甲状腺峡部旁淋巴结对桥本甲状腺炎的超声诊断价值

Ultrasound Diagnostic Value of Parathyroid Lymph Nodes in Hashimoto's Thyroiditis

摘要:

〔摘 要〕 目的：探讨甲状腺峡部旁淋巴结（PLN）对桥本甲状腺炎（HT）的超声诊断价值。方法：选取深圳市 第二人民医院 2018 年 10 月至 2020 年 10 月期间收治的 64 例术前超声均未提示 HT 的甲状腺结节手术患者，术前以 PLN 是否可见分观察组和对照组，其中 PLN 可见的观察组 37 例，PLN 不可见的对照组 27 例；术前选用高频超声观 察淋巴结数目、形态、最大径、回声及血流等，术后与病理对照。结果：（1）观察组患者中，术后病理诊断为甲状 腺乳头状癌（PTC）有 25 例、增生结节（NG）10 例、亚急性甲状腺炎（ST）2 例，其中 35 例合并有 HT，占 94.6 % （35/37），淋巴结声像图表现为：数目多为 1 ~ 3 个，纵横比＞ 1（水平生长），最大径 3 ~ 7 mm，回声呈低回声或 极低回声，分布均匀，淋巴门和髓质不显示，未见强回声钙化和无回声囊性变，内部多无血流信号；对照组中，术后 病理诊断为 PTC 的有 12 例、NG 11 例、ST 1 例和甲状腺滤泡肿瘤（TFT）3 例，只有 1 例合并有 HT。（2）PLN 可 见来诊断 HT 的灵敏度、特异度、阳性预测值和阴性预测值分别为 97.2 %、92.8 %、94.6 % 和 96.3 %。结论：PLN 是 否可见对 HT 的诊断具有高灵敏度和高特异度。

Abstract:

〔Abstract〕 Objective To investigate the ultrasound diagnostic value of parathyroid lymph nodes (PLN) in Hashimoto's thyroiditis (HT). Methods 64 patients with thyroid nodules who were treated in the Second People's Hospital of Shenzhen from October 2018 to October 2020 without preoperative ultrasonography indicating HT were selected. According to whether PLN was visible before surgery, they were divided into observation group and control group, including 37 patients in the observation group with visible PLN, and 27 patients in the control group without visible PLN. High frequency ultrasound was used to observe the number, morphology, maximum diameter, echo and blood flow of lymph nodes before surgery, and the postoperative comparison with pathology. Results (1) In the observation group, 25 cases were pathologically diagnosed as papillary thyroid carcinoma (PTC), 10 cases as nodular hyperplasia (NG), and 2 cases as subacute thyroiditis (ST), among which 35 cases complicated with HT, it accounted for 94.6 % (35/37). The ultrasonographic manifestations of lymph nodes were as follows: most of them were 1 ~ 3, with aspect ratio > 1 (horizontal growth) and maximum diameter of 3 ~ 7 mm. The echo was hypoechoic or very hypoechoic, evenly distributed, lymphatic hilum and medulla were not shown, no strong echo calcification and no echo cystic changes were observed, and most of the internal blood flow signals were not observed. In the control group, 12 cases were pathologically diagnosed as PTC, 11 cases as NG, 1 case as ST, 3 cases as thyroid follicular tumor (TFT), and only 1 case was complicated with HT. (2) The sensitivity, specificity, positive predictive value and negative predictive value of PLN for the diagnosis of HT were 97.2%, 92.8%, 94.6% and 96.3%, respectively. Conclusion PLN visibility has high sensitivity and specificity in the diagnosis of HT.