超声实时弹性成像与常规超声检查鉴别鼻咽癌放化疗后颈部淋巴结良恶性病变的价值

Value of Ultrasound Real-time Elastography and Routine Ultrasonography in Differentiating Benign and Malignant Cervical Lymph Nodes after Radiotherapy and Chemotherapy of Nasopharyngeal Carcinoma

目的比较超声实时弹性成像(RTE)与常规超声检查鉴别鼻咽癌放化疗后颈部淋巴结良恶性病变的价值。方法选择鼻咽癌放化疗3-12个月后颈部淋巴结肿大患者60例126枚淋巴结,进行RTE与常规超声及病理学检查,以病理学检查为"金标准"分析RTE与常规超声检查鉴别诊断颈部良恶性淋巴结的灵敏度、特异度、阳性、阴性预测值以及准确率。结果 (1)126枚颈部淋巴结中,恶性55枚,良性71枚,恶性结节短轴长度≥7.3 mm、L/S<1.8、边界不规则、内部回声不均匀、淋巴门偏心或无、内部血流信号消失率显著高于良性淋巴结;(2)RTE显像:恶性淋巴结RTE评分3分以上检出率为89.09%(49/55),良性淋巴结为94.37%(67/71),比较差异有统计学意义(P<0.05);(3)鉴别诊断各项指标联合检查>RTE>常规检查,比较差异有统计学意义(P<0.05)。结论 RET在鉴别诊断鼻咽癌放化疗后颈部淋巴结良恶性病变方面,准确率高于常规超声检查,该方法值得广泛应用。

Objective to compare diagnostic value of ultrasound real-time elastography（RTE） and routine ultrasonography for benign and malignant cervical lymph nodes after radiotherapy and chemotherapy of nasopharyngeal carcinoma. Methodschoose 60 cases cervical lymph node enlargement patients with 126 lymph nodes 3-12 months after radiotherapy and chemotherapy of nasopharyngeal carcinoma. Carry on examination of RTE and routine ultrasound and pathological examination. Analyze sensitivity, specificity, positive and negative predictive value and accuracy of RTE and routine ultrasonography in differential diagnosis of cervical benign and malignant lymph nodes with ＂gold standard＂ of pathological examination. Results①among 126 cervical lymph nodes, 55 were malignant, 71 were benign, short axis length of malignant nodules was ≥ 7.3 mm, L/S〈1.8, signal disappearance rate of irregular boundary, inhomogeneous internal echo, no or eccentricity lymph, internal blood flow was significant higher than benign lymph nodes;②RTE imaging： detection rate of malignant lymph node RTE scores were 89.09%（49/55）, that of benign lymph node were 94.37%（67/71）, difference showed statistical significance（P〈0.05）;③combination examination of differential diagnosis〉 RTE 〉routine examination, difference showed statistical significance（P〈0.05）. Conclusion accuracy of RET differential diagnosis of benign and malignant cervical lymph nodes after radiotherapy and chemotherapy is higher than routine ultrasonography, which is worthy of wide application.