高频超声与喉镜检查对甲状腺癌侵犯喉返神经的术前评价价值分析

目的:比较高频超声与喉镜检查对甲状腺癌侵犯喉返神经(recurrent laryngeal nerve,RLN)的术前评价价值。方法:选择2012年2月到2019年8月在本院进行诊治的甲状腺癌患者207例,采用高频超声与喉镜进行术前评估侵犯喉返神经情况,记录超声特征并判断诊断价值(以病理检查作为金标准)。结果:在207例甲状腺癌患者中,术后病理学证实喉返神经侵犯52例(侵犯组),转移率为25.1%。侵犯组的性别、年龄、发病位置、体重指数、病程等与非侵犯组患者对比差异无统计学意义(P0.05)。侵犯组超声显示病灶形态、内部回声、边界、钙化、晕环等特征与非侵犯组对比差异有统计学意义(P0.05),主要表现为侵犯组的病灶形态不规则、无晕环、无钙化、边界不清晰、内部高超声均显著高于非侵犯组(P0.05)。侵犯组的峰值强度(Peak intensity,PI)值高于非侵犯组患者(P0.05),两组达峰时间(Peak time,TP)与AUC值对比差异无统计学意义(P0.05)。在207例患者中,高频超声判断为喉返神经侵犯43例,喉镜判断为喉返神经侵犯39例,高频超声与喉镜检查对甲状腺癌侵犯喉返神经的术前诊断敏感性为97.7%和97.4%,特异性为93.9%和91.7%,高频超声诊断的敏感性和特异性比喉镜检查稍优。ROC曲线显示高频超声诊断的AUC为0.903,喉镜检查的AUC为0.860。结论:高频超声与喉镜检查对甲状腺癌侵犯喉返神经的术前评价的应用价值相当,均有很高的敏感性与特异性,能准确反映患者侵犯喉返神经的情况。

Analysis of the Preoperative Evaluation Values of High Frequency Ultrasound and Laryngoscopy for the Thyroid Cancer Invasion of Recurrent Laryngeal Nerve

ABSTRACT Objective: Comparison of the preoperative evaluation values of high frequency ultrasound and laryngoscopy for the thyroid cancer invasion of recurrent laryngeal nerve (RLN). Methods: A total of 207 patients with the thyroid cancer who were treated in our hospital from February 2012 to August 2019 were selected. The high-frequency ultrasound and laryngoscopy were used to evaluate the preoperative RLN before surgery. The characteristics of the ultrasound were recorded and the diagnostic values were judged (Pathological examination as the gold standard). Results: There were 52 patients of RLN invasion (invasion group) by the postoperative pathology in the 207 cases that the metastatic rate of 25.1 %. There were no significant differences in gender, age, location, body mass index, and duration of disease compared between the invasive group and the non-invasive group (P>0.05). Ultrasound showed that the lesion morphology, halo, calcification, border, internal echo and other features were significantly different compared between the non-invasive group and the non-invasive group (P<0.05). It was mainly characterized by irregular lesion shapes, no halo, no Calcification, unclear borders, and internal ultrasonography were significantly higher than the non-invasive group (P>0.05). The peak intensity (PI) value of the invasion group was higher than that of the non-invasive group (P<0.05), and there were no significant difference in peak time(TP) and AUC values compared between the two groups (P>0.05). In the 207 patients, high-frequency ultrasound were judged as 43 cases of recurrent laryngeal nerve invasion, and laryngoscopy confirmed 39 cases of recurrent laryngeal nerve invasion. The preoperative diagnostic sensitivity of high-frequency ultrasound and laryngoscopy for thyroid cancer invasion of the recurrent laryngeal nerve was 97.7 % and 97.4 %, and the specificity was 93.9 % and 91.7 %. High-frequency ultrasound has slightly better sensitivity and specificity than laryngoscopy. The ROC curve shows that the AUC of the high-frequency ultrasound diagnosis is 0.903, and the AUC of the laryngoscopy is 0.860. Conclusion: High-frequency ultrasound and laryngoscopy are of equal value in the preoperative evaluation of thyroid cancer invasion of the recurrent laryngeal nerve, which have high sensitivity and specificity and can accurately reflect the patient''s recurrent laryngeal nerve invasion.