鼻咽癌颈部转移性淋巴结超声特征分析

An Analysis of Sonographic Features in Positive Cervical Nodes in Nasopharyngeal Carcinoma

[目的]探讨鼻咽癌患者颈部转移性淋巴结的超声特征和诊断标准。[方法]鼻咽癌初诊患者197例治疗前行颈部超声检查,并对随机选取的淋巴结行细针穿刺细胞学检查共计368枚,将细胞学结果与相应淋巴结超声特征进行对照分析。[结果]转移性淋巴结283枚(占穿刺淋巴结76.9%),绝大多数位于Ⅱ区、Ⅲ区和Ⅴ区(分别占42.8%、20.1%、21.9%),99.3%的淋巴结最小横径大于5mm,80.9%为类圆形(SA/LA>0.5),多不显示高回声门部或呈偏心性,少数有淋巴结内液化坏死(18.0%),40.6%有包膜受侵表现,大多数血流丰富(71.0%),且阻力指数(RI)大于0.6。[结论]鼻咽癌颈部转移性淋巴结有其特定的超声特征,建议鼻咽癌颈部淋巴结转移的超声诊断标准为SA/LA>0.5或RI>0.6,并且最小横径>5mm。

[Purpose] To explore the sonographic features and diagnosis standard of positive cervical nodes in nasopharyngeal carcinoma （NPC）. [Methods] One hundred and ninety-seven cases with NPC were examined by ultrasonography （US） and 368 lymph nodes were examined by fine needle aspiration cytology（FNAC） before treatment. The cytologic finding of the nodes and US features of corresponding nodes were analyzed. [Results] There were 283 positive nodes（76.9%）, accounting for 42.8%, 20.1% and 21.9% in level Ⅱ, Ⅲ and Ⅴ respectively. Of them, 99.3% were larger than 5mm in transverse diameter,80.9% were similar to round（SA/LA〉0.5）, most did not dis- play the lymph node＇s portal with high echo, 40.6% were infringed in envelope, and a few intralymph nodes were necrosis（18.0%）. Many of them had abundance signal of blood flowing （71.0%）, and RI （resistance index） were more than 0.6. [Conclusion] The metastatic cervical lymph nodes of NPC have specific character in sonography. SMLA〉0.5 or RI〉0.6 and the transverse diameter 〉 5mm of the node are recommonded as sonographic diagnostic criterion for positive node.