彩超在评价鼻咽癌N分期中的作用

The role of color doppler flowing imaging in assessing N stage for nasopharyngeal carcinoma

目的探讨用彩超评价鼻咽癌颈部淋巴结转移中的价值,为鼻咽癌N分期引入客观评价指标。方法对206例首程放疗的鼻咽癌患者颈部行彩超检查,记录阳性淋巴结部位、形态、数目及与周围组织关系,测量其大小和纵、横径之比(L/T)及阻力指数(RI)。选择部分受检淋巴结在超声定位引导下穿刺活检行细胞病理学检查。结果彩超联合穿刺细胞病理学检查使鼻咽癌临床触诊N分期发生较大变化。68例N0期中25例升为N1期,6例升为N2期;63例N1期中20例升为N2期,3例升为N3期;52例N2期中14例降为N1期,4例升为N3期;23例N3期中7例降为N2期。临床触诊误差率达38.3%(79/206),临床触诊淋巴结大小较彩超检查的大(P<0.05)。若以受检淋巴结的L/T比值<2且RI>0.6作为转移淋巴结诊断标准,其准确率达88.9%(288/324)。若结合直径>1cm,其准确率达92.9%(182/196),有恶性生长行为者其准确率达95.5%(107/112)。结论彩超可作为鼻咽癌N分期的客观评价指标。

Objective To explore the role of Color Doppler Flowing lmaging（CDFI） in assessing metastatic lymph node for nasopharyngeal carcinoma （NPC）. Methods Neck lymph node were detected by CDFI in 206 patients who received the initial course radiotherapy in our hospital. The characteristic of neck node, such as position, figure, number, size, its relation to surrounding soft tissue, the ratio of longitudinal diameter over trnsverses＇ （L/T） and blood flow resistance index （RI）, were recorded detailedly. Fine needle aspiration biopsy was performed on some of patients under the guide of ultrasound. Results The clinical N-stage was changed markedly after CDFI plus biopsy, with up-staging in 25 from NO to N1 , 6 N0 to N2, 20 N1 to N2, 3 N1 to N3, 4 N2 to N3; and down-staging in 14 from N2 to N1, 7 from N3 to N2. The misdiagnosis rate of node involvement by palpation was 38.3% （79/206）. The sizes of lymph node detected by palpation were larger than those by CDFI （P〈 0.05）. The accuracy was 88.9% （288/324） when the criteria of positive lymph node was set as L/T ratio〈 2 and RI 〉 0.6, and the value would reached to 92.9 % （182/196） and 95.5 % （ 107/112 ） when such criteria combined with the diameter and growth behavior of lymph node. Conclusion Color Doppler Flowing Imaging is useful in N-staging for nasopharyngeal carcinoma by providing more reliable evidence.