超声检测淋巴结髓质与整体面积比在鉴别颈部淋巴结病变中的价值

Value of ultrasonic ratio of medulla and total area of lymph node in differential diagnosis of cervical lymphadenopathy

目的探讨淋巴结髓质部面积与整体面积比值(Am/At)在鉴别颈部肿大淋巴结良恶性病变中的价值。方法对91例患者的117个颈部肿大淋巴结行二维及彩色多普勒超声检查。采用轨迹法测量淋巴结髓质部面积与整体面积,并计算面积比值;同时观测淋巴结纵横比(L/T)、内部回声、淋巴结髓质部位置形态及血管模式,应用ROC曲线评估Am/At对颈部肿大淋巴结良恶性病变的鉴别诊断价值。结果恶性淋巴结(包括淋巴瘤与转移性淋巴结)的Am/At分别与良性对照组比较差异有统计学意义(P<0.01),淋巴瘤的Am/At与转移性淋巴结相比较差异无统计学意义(P=0.113)。Am/At的ROC曲线下面积为0.857±0.034。Am/At以0.20为界值,鉴别良、恶性淋巴结的敏感度为81.4%,特异度为75.7%。结论Am/At可作为超声鉴别诊断颈部淋巴结病变的定量参考指标,有一定的鉴别诊断价值。

Objective To explore the value of ratio of medulla of lymph node area and total area （Ant/At） in differential diagnosis of cervical lymphadenopathy. Methods One hundred and seventeen cervical lymph nodes in 91 patients were examined by 2D ultrasound and color Doppler ultrasound. The medulla of lymph node area and total area were measured by path method, and the Am/At was calculated. The length and breadth ration （L/T） ,the internal echo,the position and shape of medulla of lymph node and vascular pattern were observed, the value of Am/At in differential diagnosis of cervical lymphadenopathy was evaluated by ROC curve. Results There was significant difference of Am/At between malignant group （ lymphoma and transferability lymph node ） and benign group （ P 〈 0. 001 ） , there was no significant difference of Am/At between lymphoma and metastatic lymph node （P =0. 113）. The area of Ant/At under ROC curve was 0. 857 ±0. 034. When Am/At was 0.20, the sensitivity and specificity in differential diagnosis of benign and malignant lymph node were 81.4% and 75.7% respectively. Conclusion Am/At could be an objective reference index for differential diagnosis of the cervical lymphadenopathy by ultrasound, and it has important value in differential diagnosis.