超声在胃癌左锁骨上淋巴结转移中的应用价值

Assessment of left supraclavicular lymph nodes metastases in gastric carcinoma using ultrasonography

目的:探讨超声检查(US)在胃癌左锁骨上淋巴结转移诊断中的应用价值。方法:对168例胃癌患者先后行左锁骨上窝行临床触诊、超声检查,并与细针抽吸细胞学对照。结果:细胞学病理证实左锁骨上淋巴结转移14(8.33%)例。临床触诊发现左锁骨上淋巴结肿大患者7例,6例为转移性淋巴结,1例为反应增生性。超声检出左锁骨上淋巴结肿大患者19例,其中超声诊断阴性2例,阳性17例,超声阳性结果中转移性淋巴结14例,3例为反应增生性淋巴结,超声检查的敏感性、特异性及符合率均明显高于临床触诊(100%、40%、84%vs 43%、0%、40%)。与临床触诊相比,彩超检查新增8例左锁骨上淋巴结转移性病灶,对胃癌左锁骨上淋巴结转移的检出率明显提高,差异有统计学意义(P<0.05)。结论:超声检查能显著提高胃癌患者左锁骨上淋巴结转移的检出率,有助于提高分期准确性,对胃癌的治疗及预后的判断具有重要的临床指导意义。

Objective： To explore the clinical value of ultrasonography on diagnosing left supraclavicular gastric carcinoma metastases.Methods： A total of 168 consecutive patients with gastric carcinoma proved by endoscopic biopsy underwent palpation and ultrasonography of left supraclavicular regions.US-guided Fine-needle aspiration cytologic（FNAC） analysis was performed in patients with nodes with a short-axis diameter of 5 mm or greater;cytologic diagnosis was used as the standard of reference.detection rates of palpation and US were compared with McNemar testing.Results： Left supraclavicular metastases were diagnosed cytologically in 14（8.33%） of 168 patients.Palpation showed that 6 lymph nodes were metastatic and 1 were reactive hyperplasia.In 19 patients who were initially detected of having enlarged left supraclavicular nodes at US.Nodes with metastasis were found at US in 17：14 of 17 patients with metastasis nodes and others（3/17） were reactive hyperplasia.The Sensitivity,specificity,and accuracy of US in differertiationn between benign and malignant lymph noodes were 100%,40%,and 84% versus 43%,0%,and 40% for palpation.To have a less than 50% chance of being palpable.There was significant difference between palpation and US in the detection rates of left supraclavicular metastases（P0.01）.Conclusion： The rate of detection left supraclavicular lymph nodes metastases of gastric carcinoma patients can significance improve using US.In addition,it can useful for TNM stage diagnosis and guiding the treatment and predicting the prognosis of gastric carcinoma patients.