目的:探究多模态超声在诊断T1bN1bM0 期分化型甲状腺癌侧颈区淋巴结转移中的临床价值.方法:选择2021年7 月—2023 年7 月于江西省吉安市井冈山大学附属医院及其他合作医院就诊的T1bN1bM0 期分化型甲状腺癌患者 60 例作为研究对象,均采用二维超声、超微血管成像及剪切波弹性成像检查.病理检查结果为诊断"金标准",分析病理检查结果,另分析二维超声、超微血管成像及剪切波弹性成像在分化型甲状腺癌侧颈区淋巴结转移中的诊断价值,并计算多模态超声检查与"金标准"的一致性.结果:60 例患者中经手术病理明确发生侧颈区淋巴结转移共 13 例,检出率为 21.67%(13/60).多模态超声诊断T1bN1bM0 期分化型甲状腺癌侧颈区淋巴结转移中各准确度对比,有统计学差异(P<0.05);灵敏度、特异度、阳性预测值及阴性预测值对比,无统计学差异(P>0.05).二维超声与"金标准"一致性不佳(kappa值=0.349,P=0.007),二维超声+超微血管成像、二维超声+剪切波弹性成像均与"金标准"一致性尚可(kappa值=0.442、0.592,P=0.001、0.000),二维超声+超微血管成像+剪切波弹性成像与"金标准"一致性良好(kappa值=0.857,P=0.000).结论:多模态超声在诊断T1bN1bM0 期分化型甲状腺癌侧颈区淋巴结转移诊断中具有较高的临床应用价值,能够有效明确侧颈区淋巴转移的具体情况及与周围组织间的关系,且与"金标准"存在较高的一致性,值得推广应用.
Objective:To explore the clinical value of multimodal ultrasound in diagnosing lymph node metastasis in the lateral neck region of T1bN1bM0 stage differentiated thyroid cancer.Methods:Sixty patients with T1bN1bM0 stage differentiated thyroid cancer who were treated at the Affiliated Hospital of Jinggangshan University and other cooperative hospitals in Ji'an City,Jiangxi Province from July 2021 to July 2023 were selected as the study subjects,all of whom underwent two -dimensional ultrasound, ultramicro vascular imaging,and shear wave elastography.The pathological examination results are the "gold standard"for diagnosis, and the pathological examination results are analyzed.In addition,the diagnostic value of two -dimensional ultrasound,ultramicro vascular imaging,and shear wave elastography in the lateral neck lymph node metastasis of differentiated thyroid cancer is analyzed, and the consistency between multimodal ultrasound examination and the "gold standard"is calculated.Results:Among the 60 patients,13 were confirmed to have lateral cervical lymph node metastasis through surgery and pathology,with a detection rate of 21.67% (13 /60).There was a statistical difference in the accuracy of multimodal ultrasound diagnosis of T1bN1bM0 stage differentiated thyroid cancer with lymph node metastasis in the lateral neck region(P<0.05);There was no statistically significant difference in sensitivity,specificity,positive predictive value,and negative predictive value(P>0.05).The consistency between twodimensional ultrasound and the "gold standard"is poor (kappa value =0.349,P =0.007),while the consistency between two - dimensional ultrasound+ultramicro vascular imaging,two-dimensional ultrasound+shear wave elastography and the "gold standard"is still good (kappa value=0.442,0.592,P=0.001,0.000).The consistency between two-dimensional ultrasound+ultramicro vascular imaging+shear wave elastography and the "gold standard"is good (kappa value =0.857,P =0.000).Conclusion:Multimodal ultrasound has high clinical application value in the diagnosis of lymph node metastasis in the lateral neck region of T1bN1bM0 stage differentiated thyroid cancer.It can effectively clarify the specific situation of lymph node metastasis in the lateral neck region and its relationship with surrounding tissues,and has high consistency with the "gold standard",which is worth promoting and applying.