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目的探讨前哨淋巴结活检在分化型甲状腺癌中央淋巴结清扫中的应用价值,探索合理的中央区淋巴结清扫方案。方法回顾性分析2013年6月至2016年12月期川间首都医科大学宣武医院普通外科收治的407例分化型甲状腺癌患行者的临床资料,其中包括237例微小癌患者。结果①淋巴结检出结果:全部病例检出淋巴结7 766枚(其中219例检出转移淋巴结1 238枚),检出前哨淋巴结2 085枚(其中189例检出转移前哨淋巴结448枚);微小癌病例中,检出淋巴结3614枚(其中97例检出转移淋巴结390枚),检出前哨淋巴结1 202枚(其中82例检出转移前哨淋巴结149枚)②前哨淋巴结活检对中央区淋巴结转移的预测价值:对全部病例而言,其灵敏度、特异度、假阳性率、假例阴性率、阳性预测值和阿阴性预测值分别为86.30%(189/219)、100%(188/188)、0(0/189)、13.7096(30/219)、100%(189/189)及86.24%(188/218);对微小癌病例而言其灵敏度、特异度、假阳性率、假阴性率、阳性预测值平和阴,性预测值分别为84.54%(82/97)、100%(140/140)、0(0/82)、15.46%(15/97)、100%(82/82)及90.32%(140/155)。③前哨淋巴结活检对有无额外阳性淋巴结(APLN)的预测价值:对全部病例而言,其灵敏度、特异度、假阳.性率、假阴性率、阳性预测值和阴性预测值分别为81.48%(132/162)、76.73%(188/245)、23.27%(57/245),18.52%(30/162)、69.84%(132/189)及86.24%(188/218);对微小癌病例而言其灵敏度、特异度、假阳性-韦、假阴性率、阳性预测值和阴性预测值分别为73.68%(42/57)、77.78%(140/180)、22.22%(40/180),26.322%(15/57)、51.22%(42/82)及90.32%(140/155):④前哨淋巴结阳性比(PSLNR)对有无APLN的预测价值:对全部病例而言其灵敏度、特异度、假阳性率、假阴-性率、阳性预测值和阴性预测值分别为71.97%、78.95%、21.05%、28.03%、88.79%及54.88%,最佳诊断界点为0.345 2;对微小癌病例而言其灵敏度、特异度、假阳性率、假阴性率、阳性预测值和阴性预测值分别为83.33%、67.50%、32.50%、16.67%、72.92%及79.41%,最佳诊断界点为0.291 7。结论前哨淋巴结活检对T分化型甲状腺癌的中央区淋巴结转移。情况有较好的预测价值,且PSLNR可以作为制定中央淋巴结清扫方案的有效依据。
Objective To investigate the value of sentinel lymph node biopsy in the dissection of central lymph nodes in differentiated thyroid carcinoma and to explore a reasonable central lymph node dissection scheme. Methods The clinical data of 407 patients with differentiated thyroid cancer admitted to the General Surgery Department of Xuanwu Hospital of Capital Medical University from June 2013 to December 2016 were retrospectively analyzed, including 237 patients with microcarcinoma. Results 1 Results of lymph node detection: 7766 lymph nodes were detected in all cases (219 of them were metastasized to 1 238 lymph nodes), 2 085 SLNs were detected (448 SLNs were detected in 189 cases); Among the cases, 3,614 lymph nodes were detected (of which 390 were metastatic lymph nodes detected in 97 cases), and 1 202 sentinel lymph nodes were detected (of which 149 were detected in 82 metastases). 2 Sentinel lymph node biopsy predicts central lymph node metastasis Value: For all cases, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value and A negative predictive value were 86.30% (189/219), 100% (188/188), 0, respectively. (0/189), 13.7996 (30/219), 100% (189/189), and 86.24% (188/218); sensitivity, specificity, false positive rate, false negative rate, positive for microcarcinoma The predicted value is flat and cloudy, and the sexual prediction values are respectively 84.54% (82/97), 100% (140/140), 0 (0/82), 15.46% (15/97), 100% (82/82) and 90.32. % (140/155). 3 Predictive value of sentinel lymph node biopsy for the presence or absence of additional positive lymph nodes (APLN): sensitivity, specificity, false positive rate, sexual rate, false negative rate, positive predictive value, and negative predictive value were 81.48% for all cases. (132/162), 76.73% (188/245), 23.27% (57/245), 18.52% (30/162), 69.84% (132/189), and 86.24% (188/218); for small cancer cases In terms of sensitivity, specificity, false positives, negative false positives, positive predictive values, and negative predictive values, they were 73.68% (42/57), 77.78% (140/180), and 22.22% (40/180) respectively. 26.322% (15/57), 51.22% (42/82), and 90.32% (140/155): 4 Predictive value of sentinel node ratio (PSLNR) for APLN: sensitivity, specificity for all cases The false positive rate, false negative rate, positive predictive value and negative predictive value were 71.97%, 78.95%, 21.05%, 28.03%, 88.79% and 54.88%, respectively. The best diagnosis threshold was 0.345 2; In terms of cases, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value, and negative predictive value were 83.33%, 67.50%, 32.50%, 16.67%, 72.92%, and 79.41%, respectively. 0.291 7. Conclusions Sentinel lymph node biopsy showed central lymph node metastasis in T-differentiated thyroid carcinoma. The situation has a good predictive value, and PSLNR can be used as a valid basis for developing a central lymph node dissection program.