| In recent decades, the incidence of thyroid cancer have been on the rise. For the early detection of patients with lymph node metastasis, the treatment and prognosis of patients with has important significance. However, physical palpation in the diagnosis of cervical metastatic lymph nodes and the sensitivity is not enough, especially when smaller or lymph node in neck central, sternocleidomastoid deep, physical touch more difficult. Ultrasound as a simple and economical, high clinical diagnostic value of imaging examination, in diagnosis of thyroid carcinoma of cervical lymph node metastasis is essential.With the development of ultrasound machines and ultrasonic technology, high-frequency ultrasound can not only find a little to 1 mm of thyroid ultrasound at the same time can also detect suspicious metastatic lymph nodes and on preoperative localization. Ultrasound has become a thyroid carcinoma preoperative routine inspection at present, the diagnostic accordance rate of lymph node metastasis is higher and higher. According to reports in the literature ultrasonography in the diagnosis of thyroid carcinoma of cervical lymph node metastasis in more than 90%. American Thyroid Association (American Thyroid Association, ATA) in its 2009 and 2015 guide [1] proposed in suspicious for Thyroid cancer patients for preoperative routine ultrasound examination, evaluates its properties to the cervical lymph nodes, the preliminary judgment on whether there is a transfer to the cervical lymph nodes.Thyroid cancer is the most common way of transfer of neck lymph node metastasis, differentiated thyroid cancer include thyroid papillary carcinoma and follicular thyroid carcinoma, is the proportion of the highest type of thyroid carcinoma, lymph node metastasis compared with other types of thyroid cancer is more rare. So the neck lymph node metastasis is one of the important factors of prognosis of measure, closely related with tumor recurrence and postoperative survival rate. [2] accurately assess cervical lymph node metastases situation is helpful to clinical doctors to determine the better way of treatment and surgery, for example: decide whether total thyroidectomy or total resection, side lobe resection with the contralateral mostly, etc., and decide whether the lymph node were necessary operation, etc.Currently, all imaging examination, ultrasound is found in thyroid lesions and observe the most sensitive to the cervical lymph nodes is the most convenient way to check, at the same time with a non-invasive and repeatability. It can not only observe the internal structure of metastatic lymph node and blood flow distribution, also can observe different blood flow spectrum characteristics, understand relevant hemodynamic information.The sonographic features of thyroid carcinoma cervical lymph node metastases, lymph node size, boundary is not clear, aspect ratio< 2, formed a high echo, rich internal blood flow, visible tiny calcification or liquefaction. Metastatic lymph nodes in the neck by middle, sternocleidomastoid, late can metastases of mediastinal lymph nodes or axillary lymph nodes. Ultrasound in the observation of cervical lymph nodes on the morphology, size, internal echo characteristics. [3]Tumor pathological characteristics, gene expression, and is closely related to the ultrasonic features of thyroid carcinoma. Thyroid carcinoma according to the pathological morphological classification, divided into differentiated thyroid cancer, undifferentiated carcinoma and medullary cancer, differentiated thyroid cancer including papillary carcinoma, follicular carcinoma.Thyroid papillary carcinoma is the most common type of thyroid malignant tumor, accounting for about 80% of thyroid cancer. [4] had longer duration of thyroid papillary carcinoma, the prognosis is good, for the neck lymph node metastasis, less vascular invasion and distant metastasis; And most thyroid follicular carcinoma of moderate malignant tumor, vascular invasion, the tendency of more blood vessels-primarily, often can happen distant metastases, neck lymph node metastasis is one of the important factors affect prognosis, the current line of clinical confirmed the neck lymph node metastasis in patients with cervical lymph node removal have reached a consensus, so the preoperative cervical lymph nodes in patients with thyroid cancer of accurate assessment and operation method, the patients’quality of life, the recurrence rate and survival rate of assessment is very important.Normal cervical lymph nodes oval, even inflammatory lesion enlarged, but the shape and internal structure of the echo will not significantly change, and metastatic lymph nodes its shape is round or circular. Because of the heterogeneity, invasive tumor growth and lymph node ratio was reduced, the lymph node to take effect in tumor infiltration direction and infiltration degree of different, is the appearance of the lymph node change (short length to diameter/diameter ratio change); Most studies have shown that the L/S p 2 more benign, is an effective index to reflect the lymph node form. Lymph nodes [5] the reason of morphology change may be due to extensive infiltration in the cancer cells, the level of the normal lymph node structure is destroyed, resulting in lymph nodes, ratio of length to diameter border owe rules, even the edge defect. The circular often prompts as malignant lymph node. But on the other hand, the lymph nodes distribution in different areas, the shape can vary, such as: submandibular gland and parotid lymph nodes are often rounded, combining hashimoto’s thyroiditis, located in