PET/CT误诊的原发灶隐匿颈淋巴结转移癌临床分析

Clinical analysis of PET/CT misdiagnosed cervical lymph node metastasis with occult primary tumor

目的分析PET/CT在原发灶隐匿的颈淋巴结转移癌诊断中价值,探讨多学科合作的诊疗模式在此类患者诊疗过程中的意义。方法回顾研究2012年3月~2022年3月收治的PET/CT显示原发灶部位与最终病理结果不符的以颈部淋巴结转移癌首诊患者,结合文献探讨PET/CT在诊断此类患者中的应用价值,以及多学科合作模式在诊疗过程中的应用。结果10例患者中,5例PET/CT结果证实为假阳性,5例为假阴性。PET/CT显示假阳性的病例中,4例位于扁桃体,1例位于杓会厌襞;假阴性患者的肿瘤位置各不相同。所有患者在诊断和治疗的不同阶段均经过多学科合作的诊疗模式。结论PET/CT在原发灶隐匿的颈淋巴结转移癌的检出阳性比例不高,多学科合作的诊疗模式有助于提高诊断准确率,但需对检查结果进行全面分析。

Objective To analyze the value of PET/CT in the diagnosis of cervical lymph node metastases of occult primary tumors and to discuss the significance of multidisciplinary team in diagnosing these patients.Methods A retrospective study was conducted on patients with cervical lymph node metastases as the first symptom from March 2012 to March 2022,in which the location of the primary lesion shown by PET/CT was not consistent with the final pathological results.The clinical characteristics of false negative and false positive patients were analyzed,and the application value of PET/CT and other examination methods in such patients were discussed,as well as the application of multidisciplinary team in the diagnosing and treating processes.Results Among 10 patients with lymph node metastases,5 cases were confirmed as false positive and 5 cases were false negative.The false positive sites included the tonsils in 4 cases and the aryepiglottic fold in 1 case.The false negative patients had different tumor locations.All patients had undergone multidisciplinary diagnosis and treatment during the diagnosing and treating processes.Conclusions The detection rate of PET/CT in cervical lymph node metastases with occult primary tumors is gradually decreasing.The significance and time of PET/CT scanning should be reconsidered.The combination of P16,EBER and other immunohistochemical indicators can improve the diagnostic accuracy,and the examination results need to be comprehensively analyzed.The multidisciplinary team should run through the diagnosing and treating in such patients.