Characteristics of Patients with Upstaging by Sentinel Lymph Node Biopsy of the N0 Neck in Head and Neck Cancer

Introduction: To investigate the possible role of sentinel lymph node biopsy (SLNB) to upstage the N0 neck in patients with oral and oropharyngeal squamous cell carcinoma. Methods: Patients with T1-T2 oral and oropharyngeal squamous cell carcinoma accessible to injection and staged N0 into the neck by palaption and CTscan were enrolled in the study. All patients underwent regular follow-up to identify possible recurrence. Results: A sentine lymph node biopsy was performed by 21 consecutive patients. 4 of the 21 patients were upstaged by SNLB. There was a mean follow-up of 31 months. Two patients developed subsequent disease after having been staging by SLNB, respectively negative in one case and positive in the other case. Tumor site, the staging of the primary tumor, presence of ulceration, tumor thickness were the same in the upstaged initially N0 patients. Conclusions: Sentinel lymph node biopsy can be used to upstage the N0 neck patients in perhaps well defined patients.

A new device for the identification of lymph nodes removed during different types of neck dissection

Meticulous mapping of the lymph node status is a general principle in present-day head and neck surgery. The removal of a certain number of lymphatic levels during neck dissection may well be therapeutic in intent, but it is also mandatory for correct tumour staging. We pre- sent a precise lymph node mapping during dif- ferent types of neck dissection in the course of major head and neck surgery by a sterile plastic tray moulded in the shape of the neck. This de- vice makes lymph node mapping simpler, safer, quicker and methodically more structured than any of the present methods. It facilitates the work of the pathologist and the flow of reliable information along the surgeon-pathologist- oncologist chain. With this device, a more stru- ctured, methodical means of lymph node removal has become possible.

256层CT灌注成像联合半乳糖凝集素-3在术前肺癌纵隔淋巴结转移诊断中的应用

目的:分析256层CT灌注成像参数(CTPI)联合半乳糖凝集素-3(Gal-3)在术前肺癌纵隔淋巴结转移诊断中的应用价值。方法:回顾性分析2022年4月-2023年4月收治的87例肺癌患者的临床资料,根据纵隔淋巴结转移情况分为转移组(n=45)和未转移组(n=42)。另选取2022年4月-2023年4月进行体检的健康人群作为对照组(n=40)。对所有受试者进行血清Gal-3水平检测,并采用Brilliance iCT扫描仪进行CT灌注扫描。比较三组CTPI[表面通透性(PS)、灌注值(PV)、肺动脉血流量(PAF)、血容量(BV)、平均通过时间(MTT)、强化峰值(PEI)、支气管动脉血流量(BAF)]和血清Gal-3水平,并采用受试者工作特征(ROC)曲线评估CTPI、血清Gal-3水平及联合检测在术前肺癌纵隔淋巴结转移中的诊断效能。结果:转移组PS,PV和Gal-3均高于未转移组和对照组,未转移组PS,PV和Gal-3均高于对照组,差异有统计学意义(P<0.05)。ROC曲线分析显示,PS值、PV及Gal-3水平联合检测肺癌纵隔淋巴结转移的线下面积高于各项单独检测,差异有统计学意义(P<0.05)。结论:256层CTPI联合血清Gal-3检测对术前肺癌纵隔淋巴结转移具有较高的诊断价值,可为肺癌患者术前评估提供重要依据。

Malignant proliferative ependymoma of the neck with lymph node metastasis:A case report