the thyroid gland under extremely neck lymph node in central region also often for class circle.Hilus normal structure also has implications for benign lymph nodes. [6-8] lymph node size, cortical thickening and hilus structure disappeared, is a useful indicators determine metastatic lymph nodes. Part, according to research by metastatic (69-95%), lymph (72-73%), tuberculous lymph nodes (76-86%), the sonographic findings of often cannot see normal hilus structure, only normal lymph node can usually see normal hilus structure (75-100%). [9] therefore, disappear hilus structure can be used as ultrasonic acoustic image characteristics of abnormal lymph nodes, but is not as the only standard to benign and malignancy evaluation of cervical lymph nodes.Thyroid papillary carcinoma of cervical lymph node metastasis along the sides of their internal jugular vein part before and more, a handful of metastatic lymph node has a tendency to cystic change, sonographic findings as a single small cystic in lymph nodes around the department area, multiple cystic area or replace the whole nodule in cystic area, thyroid papillary carcinoma in cervical lymph node metastasis ultrasound characteristic change. So, ultrasound showed cystic change occurs to the cervical lymph nodes of thyroid papillary carcinoma metastasis is a specific change, for patients with thyroid placeholder known, ultrasound see inside neck lymph nodes of cystic area highly suggest thyroid papillary carcinoma metastasis; Did not see clearly on the thyroid tumor patients, ultrasound to the cervical lymph nodes in cystic change, with the exception of lymph node tuberculosis, head and neck squamous carcinoma metastasis and neck after a benign cystic neoplasm, should be highly suspected potential thyroid papillary carcinoma.In the neck lymph node metastasis of thyroid carcinoma in primary besides capsule become necrotic performance, also visible dotted calcification, under the high resolution ultrasound visible dotted calcification often distribution in sound shadow area around. Rosario, such as lymph node punctate calcification is an important characteristic of thyroid cancer lymph node metastasis, and the characteristics of papillary carcinoma of the sand body is the same, has a certain specificity. [10] in addition there are literature reported higher levels of calcification in thyroid papillary carcinoma metastasis lymph nodes to judge the character of thyroid primary tumor incidence is of great significance.Objective:Analysis and discussion on differentiated thyroid cancer (papillary and follicular type) sonographic features of cervical lymph node metastasis and pathologic correlation.Methods:Retrospective analysis between December 2010 and December 2010 in zhujiang hospital, southern medical university of surgery and pathology confirmed differentiated thyroid cancer patients with cervical lymph node metastasis in 66 cases. According to different pathological types are divided into thyroid papillary carcinoma group (first division) and thyroid follicular carcinoma group (group b), including students’33 cases; In 33 cases of b. Collect the patient’s clinical and imaging data, including gender, age, thyroid and cervical lymph node sonographic features.All patients with thyroid preoperatively and neck lymph node colour to exceed check, check the use of instruments for PHILIP IU22 ALOKA alpha.10 LOGIQ 7 ultrasound diagnostic instrument, for 7-12 MHZ linear array probe frequency converter, using the model of thyroid scan. Scan method:the patient supine, head back or neck cushion in small pillow, fully exposed to the neck, in addition to observing thyroid placeholder, at the same time focus on observing the neck lymph node sonographic features, including the echo intensity, the boundary is clear, the presence of calcification, blood flow is rich or not, the aspect ratio, hilus, whether there is a cystic change, etc.Two sample t test are used to observe the age difference of two groups of patients, using the chi-square statistic method to observe the imaging data of two groups of patients, including cervical lymph node sonographic features, including the echo intensity, the boundary is clear, the presence of calcification, blood flow is rich or not, aspect ratio, hilus, whether there are seven characteristics of cystic change. The statistical differences (P< 0.05). At the same time of two groups patients age composition ratio analysis, analysis of onset age group.Results:Among all the 66 patients with differentiated thyroid cancer patients, papillary carcinoma and follicular carcinoma all 33 patients.Thyroid papillary carcinoma age composition, in order to under 40 accounted for 57.6%, only 21.2%, and follicular carcinoma.The different sonographic features:Thyroid papillary carcinoma and follicular carcinoma of various sonographic features of chi-square, calcification and cystic change only the P value is less than 0.05, calcification and cystic papillary carcinoma become more follicular carcinoma, calcified statistically significant its echo, border, blood flow, aspect ratio, hilus is P values were greater than 0.05, no statistical difference.Conclusions:Differentiated thyroid cancer sonographic features of cervical lymph node metastases, thyroid papillary carcinoma of cervical lymph node metastasis calcification and cystic change rate of the thyroid follicular carcinoma is high, the difference is statistically significant. The neck lymph node calcification and sac helps to identify the pathological types of thyroid cancer... |
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