颈部良、恶性肿大淋巴结的常规超声声像图分级鉴别诊断模式初探

A preliminary study on the differential diagnosis mode of conventional ultrasound and sonographic grading of benign and malignant lymph nodes in the neck

目的探讨基于常规超声声像图建立颈部良、恶性肿大淋巴结的分级鉴别诊断模式。方法选取颈部淋巴结肿大且行超声检查的患者529例,根据病理检查结果分为良性与恶性,在对超声声像图指标进行赋分后,将529个颈部淋巴结进行分组,并根据各组良性、恶性比例的差异建立颈部肿大淋巴结分级鉴别诊断模式。结果趋势性卡方检验结果提示,恶性淋巴结的比例随着超声声像图得分增大而逐渐上升(P<0.05);同时,将0分组作为对照后发现,3~7分组恶性淋巴结的比例分别与其比较,差异均有统计学意义(均P<0.05),且OR值随着得分增高而增高。将恶性风险级别Ⅳ级作为分界点,其诊断颈部良、恶性肿大淋巴结的敏感性为77.55%,特异性为75.81%,阳性预测率为85.53%,阴性预测率为64.68%,曲线下面积(AUC)为0.76。结论基于常规超声声像图建立颈部良、恶性肿大淋巴结的分级鉴别诊断模式,可降低不同超声医师的诊断差异,有助于减少非必要的病理有创检查。

Objective A hierarchical differential diagnosis model of benign and malignant lymph nodes in the neck was established based on conventional ultrasound imaging.Methods We retrospectively selected 529 patients with cervical lymphadenopathy and ultrasound examination.According to the results of pathological examination,they were divided divided into benign and malignant.After scoring the ultrasound image indicators,529 cervical lymph nodes were grouped.According to the difference between the benign and malignant proportions of each group,the differential diagnosis model of cervical swollen lymph nodes was established.Results Tips for trend chi-square test results showed the proportion of malignant lymph nodes gradually increased with the increase of ultrasound image score(P<0.05).At the same time,after grouping 0 as a control,it was found that the proportion of malignant lymph nodes in groups 3~7 was compared with them,the differences were statistically significant(all P<0.05),And the OR value increased as the score increases.Taking the malignant risk levelⅣas the demarcation point,the sensitivity of the diagnosis of benign and malignant neck lymph nodes was 77.55%.The specificity was 75.81%,the positive prediction rate was 85.53%,the negative predictive rate was 64.68%,and the area under the curve(AUC)was 0.76.ConclusionEstablishing a hierarchical differential diagnosis model of benign and malignant lymph nodes in the neck based on conventional ultrasound imaging can reduce the difference in diagnosis of different ultrasound doctors,help reduce unnecessary pathological invasive examination.