颈部转移淋巴结的CT、B超扫描与临床触诊对比分析

Cervical lymph node metastasis: CT, ultrasound versus physical palpation

目的评价ＣＴ、Ｂ超扫描与临床触诊诊断颈部淋巴结转移的准确性，分析ＣＴ、Ｂ超诊断颈部隐匿性淋巴结转移的价值。方法对６０例７４侧颈淋巴结清扫术的患者做术前前瞻性ＣＴ、Ｂ超检查，术后与病理对照，双盲法观察及分析影像所见，将其结果做统计学处理。结果在７４侧颈部淋巴结清扫术病理检查中５６侧有转移淋巴结，临床触诊检出其中４６侧（敏感性８２．１％，特异性８３．３％，准确性８２．４％）。ＣＴ扫描确诊其中的５３侧（敏感性９４．６％，特异性９４．４％，准确性９４．６％）；ＣＴ可以确诊７０％由临床漏诊的隐匿性转移淋巴结。Ｂ超扫描确诊其中５１侧（敏感性９１．１％，特异性９４．４％，准确性９１．９％）；可以检出５０％由临床漏诊的隐匿性转移淋巴结。结论ＣＴ、Ｂ超扫描评价颈部淋巴结的准确性明显优于临床触诊，可以检出５０％～７０％由临床漏诊的隐匿性转移淋巴结。

Objective To evaluate the accuracy of CT, ultrasonography and manual palpation in the diagnosis of cervical lymph node metastasis and to identify the value of CT and ultrasound in the diagnosis of occult cervical lymph node metastasis. Methods Sixty patients (74 sides) were studied double blindedly by CT and ultrasonography prior to cervical lymphadenectomy, and the results were correlated with histo pathologic findings. Results According to histologic examination of the dissected specimens, in 56 of 74 sides there were cervical lymph node metastases, 46 of the 56 sides with metastatic nodes were diagnosed by manual palpation(sensitivity, 82.1%; specificity, 83.3%; accuracy, 82.4%). However, lymphnode metastases in 53 sides were revealed by CT(sensitivity, 94.6%; specificity, 94.4%; accuracy, 94.6%),i.e., CT discovered 70% of the occult metastatic nodes in this series. Lymph node metastases were diagnosed accurately in 51 sides by ultrasonography (sensitivity, 91.1%; specificity, 94.4%; accuracy, 91.9%), and 50% of the occult metastatic nodes were found by ultrasound. Conclusion CT, ultrasound examinations are superior to physical palpation in ascertaining cervical lymph node metastasis, as 50%～70% of the occult cervical metastatic nodes can be diagnosed.