甲状腺CT对甲状腺乳头状微小癌宏观淋巴结转移检出的影响
本研究为单中心回顾性研究，纳入982例甲状腺乳头状微小癌（PTMC）患者，评估超声（US）联合CT对比单独US对宏观淋巴结转移（转移灶>2mm）的诊断效能。结果显示，联合CT将敏感度从26.7%提升至68.4%（P<0.001），特异度虽从97.2%降至90.9%（P<0.001）但仍保持较高水平；在US淋巴结阴性亚组中，CT额外检出8.7%的宏观转移。结论认为，US联合CT可改善宏观淋巴结转移的检出，有助于优化患者管理。
要点
- PTMC患者术前评估宏观淋巴结转移时，US联合CT可显著提高敏感度（26.7%→68.4%）。
- US淋巴结阴性患者中，CT可额外检出8.7%的宏观转移，避免误判为主动监测候选者。
- 联合CT后特异度仍达90.9%，但较单独US的97.2%有显著下降。
局限性
- 单中心回顾性设计可能限制结果的外推性。
- 联合CT后特异度较单独US显著下降，可能增加假阳性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVE: To evaluate the impact of adding CT to ultrasound (US) for nodal assessment in patients with papillary thyroid microcarcinoma (PTMC), particularly in those with US-node-negative disease.
MATERIALS AND METHODS: This single-center retrospective study included consecutive patients with PTMC (≤1 cm on US) who underwent both US and CT for PTMC staging between August 2016 and January 2020, and subsequently underwent surgery including neck dissection. The number of patients with clinical N1 and pathological N1 disease was assessed. The diagnostic performance of US, CT, and combined US + CT (positive if either was positive) for macroscopic lymph node metastasis (LNM) (i.e., metastatic tumor foci >2 mm) was evaluated. Cases with discordant nodal staging between US and CT were identified. The diagnostic utility of CT was also assessed in a subgroup of patients with node-negative findings on US.
RESULTS: Among 982 patients (mean age ± standard deviation, 47.3 ± 11.5 years; 774 female), pathological analysis confirmed cervical LNM in 377 patients, including macroscopic, microscopic, and size-unknown LNM in 187, 175, and 15 patients, respectively. The addition of CT to US improved sensitivity for detecting macroscopic LNM compared to US alone (68.4% [128/187] vs. 26.7% [50/187]; P < 0.001), while maintaining high specificity despite a significant decrease (90.9% [709/780] vs. 97.2% [758/780]; P < 0.001). Discordant nodal staging between US and CT regarding macroscopic LNM was observed in 149 cases (15.2% [149/982]), with 131 patients (87.9% [131/149]) being upstaged by CT. In patients with node-negative US findings, CT detected US-undetected macroscopic LNM in 78 patients (8.7% [78/895]) and exhibited a sensitivity of 56.9% (78/137) and specificity of 93.5% (709/758) for macroscopic LNM.
CONCLUSION: The integration of CT with US improved sensitivity for detecting macroscopic LNM in patients with PTMC, identifying those who would otherwise be inappropriately considered candidates for active surveillance based solely on US findings. This may assist in refining patient management.
引用
- Jeon YH, Lee JY, Ham T, et al. Impact of Thyroid CT on Detecting Macroscopic Nodal Metastasis in Patients With Papillary Thyroid Microcarcinoma. Korean J Radiol. 2026. PMID: 41974532. doi:10.3348/kjr.2025.1073
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。