彩色超声和磁共振成像对诊断舌鳞状细胞癌颈部微小转移淋巴结作用的比较研究

Identification of cervical lymph node micrometastasis of tongue cancer by color Doppler and MRI

目的比较彩色超声（简称彩超）和磁共振成像（MRI）在诊断舌鳞状细胞癌（简称鳞癌）颈部微小转移淋巴结中的作用。方法收集2008--2013年96例cN0舌鳞癌患者的临床资料，所有病例同时行颈部彩超和MRI检查以评价颈部淋巴结情况，并以术后病理结果为金标准，采用x^2检验比较两种诊断方法在评价舌癌颈部微小淋巴结转移中的价值和区别。结果彩超在判定淋巴结微小转移的敏感度为72．5％，MRI为50．0％，差异有统计学意义（x^2=4．266，P=0．039）；彩超诊断的特异度为82．1％，MRI为75．0％，差异无统计学意义（x^2=0．848，P=0．357）；彩超的准确率为78．1％，MRI为64．6％，差异有统计学意义（x^2=4．306，P=0．038）；彩超预测淋巴结微小转移的阳性预测值为74．4％，阴性预测值为80．7％，MRI分别为58．8％和67．7％，差异均无统计学意义（x^2=1．987，x^2=2．589，P均〉0．05）。结论彩超在舌癌颈部微小转移淋巴结判定中的敏感度、特异度、准确率、阳性预测值和阴性预测值均高于MRI，尤其是彩超的敏感度和准确性显著高于MRI。彩超对于诊断舌癌颈部微小转移淋巴结优于MRI。

Objective To assess the values of color Doppler and magnetic resonance imaging （MRI） in the identification of cervical lymph node micrometastasis of tongue cancer. Methods Totally 96 cases of tongue cancer with impalpable neck lymph node was examined with color Doppler and MRI within one week before surgery. Chi-square test was used to assess if the presence of regional lymph node micrometastasis, histopathologieal analysis as a golden standard lymph node micrometastasis. Results For the diagnosis of cervical lymph node micrometastasis, color Doppler was significantly better than MRI in sensitivity （72.5% vs50.0%, P=0.039） and the accuracy （78.1% vs 64.6%, P=0.038）, but no significant difference in the specificity （82.1% vs 75.0% , P = 0. 357 ）, the positive predictive value （74. 4% vs 58. 8%, P =0. 159） and the negative predictive value （80. 7% vs 67. 7%, P =0. 108）. Conclusion Color Doppler is better than MRI in the sensitivity and accuracy for the diagnosis of cervical lymph node micrometastasis of tongue cancer.