摘要
目的：已经证明超声是判断鼻咽癌治疗后颈淋巴结残留或复发的较好方法，本研究探讨对预判鼻咽癌治疗后颈淋巴结残留或复发最为重要的超声指标。方法：对45例患者的179枚鼻咽癌治疗后颈淋巴结（复发或残留114枚，反应性增生65枚）用彩色多普勒进行术前探查，而后行颈淋巴结清扫术，术后标本送病理检查。观察彩色多普勒超声指标包括淋巴结长轴直径、淋巴结短轴直径、长/短轴的比率、有无淋巴门结构、淋巴结回声是否均匀、淋巴结边界清晰情况和淋巴结内血流情况。而后进行多因素Logistic回归分析各彩色多普勒超声指标的相关价值。结果：在多因素分析里，无淋巴门结构、淋巴结短轴直径增加（≥10mm）是预测鼻咽癌治疗后颈淋巴结残留或复发的重要指标，淋巴结长轴直径、长/短轴的比率（＜2）、回声是否均匀、淋巴结边界清晰情况和淋巴结内血流情况不能作为预判鼻咽癌治疗后颈淋巴结复发或残留的指标。结论：彩色多普勒超声诊断鼻咽癌治疗后颈淋巴结残留或复发的最有意义的指标是无淋巴门结构和淋巴结短轴直径增加（≥10mm），可作为临床上诊断的客观指标。
Abstract
Objective: Sonographic criteria of the lymph node have been found to be good indicators for metastatic lymph nodes. We determined which sonographic features are most predictive of residual-relapse in cervical lymph nodes among patients with post-therapy nasopharyngeal carcinoma. Methods: Power Doppler sonography were analyzed in 179 cervical nodes(114 residual-relapse and 65 reactive nodes) from patients with post-therapeutic nasopharyngeal carcinoma after neck lymph node radical dissection or selective dissection, All cases were proven by post-surgery pathology. The gray-scale sonographic features of the presence or absence of hilar structure, the even or uneven of lymph node echo, short axis length(≥10mm), long axis length, long-short axis ratio(L/S 2), the boundary, the blood flow were evaluated. Multivariate logistic regression analyses were conducted to determine the relative value of each sonographic feature. Results: Multivariate analysis suggested that the absence of hilar structure, increase in short axis length(≥10mm) were the sonographic features for prediction of residual-relapse lymph nodes. Specificity, sensitivity, accuracy and Kappa index was 90.4%, 84.6%, 88.2% and 0.75 for node short axis diameter(≥10mm). 95.6%, 86.5%, 92.1% and 0.82 for the absence of hilar structure. The sonographic features of absence of hilar structure was the better index than the features of short axis diameter(≥10mm). Conclusions: The sonographic criteria most predictive of metastatic cervical lymph nodes were absent hilar structure and increase in short axis length(≥10mm), as assessed by logistic regression analysis. It can be used as an clinical criteria to diagnosis residual-relapse lymph nodes in post-therapy nasopharyngeal carcinoma.
关键词
鼻咽肿瘤 /
超声检查 /
多普勒 /
彩色
Key words
Nasopharyngeal neoplasms /
Ultrasonography /
Doppler /
color
何承诚;司勇锋;康利克;王小燕;覃 颖;江 河;陶仲强;覃扬达.
预判鼻咽癌治疗后颈淋巴结残留或复发的彩色多普勒超声指标多因素分析[J]. 中国临床医学影像杂志. 2011, 22(8): 541-543
HE Cheng-cheng;SI Yong-feng;KANG Li-ke;WANG Xiao-yan;QIN Ying;JIANG He;TAO Zhong-qiang;QIN Yang-da.
Multivariate feature analysis of power Doppler sonographic findings of residual-relapse lymph node in post-therapy of nasopharyngeal carcinoma[J]. Journal of China Clinic Medical Imaging. 2011, 22(8): 541-543
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