肿瘤嗜神经生长对鼻腭部腺样囊性癌和鳞癌的鉴别

Value of perineural spread in the differential diagnosis of adenoid cystic carcinoma and squamous cell carcinoma of nasal cavity, paranasal sinus, and palate

目的研究头颈部肿瘤嗜神经生长影像学征象,探讨其对鼻腭部腺样囊性癌(ACC)和鳞状细胞癌(SCC)的鉴别价值。方法回顾性分析本院2012年~2018年手术病理证实的鼻腭部原发性腺样囊性癌和鼻腭部原发鳞癌的临床及影像学资料,分析其嗜神经征象发生率以及对神经孔道侵蚀的差异。采用Kappa检验评价两名医师对嗜神经征象评估的一致性。采用两独立样本χ2检验或Fisher确切概率法分析两组间嗜神经生长征象发生率的差异。对有统计学意义的征象进行多变量Logistic回归分析。绘制ROC曲线评估嗜神经征象对两组肿瘤的鉴别诊断效能。结果两名医师对嗜神经征象评估一致性好(Kappa值均>0.75,P<0.001)。腺样囊性癌翼腭窝脂肪间隙消失、神经不对称增粗强化、海绵窦被软组织包绕、Meckel腔T2高信号消失、颞下窝肌肉水肿强化发生率均高于鳞癌(P<0.05)。腺样囊性癌对翼管、腭大孔、圆孔、卵圆孔侵蚀的发生率高于鳞癌(P<0.05);两组间对眶上裂、视神经管、眶下裂、蝶腭孔侵蚀的发生率无显著差异(P>0.05)。经多变量Logistic回归分析,神经不对称增粗强化和腭大孔扩大是鼻腭部腺样囊性癌显著预测因子,优势比分别为14.5(95%CI:2.981~70.384)、7.1(95%CI:1.406~35.891)。腺样囊性癌嗜神经生长征象发生率(0.50±0.28)高于鳞状细胞癌(0.13±0.14),P<0.05。以出现3个嗜神经征象为诊断指标,鉴别腺样囊性癌和鳞癌的敏感度为78.3%,特异度为88.0%,ROC下面积(AUC)为0.88。结论肿瘤嗜神经生长影像学特征在鼻腭部腺样囊性癌和鳞癌的发生率有显著差异,可用于两种疾病的鉴别诊断。

Objective To investigate the imaging signs of perineural spread in head and neck tumors,and to explore its value in the differential diagnosis of adenoid cystic carcinoma(ACC)and squamous cell carcinoma(SCC)of nasal cavity,paranasal sinus,and palate.Methods The clinical and imaging data of pathologically confirmed primary ACC and primary SCC of nasal cavity,paranasal sinus,and palate from 2012 through 2018 were analyzed retrospectively.The MRI signs of perineural spread and erosion of cranial nerve canals were analyzed.Κappa test was used to evaluate the consistency of the two reviewers.Two independent samples chi-square test or fisher exact probability method was used to analyze the difference in the incidence of perineural spread between the two groups.Multivariate logistic regression analysis was performed for statistically significant signs.ROC curve was drawn to evaluate the effectiveness of MRI signs of perineural spread in the differential diagnosis of tumors in the two groups.Results The two reviewers were consistent in evaluating the signs of perineural spread(κ>0.75,P<0.001).In ACC,the signs included asymmetrical neural thickening and enhancement,obliteration of the fat of pterygopalatine fossa,soft tissue surrounding the cavernous sinus,loss of long T2 signal of Meckel cavity,with significantly higher incidence of muscle edema and enhancement of infratemporal fossa than that in SCC(P<0.05).The incidence of erosion of vidian canal,greater palatine foramen,round foramen and foramen ovale in ACC was also significantly higher than that in SCC(P<0.05).There was no significant difference in the incidence of erosion of supraorbital fissure,optic canal,infraorbital fissure,and sphenopalatine foramen between the two groups(P>0.05).Multivariate logistic regression analysis showed that asymmetric neural thickening and erosion of greater palatine foramen were significant predictors of ACC in nasal cavity,paranasal sinus and palate with odds ratios of 14.5(95%CI:2.981-70.384)and 7.1(95%CI:1.406-35.891),respectively.The incidence of MRI signs of perineural spread in ACC(0.50±0.28)was significantly higher(P<0.05)than that in SCC(0.13±0.14).Using 3 perineural spread signs as diagnostic indicators,78.3%sensitivity,88.0%specificity,and 0.88 area under receiver operating characteristic curve were obtained.Conclusion There is a significant difference in the incidence of perineural spread in ACC and SCC of nasal cavity,paranasal sinus,and palate,which can aid the differential diagnosis.