鼻咽镜、CT、病理活检检查单侧鼻咽癌T范围的差异和其意义——附50例临床报告

Study of local tumor involvement in nasopharyngeal carcinoma with fiberendoscope,CT scanning,and pathological evidence

目的：了解ＣＴ显示不超过正中线的单侧鼻咽癌对侧正常隐窝是否有癌细胞及其意义。方法：选择５０例临床确诊ＣＴ显示不超过正中线的单侧鼻咽癌在肿物、顶后正中、对侧正常隐窝作病理活检。结果：在未见肿物的对侧正常隐窝癌细胞阳性率为１８％，顶后癌细胞阳性率为４４％。ＮＰＣＴ对本组５０例单侧鼻咽癌顶后描述分为正常、轻度增厚、明显增厚、结节肿物四组，而各组活检癌细胞阳性，阴性对照计算Ｐ＝０５５３６无统计学差异。结论：根据肉眼观察一个壁或二个壁有肿物作Ｔ分期的Ｔ１Ｔ２是不恰当的。设计放射野时，ＣＴＶ应把看似没有肿瘤部位考虑进去。对单侧鼻咽癌ＣＴ不能准确判断顶顶后正中有无肿瘤。

Objective:To elucidate the local involvement of nasopharyngeal carcinoma(NPC)in the cases with imaging and macroscopic evidences of unilaterall nasopharyngeal lesions.Methods:A total of 50 cases of NPC patients with the evidences provided by CT scanning and macroscopy that the local lesions did not extend beyond medial line were selected prospectively for fiberendoscopic biopsy.The tumor tissue,the membranous tissues of the opposite side and the posterosuperior side of the nasopharynx were obtained by protractor biopsy under nasopharygeal fiberendoscope in each case.All specimens were prepared for routinely pathological examination.The description of CT scanning referred to posterosuperior wall of nasopharynx fell in four types in our hospital:normal,slightly thickening,obviously thickening,and nodal neoplasm. Results:Eighteen percent of the patients was confirmed to be carcinomous in membranous tissues from oppostie Rosenmuller′s fossa.While 44 percent of the patients was found to be carcinomous in the membranous tissues from posterosuperior wall of nasopharynx.There was no significant difference among four types of CT description of the posterosuperior wall of nasopharynx in terms of positive or negative involvement of primary tumors confirmed by pathological evidences(P=05536). Conclusions:It is not appropriate to establish T staging system by division of the patients according to the involved walls of nasopharynx in CT scanning.CT scanning cannot assess accurately the involvement of primary tumors in posterosuperior wall of nasopharynx.There is not much value to consider the unilateral NPC in designing of the radiotherapy fields for primary tumor.