巴结患者,于术前对可疑肿大淋巴结行超声引导下FNA细胞学检查,用1 ml生理盐水冲洗穿刺针管制成洗脱液,采用电化学发光免疫法检测洗脱液内球蛋白(Tg)浓度。以手术病理为金标准,绘制ROC曲线,获得FNA-Tg最佳诊断阈值,比较FNA、FNA-Tg及二者联合对可疑肿大淋巴结的诊断效能。结果 118个侧颈区可疑肿大淋巴结,术后病理证实81个(81/118,68.64%)存在PTC转移,37个(37/118,31.36%)未转移。转移淋巴结FNA-Tg浓度明显高于未转移淋巴结(P<0.001);FNA-Tg诊断PTC淋巴结转移的最佳诊断阈值为2.65μg/L,AUC为0.937[95%CI(0.894,0.980),P<0.001]。与FNA比较,FNA-Tg诊断淋巴结转移的准确率、敏感度及阴性预测值差异有统计学意义(P均<0.05);二者联合的准确率、敏感度及阴性预测值均明显高于FNA(P均<0.05)。22个淋巴结FNA细胞学检查呈假阴性,结合FNA-Tg检测后获得正确诊断。结论 FNA和FNA-Tg是诊断PTC侧颈区淋巴结转移的有效辅助方法,二者联合可提高诊断准确率和敏感度。更多还原

【Abstract】 Objective To investigate the value of ultrasound-guided fine-needle aspiration(FNA) biopsy combined with thyroglobulin in fine-needle aspirate fluid(FNA-Tg) measurement in diagnosis of preoperative lateral neck lymph node(LN) metastasis of papillary thyroid carcinoma(PTC). Methods Totally 111 preoperative PTC patients diagnosed with FNA with suspected metastatic LNs were collected and then underwent neck ultrasonography together with FNA cytclogy. FNA-Tg was measured, then the eluents were obtained by flushing aspiration needle with 1 ml normal saline. FNA-Tg of elution was measured by electrochemiluminescence immunoassay. Taken postoperative pathologic results as the gold standards, ROC curve was drawn, the optimal threshold value for diagnosis of FNA-Tg, the diagnostic efficiency of FNA, FNA-Tg, combined FNA and FNA-Tg for suspected metastatic LNs were evaluated. Results Among 118 suspicious LNs, 81(81/118, 68.64%) LNs of metastasis and 37(37/118, 31.36%) LNs without metastasis were confirmed by postoperative pathology. The average value of FNA-Tg in metastasis LNs was significantly higher than that of LNs without metastasis(P<0.001). The optimal diagnostic value of FNA-Tg in diagnosis of LNs metastasis was 2.65 μg/L, and the AUC was 0.937(95%CI [0.894, 0.980], P<0.001). The differences of accuracy, sensitivity and negative predictive value were all statistically significant between FNA-Tg and FNA(all P<0.05). The accuracy, sensitivity and negative predictive value of FNA combined with FNA-Tg were higher than that of only FNA(all P<0.05). Twenty-two FNA false-negative nodes were correctly diagnosed with FNA-Tg testing. Conclusion FNA cytology and FNA-Tg detection are useful ancillary tests that can improve the detection of lateral neck LN metastasis of PTC. Combination of FNA and FNA-Tg can significantly increase the accuracy and sensitivity of preoperative diagnosis of lateral neck LN metastasis of PTC, and may have an important role in surgical planning of PTC patients.更多还原