标题：超声造影联合细针穿刺细胞学检查对甲状腺乳头状癌患者颈淋巴结转移的诊断价值

      作者：唐艳 1，高阿维 1，白玲娇 2，栗玉姣 1    唐艳 1，高阿维 1，白玲娇 2，栗玉姣 11.西安凤城医院超声科，陕西 西安 710016；2.延安市人民医院超声诊断科，陕西 延安 716000

      卷次： 2023年34卷7期

      【摘要】 目的 分析超声造影(CEUS)联合细针穿刺细胞学检查(FNAC)对甲状腺乳头状癌(PTC)患者颈淋巴结转移的诊断价值。方法 回顾性分析2017年 1月至2021年1月西安凤城医院诊治的145例PTC患者的临床资料。所有患者均进行CEUS联合FNAC检查，以手术病理结果作为金标准，根据患者是否发生颈淋巴结转移将其分为颈淋巴结转移阳性组(n=87)和颈淋巴结转移阴性组(n=58)。评估CEUS、FNAC及两者联合对PTC患者颈淋巴结转移的诊断价值。结果 颈淋巴结转移阳性组与颈淋巴结转移阴性组患者在造影增强方向、造影增强均匀度、造影增强程度方面比较差异均有统计学意义(P<0.05)，但在灌注缺损方面比较差异无统计学意义(P>0.05)；145例PTC患者中，CEUS正确诊断73例发生颈淋巴结转移，FNAC正确诊断62例发生颈淋巴结转移，两者联合正确诊断85例发生颈淋巴结转移；CEUS联合FNAC诊断PTC患者颈淋巴结转移的灵敏度为97.70%、特异度为62.07%、准确率为83.45%、阳性预测值为79.44%、阴性预测值为94.74%，且两者联合诊断的灵敏度、阴性预测值显著高于单独CEUS或FNAC诊断，差异均有统计学意义(P<0.05)。结论 CEUS联合FNAC可准确诊断PTC患者是否发生颈淋巴结转移，诊断灵敏度明显提高。
      【关键词】 超声造影；细针穿刺细胞学检查；甲状腺乳头状癌；颈淋巴结转移；诊断价值
      【中图分类号】 R736.1 【文献标识码】 A 【文章编号】 1003—6350（2023）07—0998—05

Diagnostic value of contrast-enhanced ultrasound combined with fine needle aspiration cytology for cervicallymph node metastasis in patients with papillary thyroid carcinoma.
TANG Yan 1, GAO A-wei 1, BAI Ling-jiao 2, LIYu-jiao 1. 1. Department of Ultrasound, Xi'an Fengcheng Hospital, Xi'an 710016, Shaanxi, CHINA; 2. Department ofUltrasound Diagnosis, Yan'an People's Hospital, Yan'an 716000, Shaanxi, CHINA
【Abstract】 Objective To analyze the diagnostic value of contrast-enhanced ultrasound (CEUS) combined withfine needle aspiration cytology (FNAC) for cervical lymph node metastasis in patients with papillary thyroid carcinoma(PTC). Methods The clinical data of 145 PTC patients diagnosed and treated in Department of Ultrasound, Xi'anFengcheng Hospital from January 2017 to January 2021 were retrospectively analyzed. All patients underwent CEUScombined with FNAC examination, and the surgical pathological results were used as the gold standard. Patients were di-vided into positive group of cervical lymph node metastasis (n=87) and negative group of cervical lymph node metasta-sis (n=58) according to whether they had cervical lymph node metastasis. The diagnostic value of CEUS, FNAC andtheir combination for cervical lymph node metastasis in patients with PTC were evaluated. Results There were signifi-cant differences in the direction of contrast enhancement, uniformity of contrast enhancement, and degree of contrast en-hancement between the positive group and the negative group of cervical lymph node metastasis (P<0.05), but there wasno significant difference in the perfusion defect (P>0.05). Among the 145 PTC patients, 73 cases of cervical lymph nodemetastasis were correctly diagnosed by CEUS, 62 cases of cervical lymph node metastasis by FNAC, and 85 cases of cer-vical lymph node metastasis were correctly diagnosed by the combination of CEUS and FNAC. The sensitivity, specifici-ty, accuracy, positive predictive value, and negative predictive value of CEUS combined with FNAC in the diagnosis ofcervical lymph node metastasis in PTC patients were 97.70%, 62.07%, 83.45%, 79.44%, and 94.74%; the sensitivity andnegative predictive value of CEUS combined with FNAC were significantly higher than those of CEUS or FNAC alone;the differences were statistically significant (P<0.05). Conclusion CEUS combined with FNAC can accurately deter-mine cervical lymph node metastasis in PTC patients, with higher diagnostic sensitivity.
      【Key words】 Contrast-enhanced ultrasound; Fine needle aspiration cytology; Papillary thyroid carcinoma; Cervi-cal lymph node metastasis; Diagnostic value