Staging of Papillary Thyroid Carcinoma with Ultrasonography: Performance in a Large Series
Staging of Papillary Thyroid Carcinoma with Ultrasonography: Performance in a Large Series
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DOI：
10.1245/s10434-011-1783-3
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发表时间：
2011-12-01
影响因子：
3.7
通讯作者：
Kim, Eun-Kyung
中科院分区：
文献类型：
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作者：
Choi, Ji Soo;Chung, Woong Youn;Kim, Eun-Kyung
为评价超声对甲状腺乳头状癌（PTC）术前分期的价值，对722例经细胞学证实的PTC患者进行了术前超声检查，并对原发灶和淋巴结转移进行了分析。三位经验丰富的放射科医生前瞻性地确定了PTC的T和N类别。N分类基于室，包括左侧和右侧室（II-V级）和中央室（VI级）。所有患者均接受了手术和中央室夹层。选择性地进行了外侧间室分离。我们根据手术标本的病理结果评估术前US对PTC分期的诊断性能。根据超声诊断弥漫性甲状腺疾病（DTD）的可疑性进行亚组分析，比较超声对N分类的准确性，超声对多灶性PTC的预测率为61.7%（142/230），对双侧恶性肿瘤的预测率为67.1%（100/149）。超声对T分类的总体准确率为69.7%（503/722），对N分类的总体准确率为59%（426/722）。N 0、N1 a和N1 b的超声分类准确率分别为66%（276/418）、33.3%（70/210）和85.1%（80/94）。在有超声指征的DTD患者中，超声预测N分类的总体准确性（51.1%，67/131）显著低于无DTD患者（60.7%，359/591; P = 0.043）。术前超声是一种可行的PTC术前分期技术，有助于发现侧间室转移。DTD的存在可影响淋巴结转移的分期。
This study was designed to evaluate the performance of ultrasonography (US) for the preoperative staging of papillary thyroid carcinoma (PTC) in a large series according to the TNM classification.Preoperative US was performed for the evaluation of primary tumors and lymph node metastasis in 722 consecutive patients with cytologically proven PTC. Three experienced radiologists prospectively determined T and N categories of PTC. N categorization was based on compartments, including left and right lateral compartments (levels II-V) and central compartment (level VI). All patients underwent surgery and central compartment dissection. Lateral compartment dissection was selectively performed. We assessed the diagnostic performance of preoperative US for staging of PTC on the basis of pathologic findings of surgical specimens. Subgroup analysis according to suspicion of diffuse thyroid disease (DTD) on US was performed to compare US accuracies for N categorization.US predicted 61.7% (142/230) of patients with multifocal PTC and 67.1% (100/149) of patients with bilateral malignancy. Overall accuracy of US for T categorization was 69.7% (503/722) and that of US for N categorization was 59% (426/722). Accuracies of sonographic categorization for N0, N1a, and N1b were 66% (276/418), 33.3% (70/210), and 85.1% (80/94), respectively. Overall US accuracy for prediction of an N category was significantly lower in patients with US-indicated DTD (51.1%, 67/131) than it was in patients without DTD (60.7%, 359/591; P = 0.043).Preoperative US is a feasible technique for the preoperative staging of PTC and is helpful for the detection of lateral compartment metastasis. Presence of DTD can affect the staging of lymph node metastasis.