The Diagnostic Value Of High-frequency Ultrasound And CT And The Choice Of Surgical Treatment In Thyroid Papillary Carcinoma And Neck Lymph Node

Objiective：To study the CT and High-frequency Ultrasound(US) appearances ofpreoperative thyroid carcinoma, so as to evaluate the value of the two modalities indiagnostic of thyroid cancer and metastatic cervical lymph nodes. And to explore themetastasis of cervical lymph node dissection in papillary thyroid carcinoma and areasonable choice of surgical methods.Methods: A retrospective analysis of274cases of patients with papillary thyroidcarcinoma associated imaging findings and clinical data, who had completed US andCT examination in hospital. Comparison with the results of clinical operation andpathology. The primary lesion and metastatic cervical lymph nodes of papillarythyroid carcinoma were analyzed in clinical surgery.Results: In274patients with thyroid papillary carcinoma,, The diagnosis rate of CTwas significantly higher than US, especially the thyroid nodules of1.0cm below. CTon thyroid cancer diagnosis coincidence rate was84.23%(203/241), US on thyroidcancer diagnosis coincidence rate was78.47%(215/274), CT on thyroid cancerdiagnosis coincidence rate is higher than US, but there was no significant difference(P>0.05). The diagnosis coincidence rate Of the joint inspection US and CT was95.26%(261/274), which wan significantly higher than the single US or CTexamination in the diagnosis coincidence rate (P <0.05). For thyroid papillarymicrocarcinoma(PTMC) patients, that lesions≤1.0cm. in diameter. US diagnosticcoincidence rate was68.13%(62/91), CT diagnosis coincidence rate was44.44%(20/45), ultrasound diagnosis coincidence rate is significantly higher than CTdiagnosis coincidence rate (P <0.05); But for patients with PTC that lesions>1.0cmin diameter, the US diagnostic coincidence rate was83.6%(153/183), CT diagnosiscoincidence rate was93.36%(183/196), CT diagnosis coincidence rate was significantly higher than that of ultrasound diagnosis coincidence rate (P <0.05).In terms of neck lymph node metastasis, US examination that showed the rate of49.27%(135/274) is slightly lower than CT examination that show rate is60.22%(165/274). US diagnostic coincidence rate was60.74%(82/135), CT diagnosiscoincidence rate was71.52%(118/165), computed tomography (CT) in the diagnosisof cervical lymph node metastasis coincidence rate is significantly higher than USdiagnosis coincidence rate (P <0.05). US and CT joint inspection diagnosiscoincidence rate83.07%(157/189), it was significantly higher than the single US orCT examination diagnosis coincidence rate (P <0.05). The central area (VI) andlateral neck area (II, III, IV) of the lymph node metastasis rate was respectively56.04%(51/91),5.49%(5/91). that tumor diameter was of1.0cm or less in PTMCpatients. The central area (VI) and lateral neck area (II, III, IV, V) of the lymph nodemetastasis rate was respectively69.95%(128/183),19.67%(36/183). that tumordiameter was greater than1.0cm of PTC patients. The central area (VI) and centrallateral neck area (II, III, IV, V) of PTC (>1.0cm in diameter) patients with lymphnode metastasis rate was significantly higher than that of PTMC (P <0.05). InClinical cervical lymph node negative (cN0period) of the PTC patients, lymph nodemetastasis rate was54.12%(46/85), In Clinical neck lymph node positive (cN1period)of PTC patients, lymph node metastasis rate was70.37%(133/189), In Patients withthyroid papillary carcinoma, The neck lymph node metastasis rate of cN1period issignificantly higher than patients with lymph node metastasis rate of cN0period(P <0.05).Conclusions：High frequency ultrasound should be as the first choice for the thyroidpapillary carcinoma, especially in the evaluation of the primary lesion (lesions≤1.0cm. in diameter.) and cervical metastatic lymph nodes; CT in tumor qualitativediagnosis has high diagnostic value, at the same time with the advantage thatultrasonic don’t have. Combination of two kinds of inspection methods, can improvethe accuracy of thyroid cancer diagnosis and preoperative evaluation, but in clinicalCT is mainly used to determine the range of mass and the relationship of thesurrounding adjacent, and to clear whether lymph node metastasis. In PTC, neck lymph node metastasis rate is high, the central area(VI area) is themost common part of the neck lymph node metastasis area, followed by deep necklymph nodes (II, III, IV area), the neck lymph node metastasis area are mainlyconcentrated in the VI area in PTMC, the neck lymph node metastasis area mainlyconcentrated in the VI and II, III and IV area in PTC (lesions>1.0cm in diameter).Therefore, for the preoperative it’s not clear Whether there was no lymph nodemetastasis found in patients with PTC, During the ipsilateral thyroid lobe standardexcision, we suggest that the conventional line cleaning lymph node in central regionis necessary.