超声造影在侧颈部淋巴结良恶性鉴别诊断中的价值

Evaluation of contrast-enhanced ultrasound in the differential diagnosis of benign and malignant lateral cervical lymph nodes

目的探讨超声造影(CEUS)在侧颈部淋巴结良恶性诊断中的价值。方法回顾性收集2018年11月至2019年6月在福建省肿瘤医院门诊和住院的115例可疑侧颈部淋巴结病例资料,男60例,女55例。对115例侧颈部淋巴结行常规超声及CEUS检查,所有病例行超声引导下穿刺活检,根据病理结果分为良恶性淋巴结2组,分析2组的差异,并进行统计学分析。用率和频数对常规超声和CEUS两组间超声表现及观察到的淋巴结形态进行定性描述。用敏感度、特异度、准确率、阴性预测值和阳性预测值评价常规超声和CEUS组间的效能。结果良性淋巴结37例,恶性淋巴结78例。良性淋巴结51.4%(19/37)表现为均匀高增强,48.6%(18/37)表现为边界清楚、局部无增强区的不均匀增强或环状增强;恶性淋巴结中94.9%(74/78)表现为不均匀增强,5.1%(4/78)为均匀增强。造影剂均匀度在鉴别诊断良恶性上差异有统计学意义(P<0.001)。常规超声诊断淋巴结良恶性的敏感度、准确率、阴性预测值和阳性预测值分别是64.1%、65.2%、47.2%、66.7%,CEUS诊断则分别为93.6%、75.7%、73.7%、83.9%。结论CEUS可以为侧颈部淋巴结进行良恶性鉴别诊断提供有价值的依据。

Objective To investigate the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of benign and malignant lateral cervical lymph nodes.Methods One hundred and fifteen cases of suspected lymph nodes disease, 60 males, 55 females, between November 2018 and June 2019 from clinic and inpatient in Fujian Cancer Hospital were collected. Routine ultrasound and CEUS were performed in 115 cases of lateral cervical lymph nodes. All cases underwent ultrasound-guided biopsy, and were divided into two groups of benign and malignant lymph nodes according to pathological results. The differences between the two groups were analyzed and statistically analyzed. The rate and frequency were used to qualitatively describe the ultrasound performance and observed lymph node morphology between the two groups of routine ultrasound and CEUS. The sensitivity, specificity, accuracy, negative predictive value and positive predictive value were used to evaluate the efficacy of routine ultrasound and CEUS.Results There were 37 cases of benign lymph nodes and 78 cases of malignant lymph nodes. In benign lymph nodes, 51.4% (19/37) showed uniform high enhancement, and 48.6% (18/37) showed uneven or circular enhancement with clear boundaries and no focal enhancement area. In malignant lymph nodes, 94.9% (74/78) showed uneven enhancement, and only 5.1% (4/78) showed uniform enhancement. The difference of ultrasonic contrast medium uniformities in differentiating benign from malignant was statistically significant (P<0.001). The sensitivity, accuracy, negative predictive value and positive predictive value of routine ultrasound to differentiate benign and malignant lymph nodes were 64.1%, 65.2%, 47.2%, and 66.7%, respectively, while the corresponding values of CEUS were 93.6%, 75.7%, 73.7% and 83.9%.Conclusion CEUS may provide a valuable basis for the differential diagnosis of benign and malignant lateral cervical lymph nodes.