高频超声联合弹性成像技术对鼻咽癌放化疗后颈部淋巴结良恶性病变的鉴别诊断价值

Diagnostic value of high-frequency ultrasound combined with elastography for benign and malignant lesions in cervical lymph nodes after radiotherapy and chemotherapy for nasopharyngeal carcinoma

目的:探讨高频超声联合弹性成像技术对鼻咽癌放化疗后颈部淋巴结良恶性病变的诊断价值。方法:选取鼻咽癌放化疗后3个月~1 a复查(均进行手术病理学检查)发现颈部淋巴结肿大的患者65例,132枚颈部淋巴结(良性74枚、恶性58枚),均予以颈部淋巴结高频超声及弹性成像技术检查。观察淋巴结超声表现,以病理诊断为“金标准”,分析高频超声、弹性成像技术及二者联合诊断的敏感度、特异度、准确率、阳性预测值及阴性预测值。采用SPSS 19.0统计学软件进行数据分析。结果:大部分恶性淋巴结短径≥7.3 mm、长径/短径(L/S)<1.8,且超声表现内部回声不均匀、边界不规则、外周型或混合型血流、淋巴结偏心或无的比例均显著高于良性淋巴结。高频超声联合弹性成像技术诊断颈部恶性淋巴结的敏感度、准确度均高于高频超声单独诊断,差异有统计学意义(P<0.05);二者联合诊断的特异度、阳性预测值、阴性预测值均高于高频超声单独诊断,差异无统计学意义(P>0.05);二者联合诊断的准确度高于弹性成像技术单独诊断,差异有统计学意义(P<0.05);二者联合诊断的敏感度、特异度、阳性预测值、阴性预测值均高于弹性成像技术单独诊断,差异无统计学意义(P>0.05)。结论:高频超声联合弹性成像技术对鼻咽癌放化疗后颈部淋巴结良恶性病变具有较高的诊断价值,能够提高诊断的准确性。

Objective To evaluate the diagnostic value of high-frequency ultrasound combined with elastography for benign and malignant lesions in cervical lymph nodes after radiotherapy and chemotherapy for the nasopharyngeal carcinomas.Methods Totally 65 nasopharyngeal carcinoma patients with neck lymph node enlargement confirmed by reexamination 3 months to 1 year after radiotherapy and chemotherapy were enrolled in the study,who proved to have 132 enlarged lymph nodes including 74 benign and 58 malignant ones,and were examined with neck high-frequency ultrasound and elastography.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of high-frequency ultrasound,elastography and the combined diagnosis were analyzed using pathological diagnosis as the gold standard.SPSS 19.0 statistical software was used for data analysis.Results The malignant lymph nodes had a short diameter of not lower than 7.3 mm and a long/short diameter ratio(L/S)lower than 1.8;the ultrasound showed significantly higher proportions of internal echogenicity,irregular borders,peripheral or mixed blood flow,and eccentric or absent lymph nodes than benign lymph nodes;the sensitivity and accuracy for diagnosing malignant lymph nodes in the neck by high-frequency ultrasound combined with elastography were statistically higher than those by high-frequency ultrasound alone(P<0.05);the specificity,positive predictive value and negative predictive value of the combined diagnosis were higher than those of high-frequency ultrasound alone,while the difference was not statistically significant(P>0.05);the accuracy of the combined diagnosis was significantly higher than that by elastography alone(P<0.05);the sensitivity,specificity,positive predictive valueand negative predictive value by the combined diagnosis were higher than those by elastography alone,while the difference was not statistically significant(P>0.05).Conclusion High-frequency ultrasound combined with elastography has a high diagnostic value for benign and malignant lesions in the neck lymph nodes after radiotherapy and chemotherapy for the nasopharyngeal carcinomas,which can improve the accuracy of diagnosis.