评估甲状腺癌患者颈部淋巴结转移的超声(US)特征,并比较欧洲和韩国指南中LN转移风险的US分类。
2014年1月至2018年12月,在美国引导下对714例患者的836例LN进行细针穿刺,以进行甲状腺癌的术前淋巴结分期。回顾性审查了LN的美国特征的以下特征:大小,存在的门,margin,定位,囊性改变,点状回声灶(PEF),大回声灶,偏心皮质增厚,血管异常,和皮质高回声性。进行了多元逻辑回归分析,以确定诊断转移性LN的独立US特征。随后评估了独立US特征的诊断性能。根据韩国甲状腺成像报告和数据系统(K-TIRADS)和欧洲甲状腺协会(ETA)指南对LN进行分类。并评估了两组分类之间的相关性。
没有门儿,存在囊性改变,PEF,血管异常,皮质高回声是转移性LN的独立US特征。囊性变化,PEF,血管异常,皮质高回声表现出很高的特异性(86.8%-99.6%)。缺乏肺门的敏感性最高,但特异性较低(66.4%)。当根据ETA指南和K-TIRADS对LN进行分类时,它们产生了类似的恶性肿瘤风险分类,并且密切相关(斯皮尔曼系数,0.9766[95%置信区间,0.973-0.979])。根据ETA指南,9.8%(82/836)的LN被归类为“未指定”。\"
没有肺门,囊性改变,PEF,血管异常,和皮质高回声是提示甲状腺癌转移性LN的独立US特征。K-TIRADS和ETA指南都为转移性LNs提供了相似的风险分层,具有高度相关性;然而,ETA指南未能将9.8%的LN分类为特定风险层.这些结果可能为将来指南中修改LN分类提供基础。
To evaluate the ultrasonography (US) features for diagnosing metastasis in cervical lymph nodes (LNs) in patients with thyroid cancer and compare the US classification of risk of LN metastasis between European and Korean
guidelines.
From January 2014 to December 2018, US-guided fine-needle aspiration was performed on 836 LNs from 714 patients for the preoperative nodal staging of thyroid cancer. The US features of LNs were retrospectively reviewed for the following features: size, presence of hilum, margin, orientation, cystic change, punctate echogenic foci (PEF), large echogenic foci, eccentric cortical thickening, abnormal vascularity, and cortical hyperechogenicity. A multiple logistic regression analysis was performed to identify the independent US features for the diagnosis of metastatic LNs. The diagnostic performance of independent US features was subsequently evaluated. LNs were categorized according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and European Thyroid Association (ETA) guidelines, and the correlation between the two sets of classifications was assessed.
Absence of the hilum, presence of cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features of metastatic LNs. Cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity showed high specificity (86.8%-99.6%). The absence of the hilum had the highest sensitivity yet low specificity (66.4%). When LNs were classified according to the ETA guidelines and K-TIRADS, they yielded similar categorizations of malignancy risks and were strongly correlated (Spearman coefficient, 0.9766 [95% confidence interval, 0.973-0.979]). According to the ETA
guidelines, 9.8% (82/836) of LNs were classified as \"not specified.\"
Absence of hilum, cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features suggestive of metastatic LNs in thyroid cancer. Both K-TIRADS and the ETA
guidelines provided similar risk stratification for metastatic LNs with a high correlation; however, the ETA
guidelines failed to classify 9.8% of LNs into a specific risk stratum. These results may provide a basis for revising LN classification in future
guidelines.