超声检查及细针穿刺洗脱液降钙素检测在甲状腺髓样癌侧颈淋巴结转移术前诊断中的应用价值  期刊论文  

Objective:To investigate the suspicious ultrasound features of lateral cervical metastatic lymph nodes in medullary thyroid carcinoma（MTC），and evaluate the preoperative diagnostic value of calcitonin in washout fluid of fine-needle aspiration（FNA-CT）.Methods:A total of 159 lymph nodes from 133 MTC patients who underwent lateral cervical lymph node dissection at Tianjin Medical University Cancer Institute & Hospital from January 2020 to January 2025 were retrospectively included. Based on the postoperative pathology，the lymph nodes were divided into lateral lymph node metastasis group（ n=119）and lateral lymph node non-metastasis group（ n=40）. Univariate and multivariate Logistic regression analyses were performed to analyze the sonographic features of lymph nodes in the two groups and identify the risk features of MTC lateral cervical metastatic lymph nodes. Preoperative fine-needle aspiration cytology（FNAC）and FNA-CT were performed on the lateral cervical lymph nodes. Among the 159 lymph nodes，102 underwent FNAC and FNA-CT test，the lymph nodes were divided into lateral lymph node metastasis group（ n=62）or lateral lymph node non-metastasis group（ n=40）by postoperative pathology. ROC curve was plotted，the optimal cutoff value of FNA-CT for diagnosing metastasis was calculated. The diagnostic efficacies were compared among FNAC，FNA-CT，and the combination of FNA-CT and FNAC. Results:Multivariate Logistic regression analysis showed that enlarged lymph nodes size（ OR=7.462，95% CI=2.145-25.954），round shape（ OR=13.711，95% CI=3.286-57.212），loss of fatty hilum（ OR=3.758，95 %CI=1.015-13.918）and increased peripheral vascularity（ OR=15.716，95 %CI=4.131-59.786）were risk features for lateral cervical lymph node metastasis in MTC. The best cutoff points for FNA-CT diagnosis of lateral cervical lymph node metastasis in MTC were 45.6 ng/L（ U=40.000， P<0.001）. The sensitivities of FNA-CT，FNAC，and the combination of FNA-CT and FNAC in diagnosing lateral cervical lymph node metastasis were 98.4%，67.7% and 100%，the specificities were 92.5%，100% and 92.5%，the accuracies were 96.1%，80.4% and 97.1%. the areas under the curve（AUCs）were 0.954，0.839 and 0.963，respectively. The difference in AUC between FNA-CT and FNAC was statistically significant（ P=0.002）. The difference in AUC between FNAC and FNA-CT combined with FNAC was also statistically significant（ P<0.001）. The difference in AUC between FNA-CT and FNA-CT combined with FNAC was not statistically significant（ P=0.317）. Conclusions:FNA-CT demonstrats near-perfect diagnostic performance and improves the preoperative diagnostic efficacy of metastatic lateral cervical lymph nodes in MTC. The presence of suspicious ultrasound features，including enlarged size，rounded morphology，loss of the fatty hilum and enhanced peripheral vascularity，warrants further FNA-CT evaluation to assess the risk of metastasis.