中国实用外科杂志

中国实用外科杂志

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细针穿刺活检及洗脱液检测在甲状腺癌颈淋巴结清扫决策中的应用研究

周    乐a，张    广a，张大奇a，边学海a，付庆锋a，张文杰b，王    慧a，孙    辉a   

  1. 吉林大学中日联谊医院 a.甲状腺外科 b.病理科，吉林长春 130033
  • 出版日期:2017-09-01 发布日期:2017-09-05

  • Online:2017-09-01 Published:2017-09-05

摘要：

目的    探讨超声引导下细针穿刺活检及洗脱液检测技术在甲状腺癌颈淋巴结清扫中的应用价值。方法回顾性分析吉林大学中日联谊医院甲状腺外科2013年1月至2017年5月初次手术的甲状腺乳头状癌病人资料，统计在术前行颈部淋巴结超声引导下细针穿刺细胞学（FNAC）检查及洗脱液甲状腺球蛋白（FNA-Tg）检测的病例，将该检测结果与术前超声诊断、术后石蜡病理学检查结果进行对比研究，并就该组病人的一些卫生经济学指标进行分析。结果    入组病人9923例，其中经超声引导下联合FNAC和FNA-Tg检查（FNAC-Tg）评估2609例，经评估后行颈侧区淋巴结清扫术（侧清）254例，术后均行石蜡病理学检查。对于颈侧区淋巴结的诊断，超声和FNAC-Tg的诊断敏感度、特异度、准确率分别为67.57% vs. 97.30%、71.01% vs. 82.61%和68.38% vs. 93.81%。穿刺病人无颈部血肿、术后感染及无针道转移发生。2013—2017年各年度手术病人平均住院日分别为7.9 、7.3 、7.0 、6.5 、6.3 d；侧清病人占同期比例分别为52.6%、34.2%、30.8%、14.7%、12.4%；侧清标本中淋巴结转移发生率分别为35.8%、67.1%、60.4%、78.0%、 80.1%。结论    FNAC-Tg诊断甲状腺癌颈侧区淋巴结转移准确率高，可为侧清策略的制定提供有力的循证医学依据，有利于减少预防性侧清，节省医疗资源。

关键词: 分化型甲状腺癌, 活组织检查, 细针, 超声检查, 介入性, 淋巴结清扫, 甲状腺球蛋白, 转移

Abstract:

Application and evaluation of fine needle aspiration biopsy and eluate detection for cervical lymph node dissection decision in patients with thyroid carcinoma        ZHOU Le*, ZHANG Guang, ZHANG Da-qi, et al. *Department of Thyroid Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033,China
Corresponding author: SUN Hui, E-mail：sunhui1229@163.com
Abstract    Objective    To investigate the value of ultrasound-guided fine needle aspiration biopsy and technology of elution detection in strategy of cervical lymph node dissection in thyroid cancer patients. Methods    The retrospective study included all thyroid papillary carcinoma patients who underwent primary surgical treatment in Department of Thyroid Surgery China-Japan Union Hospital from January 2013 to May 2017. The patients who received both fine needle aspiration cytology （FNAC）and thyroglobulin detection in eluate（FNA-Tg） were further analyzed. The diagnostic results of the above mentioned were compared with preoperative ultrasound image and postoperative paraffin pathology， and some health economics indexes were also analyzed. Results    Totally 9923 patients were enrolled in the study， of whom 2609 patients were evaluated by ultrasound guided combined FNAC and FNA-Tg （FNAC-Tg）， and then 254 patients among them underwent lateral cervical lymph node dissection and paraffin pathological examination. For the diagnosis of the lateral cervical lymph node， the sensitivity， specificity and accuracy of ultrasonography and FNAC-Tg were 67.57% vs. 97.30%， 71.01% vs. 82.61% and 68.38% vs.93.81%， respectively. No neck hematoma， postoperative infection or needle-related metastasis occurred. The average hospitalization days of patients performed operation were 7.9, 7.3, 7.0, 6.5, 6.3 days each year from 2013 to 2017. The lateral cervical lymph node dissection accounted for the proportion of patients were 52.6%, 34.2%, 30.8%, 14.7%, 12.4%, respectively. Lymph node metastasis rate in lateral cervical lymph node dissection samples were 35.8%, 67.1%, 60.4%, 78.0%, 80.1%, respectively. Conclusion    The combination of FNAC and FNA-Tg can increase the diagnostic accuracy of lymph node metastasis in thyroid carcinoma. It provides strong basis of evidence-based medicine for the development of the strategy of lateral cervical lymph node dissection， which is helpful to reduce the proportion of prophylactic lateral cervical lymph node dissection and then save medical resources.

Key words: differentiated thyroid cancer, biopsy, fine needle, ultrasonography, interventional, lymph node dissection, thyroglobulin, metastasis