标题：增强CT联合超声对甲状腺乳头状癌中央区淋巴结转移的诊断价值

      作者：王进 1，杨欢欢 2    榆林市第三医院影像科 1、B超室 2，陕西 榆林 719000

      卷次： 2019年30卷21期

      【摘要】 目的 分析增强CT联合超声对甲状腺乳头状癌(PTC)中央区淋巴结转移的诊断效能。方法 回顾性分析2014年1月至2019年1月间在榆林市第三医院接受治疗的68例初治PTC患者的临床资料，所有患者均由同一治疗小组完成甲状腺切除手术联合中央区淋巴结清扫，经手术病理验证，患者在术前1周均进行增强CT和超声检测。以病理学诊断为金标准，同时确定增强CT、超声检测及联合诊断的假阴性、真阴性、假阳性和真阳性，并计算准确度、特异度与敏感度，分析不同诊断方法间整体诊断情况有无差异。结果 以病理学诊断作为转移性淋巴结诊断标准，增强CT、超声、联合检测的特异度分别为92.50%、75.00%、97.50%；准确度分别为72.06%、67.65%、77.94%，敏感度分别为35.71%、57.14%、61.30%，增强CT诊断真阳性37例、假阳性12例、真阴性16例、假阴性3例，超声检测真阳性30例、假阳性12例、真阴性16例、假阴性10例，联合检测真阳性39例、假阳性18例、真阴性10例、假阴性 1例，增强CT和超声诊断一致性较差(K=0.236)，增强CT、超声和联合诊断一致性一般(K分别是 0.646、0.478)。结论 增强CT联合超声能够克服各自的不足，能提高检测PTC患者中央区转移性淋巴结诊断效能。
      【关键词】 甲状腺乳头状癌；淋巴结；超声检查；增强CT；诊断价值
      【中图分类号】 R736.1 【文献标识码】 A 【文章编号】 1003—6350（2019）21—2811—03

Efficacy of enhanced CT combined with ultrasound in the diagnosis of central lymph node metastasis of papillarythyroid carcinoma.
WANG Jin 1, YANG Huan-huan 2. Department of Imaging 1, B-Ultrasound Room 2, the Third Hospitalof Yulin City, Yulin 719000, Shaanxi, CHINA
【Abstract】 Objective To analyze the efficacy of enhanced CT combined with ultrasound in the diagnosis ofcentral lymph node metastasis of papillary thyroid carcinoma (PTC). Methods The clinical data of 68 patients withnewly diagnosed PTC who were treated at the Third Hospital of Yulin City from January 2014 to January 2019 were ret-rospectively analyzed. All patients underwent thyroidectomy combined with central lymph node dissection and sufferedpostoperative pathological analysis. The patients all received enhanced CT and ultrasound examination 1 week beforesurgery. Taking pathological diagnosis as the golden standard, the values for false negative, true negative, false positive,and true positive of enhanced CT, ultrasond, and combined diagnosis were determined, and the accuracy, specificity, andsensitivity were calculated, to analyze the difference between the overall diagnosis of different methods. Results Tak-ing pathological diagnosis as the golden standard, the specificity of enhanced CT, ultrasound, and combined detectionwere 92.50%, 75.00%, and 97.50%, respectively; the accuracy were 72.06%, 67.65%, and 77.94%, respectively; the sen-sitivity were 35.71%, 57.14%, 61.30%. Enhanced CT showed 37 cases of true positive, 12 cases of false positive, 16 cas-es of true negative, and 3 cases of false negative; ultrasound showed 30 cases of true positive, 12 cases of false positive,16 cases of true negative, 10 cases of false negative; combined detection showed 39 cases of true positive, 18 cases offalse positive, 10 cases of true negative, 1 case of false negative; the consistency between enhanced CT and ultrasoundwas poor (K=0.236), and the consistency of enhanced CT, ultrasound and combined diagnosis was general (K=0.646,0.478, respectively). Conclusion Enhanced CT combined with ultrasound can overcome the deficiencies of single useand improve the diagnostic efficiency of metastatic lymph nodes in the central region of PTC.
      【Key words】 Papillary thyroid carcinoma; Lymph node; Ultrasonography; Enhanced CT; Diagnostic value·短篇论著·doi:10.3969/j.issn.1003-6350.2019.21.027