| 摘要: |
| 目的 探讨超声造影结合血清IL-17、SIL-2R及TG对于甲状腺乳头状癌淋巴结转移与颈部淋巴结结核鉴别诊断价值。方法 回顾性分析2015年1月-2020年10月于我院行颈部及甲状腺超声造影检查，并经病理证实为甲状腺乳头状癌淋巴结转移的患者59例（转移组）和颈部淋巴结结核患者63例（结核组），观察淋巴结分区、长径/短径比值、淋巴门、内部坏死、钙化、血流、阻力指数及超声造影的增强模式。所有患者均进行血清IL-17、SIL-2R及TG水平检测。比较两组患者超声造影淋巴结及血清各指标情况。分析超声造影和血清IL-17、SIL-2R、TG鉴别诊断甲状腺乳头状癌淋巴结转移与颈部淋巴结结核的诊断敏感度和特异度。结果 甲状腺乳头状癌淋巴结转移患者常规超声多呈微钙化，颈部淋巴结结核多呈粗钙化，两者比较差异有统计学意义（P＝0.000），而两组间长径/短径比值、淋巴门、内部坏死、血流成像比较差异均无统计学意义（P＞0.05）。甲状腺乳头状癌淋巴结转移患者分区以III区和IV区为主，占76.29%，颈部淋巴结结核患者分区以II区、III区和IV区为主，占74.58%，两者之间差异无统计学意义（P＝0.129）。甲状腺乳头状癌淋巴结转移患者与颈部淋巴结结核患者两组不同增强模式之间差异无统计学意义（P＞0.05）；其中不均匀增强型甲状腺乳头状癌淋巴结转移中薄环36例（36/52,69.23%），不均匀增强型颈部淋巴结结核中厚环42例（42/54,77.78%），两组间差异有统计学意义（P＝0.000）。甲状腺乳头状癌淋巴结转移组患者血清IL-17、SIL-2R及TG表达水平均高于颈部淋巴结结核组患者，差异有统计学意义（P＝0.000）。超声造影曲线下面积为0.781，对鉴别诊断2种病变的诊断敏感度为61%，特异度为82%；血清IL-17、SIL-2R、TG曲线下面积为0.673，对鉴别诊断2种病变的诊断敏感度为55%，特异度为71%；超声造影联合血清IL-17、SIL-2R、TG曲线下面积为0.915，对鉴别诊断2种病变的诊断敏感度为83%，特异度为94%。结论 超声造影能提供淋巴结增强特征信息，血清IL-17、SIL-2R、TG可在一定程度上提供病变良恶性表现程度，对甲状腺乳头状癌淋巴结转移与颈部淋巴结结核均具有一定诊断价值，且两者联合诊断价值优于单一诊断效能，有助于两者的鉴别诊断。 |
| 关键词: 超声造影 血清 甲状腺乳头状癌淋巴结转移 颈部淋巴结结核 |
| DOI： |
| 投稿时间：2020-11-24修订日期：2020-12-08 |
| 基金项目:山东省医药卫生科技发展计划(2017DX0055) |
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| Contrast-enhanced ultrasound combined with serum IL-17, SIL-2R and TG for the differential diagnosis of lymph node metastasis of papillary thyroid carcinoma and tuberculosis of cervical lymph nodes |
| duludi,wang chao,XU LEI |
| (QUZHOU PEOPLE''''S HOSPITAL) |
| Abstract: |
| Objective：To investigate the value of contrast-enhanced ultrasound combined with serum IL-17, SIL-2R and TG in the differential diagnosis of lymph node metastasis of papillary thyroid carcinoma and tuberculosis of cervical lymph nodes. Methods：Retrospective analysis of 59 patients (metastatic group) and 63 patients (tuberculosis group) who received neck and thyroid contrast-enhanced ultrasonography in our hospital from January 2015 to October 2020 and were pathologically confirmed to have lymph node metastasis of thyroid papillary carcinoma (metastatic group) and cervical lymph node tuberculosis (tuberculosis group). The lymph node region, ratio of length to short diameter, hilum, internal necrosis, calcification, blood flow, resistance index, and contrast-enhanced pattern were observed. Serum levels of IL-17, SIL-2R and TG were detected in all patients. Ceus lymph node and serum indexes were compared between the two groups. The diagnostic sensitivity and specificity of contrast-enhanced ultrasound and serum IL-17, SIL-2R and TG in differential diagnosis of lymph node metastasis of papillary thyroid carcinoma and tuberculosis of cervical lymph nodes were analyzed. Results：In patients with lymph node metastasis of papillary thyroid carcinoma, microcalcification was more common on routine ultrasound, and crude calcification was more common on cervical lymph node tuberculosis. The difference between the two groups was statistically significant (P = 0.000), while there were no statistically significant differences in long-diameter/short-diameter ratio, hilum, internal necrosis, and blood flow imaging between the two groups (P > 0.05). Patients with lymph node metastasis of papillary thyroid carcinoma were mainly in areas III and IV, accounting for 76.29%; patients with tuberculosis of cervical lymph nodes were mainly in areas II, III and IV, accounting for 74.58%, with no statistically significant difference between the two (P = 0.129). There was no significant difference in enhancement patterns between patients with papillary thyroid carcinoma with lymph node metastasis and patients with cervical lymph node tuberculosis (P > 0.05).Among them, there were 36 cases (36/52,69.23%) with thin ring in lymph node metastasis of inhomogeneous enhanced thyroid papillary carcinoma, and 42 cases (42/54,77.78%) with inhomogeneous enhanced tuberculosis of cervical lymph node and thick ring in lymph node metastasis. The difference between the two groups was statistically significant (P = 0.000). The expression levels of IL-17, SIL-2R and TG in patients with lymph node metastasis of thyroid papillary carcinoma were higher than those in patients with tuberculosis of cervical lymph node, and the differences were statistically significant (P = 0.000). The area under the CEUS curve was 0.781, and the diagnostic sensitivity and specificity for the differential diagnosis of the two lesions were 61% and 82%.The area under serum IL-17, SIL-2R and TG curves was 0.673, and the diagnostic sensitivity and specificity of the two lesions were 55% and 71% respectively.The area of CEUS combined with serum IL-17, SIL 2R and TG curves was 0.915. The diagnostic sensitivity and specificity of CEUS combined with serum IL-17, SIL 2R and TG were 83% and 94% respectively for the differential diagnosis of the two lesions. Conclusion：Contrast-enhanced ultrasound can provide enhanced lymph node characteristic information, the serum IL - 17, SIL - 2R, TG can to a certain extent, providing that the performance of benign and malignant lesion, lymph node metastasis of papillary thyroid carcinoma and cervical lymph node tuberculosis were diagnosed with certain value, and the two combined diagnostic value is superior to the single diagnostic performance, help the differential diagnosis. |
| Key words: ultrasound?contrast serum Lymph node metastasis of papillary thyroid carcinoma Tuberculosis of cervical lymph nodes |
