年4月，詹维伟主任医师在《EUROPEANRADIOLOGY》杂志在线发表题名为“Ultrasoundlymphaticimagingforthediagnosisofmetastaticcentrallymphnodesinpapillarythyroidcancer.”——前哨淋巴结超声造影在评估甲状腺癌中央组淋巴结转移中的应用的研究论文。
超声诊断科詹维伟主任医师、周建桥主任医师为论文的共同通讯作者，刘振华副主任医师、汪蓉晖医师为论文的共同第一作者。
doi:10./s---y.
通过超声经皮穿刺甲状腺内注射超声微泡造影剂的方法可追踪引流淋巴管实现甲状腺前哨淋巴结超声造影，这种新技术大大提高了术前评估甲状腺癌中央组淋巴结转移的诊断效能。前哨淋巴结超声造影表现为灌注缺损或无灌注是转移性前哨淋巴结的超声特征性表现。基于前哨淋巴结造影及常规超声的图像特征为基础的评分系统可用于评估中央组淋巴结的肿瘤负荷。
国内外首创甲状腺前哨淋巴结造影技术，有望解决临床术前评估淋巴结转移的难题。前哨淋巴结造影评分系统为颈部淋巴结清扫直接提供可视化依据，可以防止过度医疗，也为临床保守治疗、介入治疗的选择提供医学证据。
Objectives:Upto40%ofpapillarythyroidcancer(PTC)patientshavelymphnodemetastasis,aconditionthatimpliespersistent,recurrent,orprogressivedisease.However,theAmericanJointCommitteeonCancerManualstatesthatthereisnoreliableexaminationforadequatelymphnodestaging.Therefore,ouraimistodevelopalymphaticimagingtechniqueusingultrasonographytoaddressthischallenge.
Methods:WeconsecutivelyenrolledPTCpatientswhounderwentultrasound(US)lymphaticimagingviatheperitumouralinjectionofcontrastmedia.Identificationofthesentinellymphnodesandthetargetedsentinellymphnodeswasseparatelybasedonthelymphaticdrainagepathwayandtheenhancementpatterns.Everyidentifiedtargetednodewasassignedascore,accordingtothefeaturesonconventionalUSandenhancementpatterns,andwasreferredforultrasound-guidedfine-needleaspiration.Cytologicalandhistopathologicresultsrepresentedthestatusesofthetargetedlymphnodesandoverallcentrallymphnodes,respectively,whichwereappliedtoevaluatethediagnosticperformanceofUSlymphaticimaging.
Results:PTCpatientswereincluded.Onthebasisofthecytologicresults,thesensitivity(97.1%,95%confidenceinterval[CI]:84.7-99.9%)ofdetectingpositivetargetednodesbyUSlymphaticimagingsignificantlyincreasedby45.5%atathresholdof4orhigher(P=0.),withoutlossofspecificity(P=1.).Thesurgicalresultsshowedthatthemetastaticdegreewaspositivelycorrelatedwithanincreaseinthescore(τ:0.,P0.).
Conclusion:Ultrasoundlymphaticimaginghasahighdiagnosticperformance,anditscorrespondingscoringsystemfacilitatesgradingofthenodalburdeninthecentral
