鼻咽癌治疗后颈淋巴结残留或复发磁共振成像彩色多普勒超声和触诊的对比分析

Residual or relapse cervical lymph node metastasis after radiotherapy and/or chemotherapy for nasopharyngeal carcinoma:MRI,color Doppler ultrasonography versus physical palpation

目的探讨磁共振成像、彩色多普勒超声诊断鼻咽癌治疗后颈淋巴结残留或复发隐匿性淋巴结的价值。方法对56例(60侧)颈淋巴结清扫术的患者的术前前瞻性磁共振成像、彩色多普勒超声诊断和临床触诊与术后病理结果进行对照分析。结果在60侧颈部淋巴结清扫术病理检查中有43侧证实有颈淋巴结残留或复发,其中临床触诊检出者30侧(敏感度为69.77%,特异度为64.70%,正确率为68.33%),漏诊13侧(漏诊率为30.2%);磁共振成像检出者40侧(敏感度为93.02%,特异度为88.89%,正确率为91.66%),漏诊3侧(漏诊率为6.9%);彩色多普勒超声检出者39侧(敏感度为92.85%,特异度为76.47%,正确率为86.67%),漏诊4侧(漏诊率为9.3%)。结论磁共振成像、彩色多普勒超声诊断鼻咽癌治疗后颈淋巴结残留或复发的正确率明显高于临床触诊。

Objective To study the value of magnetic resonance imaging （MRI） and color Doppler ultra- sonography （CDU） in the diagnosis of occult residual or relapse cervical lymph node metastasis after radiotherapy and/or chemotherapy for nasopharyngeal carcinoma. Methods Fifty-six patients （60 sides） were studied double- blindedly by MRI, CDU and physical palpation prior to cervical lymphadenctomy, and the results were contrasted with histopathologic findings. Results According to histologic examination of the dissected specimens, in 43 of 60 sides there were occult residual or relapse cervical lymph node metastasis, 30 of 43 sides with occult residual or relapse cervical lymph node metastasis were diagnosed by manual palpation （ sensitivity 69.77 % ; specificity 64. 70 % ; ac- curacy 68.33% ）. However, residual or relapse cervical lymph node metastasis in 40 sides were revealed by MRI （ sensitivity 93.02% ; specificity 88.89% ; accuracy 91.66% ） and MR/discovered 76.9% （10/13） of occult resid- ual or relapse cervical lymph node metastasis which were not found in physical palpation. Residual or relapse cervical lymph node metastasis were diagnosed accurately in 39 sides by CDU （ sensitivity 92. 85% ; specificity 76.47% ; ac- curacy 86. 67% ）, and 69. 23% （9/13） of the occult residual or relapse cervical lymph node metastasis which were not found in physical palpation were found by CDU. Conclusion MRI, CDU examinations are superior to physical palpation in ascertaining occult residual or relapse cervical lymph node metastasis after radiotherapy and/or chemo- therapy for nasopharyngeal carcinoma.