颈部MRI对头颈部鳞癌淋巴结转移诊断价值及准确度分析

Analysis of cervical MRI in diagnostic value and accuracy in head and neck squamous cell carcinoma

目的探讨颈部MRI对头颈部鳞癌淋巴结转移诊断价值及准确率的影响因素。方法回顾分析2016年7月至2022年12月沧州市中心医院收治的293例头颈部鳞癌手术患者的临床资料。对比术前MRI和术后病理,评价MRI常规诊断淋巴结转移的价值。对常见危险因素进行多因素分析。计算MRI结合危险因素的诊断效能。结果MRI常规诊断对cN0和cN+的诊断准确率分别为73.6%和83.7%。MRI常规诊断淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值、约登指数分别为77.6%、80.5%、83.7%、73.6%、0.58。多因素分析显示淋巴结短/长径比(χ^(2)=33.397,P<0.001)、淋巴结边缘情况(χ^(2)=11.656,P=0.001)是影响MRI诊断淋巴结转移准确度的独立危险因素。MRI结合危险因素对cN0和cN+的诊断准确率分别为84.3%和90.6%,较常规诊断分别提高了10.7%和6.9%。结论淋巴结边缘情况和/或淋巴结短/长径比是影响MRI诊断头颈部鳞癌淋巴结转移准确度的独立危险因素。

To explore the influence factors of cervical magnetic resonance imaging(MRI)on the diagnostic value and accuracy in lymph node metastasis of head and neck squamous cell carcinoma.Methods Clinical data of 293 surgical patients with head and neck squamous cell carcinoma admitted to Cangzhou Central Hospital from July 2016 to December 2022 were retrospectively analyzed.Preoperative cervical MRI and postoperative pathological results were compared to evaluate the value of cervical MRI to diagnose lymph node metastasis.Univariate analysis was performed on common risk factors.Multivariate logistic regression analysis was performed for the statistically significant factors.Results Among the 293 cases of head and neck squamous cell carcinoma,the diagnostic accuracies of cervical MRI for cN0 and cN+were 73.6%and 83.7%,respectively.The sensitivity,specificity,positive predictive value,negative predictive value,and Youden index of neck MRI in diagnosing lymph node metastasis were 77.6%,80.5%,83.7%,73.6%,and 0.58,respectively.Multivariate Logistic analysis showed that lymph node short/length ratio(χ^(2)=33.397,P<0.001)and lymph node margin(χ^(2)=11.656,P=0.001)were independent risk factors for influencing the accuracy of cervical MRI to diagnose lymph node metastasis.The diagnostic accuracies of neck MRI combined with risk factors for cN0 and cN+were 73.6%and 83.7%,respectively,which were 10.7%and 6.9%higher than that of conventional diagnosis.Conclusion Lymph node margin and short/length ratio were independent risk factors that affect the accuracy of neck MRI in diagnosing lymph node metastasis in head and neck squamous cell carcinoma.