彩超检查对食管癌颈部淋巴结转移的诊断价值(附150例分析)

Diagnostic value of color Doppler ultrasound in the determination of cervical metastatic LNs in esophageal cancer patients

目的观察食管癌颈部淋巴结的超声学特点,评价彩超对食管癌颈部淋巴结转移的诊断价值。方法对150例胸段食管癌患者进行颈淋巴结彩超检查,记录其特征,包括大小、短长径比率(S/L)、血流分级,对血流分级I级以上者测定最大血流速度(Vmax)及阻力指数(RI),将S/L<0.5、无血流或血流<Ⅰ级者视为非转移性淋巴结,其余为转移性,对比彩超与病理结果,计算诊断符合率、特异度及敏感度。结果150例患者中,病理证实颈部淋巴结转移61例,无转移89例;彩超判定转移66例,非转移84例;其中假阳性9例(6.00%),假阴性4例(2.67%)。彩超的敏感度为93.44%(57/61),特异度89.89%(80/89)。转移性淋巴结大多S/L>0.5,血流分级Ⅱ级以上,高流速,高阻力。结论彩超可作为食管癌颈部转移淋巴结无创、定性的一种诊断方法。

Objective To observe the ultrasonographic features of metastatic cervical lymph nodes （LNs） and evaluate the value of color Doppler ultrasound in diagnosing cervical LNs metastasis in the patients with esophageal cancer. Methods All the 150 consecutive patients with esophageal cancer were involved. Ultrasonography was used to determine the features of cervical LNs, including the size, short-to-long axis ratio （S/L）, and bloodstream grading. As for LNs grading more than I , maximal bloodstream velocity （Vmax） and resistance index （RI） were determined. LNs with S/L lesser than 0.5, bloodstream absent or lesser than grade I were considered non-metastatic and the others metastatic. Then sensibility and specificity were cal culated, based on comparison between ultrasonographic and pathological findings. Results According to the pathological result, 61 （41%） out of 150 were proved cervical LNs metastatic and 89 （59%） non-metastatic, while 66 （44%） metastatic and 84 （56%） non-metastatic in accordance with ultrasonographic finding. In comparison to pathological result, the sensibility of ultra-sonography in cervical LNs metastasis determination was 93.44%（57/61）, and the specificity was 89.89%（80/89）, including nine false positive （6.00%） and four false negative （2.67%）. Metastatic LNs often manifest the S/L more than 0.5, the bloodstream more than grade Ⅱ and high Vmax and RI. Conclusion Ultrasonography is a practical and non-invasive method to determine cervical LNs metastasis in the patients with esophageal cancer.