超声引导下FNAC联合FNA-Tg检测对甲状腺乳头状癌颈侧区的转移性淋巴结的诊断价值

Diagnostic value of ultrasound-guided fine needle aspiration cytology combined with thyroglobulin for metastatic lymph nodes in lateral cervical region of papillary thyroid carcinoma

摘要:

目的 分析超声引导下进行细针穿刺细胞学（FNAC）检查联合洗脱液甲状腺球蛋白（FNA-Tg）检测对甲状腺乳头状癌（PTC）发生颈侧区的转移性淋巴结（MLN）的诊断价值，以期为临床早期筛查诊断提供方案。方法 选取2022年1月至2022年12月河南宏力医院就诊的128例PTC且超声检查疑似发生颈侧区的MLN患者作为研究对象，入院后均行FNAC检查及FNA-Tg检测，分析PTC患者发生颈侧区的MLN的超声特征。以病理诊断结果为“金标准”，比较FNAC、FNA-Tg单独检测及联合检测诊断PTC患者发生颈侧区的MLN的价值。结果 病理诊断结果显示，阳性92例，阴性36例；FNAC检查诊断结果显示，阳性81例，阴性47例，FNA-Tg检测诊断结果显示，阳性78例，阴性50例，FNAC与FNA-Tg联合诊断结果显示，阳性91例，阴性37例；FNAC与FNA-Tg联合诊断的灵敏度为95.65%、准确度为94.53%，高于FNAC单独诊断的84.78%、86.72%和FNA-Tg单独诊断的82.61%、85.94%，漏诊率为4.35%，低于FNAC单独诊断的15.22%和FNA-Tg单独诊断的17.39%，差异有统计学意义（P<0.05）；FNAC与FNA-Tg联合检测Ⅱ区淋巴结转移检出率为100%，高于FNAC单独检测的72.22%和FNA-Tg单独检测的72.22%，差异有统计学意义（P<0.05）。结论 FNAC与FNA-Tg联合检测可显著提升PTC颈侧区域的MLN诊断准确率和敏感度，降低漏诊率，为临床早期筛查诊断、制定治疗方案提供依据。

Abstract:

Objective To investigate the diagnostic value of ultrasound-guided fine needle aspiration cytology (FNAC) combined with thyroglobulin (FNA-Tg) for metastatic lymph nodes (MLN) in the lateral cervical region of papillary thyroid carcinoma (PTC), in order to provide a plan for clinical early screening and diagnosis.Methods Totally 128 patients with PTC suspected MLN in the lateral cervical region from January 2022 to December 2022 were selected as the study subjects. After admission, all patients were examined by FNAC and FNA-Tg, the ultrasonographic characteristics of MLN in the cervical region of PTC were analyzed; the pathological result was used as the "gold standard", the diagnostic values of FNAC, FNA-Tg alone and combined detection for MLN in the lateral cervical region of PTC were compared.Results Pathological diagnosis showed that there were 92 positive cases and 36 negative cases; the FNAC diagnosis results showed that there were 81 positive cases and 47 negative cases; the FNA-Tg diagnosis results showed that there were 78 positive cases and 50 negative cases; the results of FNAC and FNA-Tg combined diagnosis showed that there were 91 positive cases and 37 negative cases. The sensitivity and accuracy of FNAC and FNA-Tg combined diagnosis were 95.65% and 94.53%, respectively, which were higher than those of FNAC alone diagnosis (84.78%, 86.72%) and FNA-Tg alone diagnosis (82.61%, 85.94%), the missed diagnosis rate was 4.35%, which was obviously lower than that of FNAC alone diagnosis (15.22%) and FNA-Tg alone diagnosis (17.39%), the difference was significant (P<0.05). The detection rate of MLN in region Ⅱ by FNAC and FNA-Tg combined detection was 100%, which was higher than that by FNAC alone detection (72.22%) and FNA-Tg alone detection (72.22%), the difference was significant (P<0.05).Conclusion The combined detection of FNAC and FNA-Tg can effectively improve the diagnostic accuracy and sensitivity of MLN in the lateral cervical region of PTC, reduce the missed diagnostic rate, and provide a basis for early clinical screening diagnosis and treatment plan.