CAJ | 학술논문

目的：探讨超声对甲状腺乳头状癌（ papillary thyroid cancer，PTC）颈部淋巴结转移规律及特点的价值。方法：回顾性分析91例（112侧）颈部阳性淋巴结（ cN+）PTC患者的声像图特征，分为术前颈部淋巴结触诊阳性患者61侧和术前颈部触诊阴性而超声提示为颈淋巴转移患者51侧两组。记录术中转移淋巴结的数量及在Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区的分布。结果：PTC颈部转移性淋巴结的超声特点以类圆形及淋巴门消失多见，内部呈低回声伴钙化、囊性变或呈高回声。91例患者中21例双侧颈转移占23.1%，112侧颈清扫标本中89侧（79.5%）为多分区转移；颈转移淋巴结在Ⅱ区57.1%（64/112）、Ⅲ区56.3%（63/112）、Ⅳ区61.6%（69/112）、Ⅵ区67.9%（76/112）。Ⅴ区仅占18.8%（21/112），差异有统计学意义（ P﹤0.001）。术前超声检查可以发现45.5%（51/112）的颈部触诊漏诊的颈部淋巴转移。结论：PTC的颈部淋巴转移可以多区分布，其中Ⅱ、Ⅲ、Ⅳ、Ⅵ区为主要的转移部位，Ⅵ区相对较高，颈部转移性淋巴结呈类圆形及淋巴门消失多见，内部呈低回声伴钙化、囊性变或呈高回声。超声在PTC颈淋巴转移的诊断中具有重要的价值。
목적：탐토초성대갑상선유두상암（ papillary thyroid cancer，PTC）경부림파결전이규률급특점적개치。방법：회고성분석91례（112측）경부양성림파결（ cN+）PTC환자적성상도특정，분위술전경부림파결촉진양성환자61측화술전경부촉진음성이초성제시위경림파전이환자51측량조。기록술중전이림파결적수량급재Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ구적분포。결과：PTC경부전이성림파결적초성특점이류원형급림파문소실다견，내부정저회성반개화、낭성변혹정고회성。91례환자중21례쌍측경전이점23.1%，112측경청소표본중89측（79.5%）위다분구전이；경전이림파결재Ⅱ구57.1%（64/112）、Ⅲ구56.3%（63/112）、Ⅳ구61.6%（69/112）、Ⅵ구67.9%（76/112）。Ⅴ구부점18.8%（21/112），차이유통계학의의（ P﹤0.001）。술전초성검사가이발현45.5%（51/112）적경부촉진루진적경부림파전이。결론：PTC적경부림파전이가이다구분포，기중Ⅱ、Ⅲ、Ⅳ、Ⅵ구위주요적전이부위，Ⅵ구상대교고，경부전이성림파결정류원형급림파문소실다견，내부정저회성반개화、낭성변혹정고회성。초성재PTC경림파전이적진단중구유중요적개치。
Objective:To discuss the value of ultrasound( US )in detecting the patterns and features of cervical lymph node metastasis( LNM)in patients with papillary thyroid cancer( PTC). Methods:We retrospectively reviewed ultrasonic images of 91 patients(112 sides)with positive cervical lymph nodes(cN+)in PTC who had undergone pre-operative US and palpation. Of 112 sides,61 sides of palpation were positive,and the left 51 sides of palpation were negative while the US results were positive. The number of LNM and distribution in zoneⅡ,zoneⅢ,zoneⅣ,zone V and zone Ⅵwere recorded according to operation. Results:The ultrasonic features of LNM in PTC with quasi-circu-lar echoes and disappeared lymphatic hilum could be seen more frequently. The interior of nodes presented hypoechoic with calcification,cystic change or hyperechoic. Of 91 patients,number of bilateral cervical metastasis was 21 accoun-ted for 23. 1%. Of 112 sides of cervical dissection specimens,89 sides belonged to multi-zone metastasis. The num-ber of cervical LNM accounted for 57. 1%(64/112)in zone Ⅱ,56. 3%(63/112)in zone Ⅲ,61. 6%(69/112)in zone Ⅳ,67. 9%(76/112)in zoneⅥand only 18. 8%(21/112)in zone V. There was significant difference statisti-cally(P﹤0. 001). 45. 5%(51/112)of cervical LNM of missed diagnosis by palpation could be found by preoperative ultrasound. Conclusion:LNM in PTC could distribute in several zones simultaneously,which mainly distributed among zone Ⅱ,zoneⅢ,zoneⅣand especially zoneⅥ. The ultrasound of LNM presented quasi-circular echoes and disap-peared lymphatic hilum more frequently. The interior of nodes presented hypoechoic with calcification,cystic change or hyperechoic. Ultrasound had an important value in the diagnosis of cervical LNM in PTC.