BACKGROUND Malignant proliferating trichilemmal tumor(MPTT)is an infrequent malignant neoplasm originating from cutaneous appendages,with only a handful of documented cases.This report delineates a unique instance of MPTT situated in the neck,accompanied by lymph node metastasis.A comprehensive exposition of its clinical trajectory and imaging manifestation is presented,aiming to enhance comprehension and management of this atypical ailment.CASE SUMMARY Patient concerns:A 79-year-old male presented with a longstanding right neck mass persisting for over six decades,exhibiting recent enlargement over the past year.Diagnoses:Enhanced magnetic resonance imaging of the neck unveiled an elliptical mass on the right neck side,characterized by an ill-defined border and a heterogeneous signal pattern.The mass exhibited subdued signal intensity on T1-weighted imaging(T1WI)and a heterogeneous high signal on T2-weighted imaging(T2WI),interspersed with a lengthy T1 and T2 cystic signal motif.Close anatomical association with the submandibular gland joint was noted,and intravenous gadolinium diethylene triamine pentaacetic acid administration facilitated conspicuous enhancement.Substantial enhancement of the solid segment prompted an initial preoperative diagnosis of malignant nerve sheath tumor.However,post-surgery histopathological and immunohistochemical analysis conclusively confirmed the diagnosis as malignant hyperplastic external hair root sheath tumor.Intervention:Complete excision of the tumor was successfully executed.Outcomes:The patient experienced a favorable postoperative recovery.CONCLUSION Malignant proliferative trichilemmal tumor external hair root sheath tumor is a cystic-solid lesion,appearing as low signal on T1WI images or high signal on T2WI with enhancement of the solid component.Suspicions of malignancy are heightened when the tumor border is indistinct,tissue planes are breached,or when linear or patchy high signals are observed in the subcutaneous tissue on T1 liver acquisition with volume acceleration enhanced images along with intermediate signal on T2WI and restricted diffusion on diffusion-weighted imaging images.Strong consideration for malignancy should arise if there are signs of compromised adjacent tissue relationships or direct invasion evident on imaging.We have incorporated the above-mentioned content into the entire manuscript.

Lingual lymph nodes:Anatomy,clinical considerations,and oncological significance

Lingual lymph nodes are an inconstant group of in-transit nodes,which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II.There is growing academic data on the metastatic spread of oral cancer,particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes.These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer.Combined information on surgical anatomy,clinical observations,means of detection,and prognostic value is presented.Anatomically obtained incidence of lingual nodes ranges from 8.6%to 30.2%.Incidence of lingual lymph node metastasis ranges from 1.3%to 17.1%.It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control.Extended resection volume,which is required for the surgical treatment of lingual node metastasis,cannot be implied to every tongue cancer patient.As these lesions significantly influence prognosis,special efforts of their detection must be made.Reasonably,every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis.Lymphographic tracing methods,which are currently implied for sentinel lymph node biopsies,may improve the detection of lingual lymph nodes.

MSCT特征及血清Gal-3、TSH、E-cad与PTMC颈部淋巴结转移的相关分析

目的 分析多层螺旋CT(MSCT)特征及血清半乳糖凝集素-3(Gal-3)、促甲状腺激素(TSH)、上皮钙黏素(E-cad)与甲状腺微小乳头状癌(PTMC)颈部淋巴结转移(LNM)的相关性。方法 回顾性选择2018年1月至2019年12月于马鞍山十七冶医院就诊的PTMC患者84例纳入实验组,选择同期于本院治疗的甲状腺良性结节患者84例纳入对照组。观察两组病灶及淋巴结的MSCT特征(病灶多发、最大直径、形态不规则、微钙化、结节突破甲状腺包膜、淋巴结肿大、淋巴结不均匀强化),并检查与比较两组血清Gal-3、TSH、E-cad水平。统计实验组颈部LNM、无颈部LNM患者例数,并观察实验组颈部LNM、无颈部LNM患者病灶及淋巴结的MSCT特征,血清Gal-3、TSH、E-cad水平。分析PTMC患者病灶的MSCT特征及血清Gal-3、TSH、E-cad水平与颈部LNM的相关性。结果 实验组病灶多发比例、最大直径≥5 mm比例、形态不规则比例、结节突破甲状腺包膜比例、淋巴结肿大比例及淋巴结不均匀强化比例分别为63.10%、67.86%、72.62%、54.76%、73.81%、51.19%,均大于对照组(32.14%、38.10%、4.76%、0、17.86%、0),差异均有统计学意义(P<0.05);两组微钙化比例比较,差异无统计学意义(P>0.05)。实验组Gal-3、TSH、E-cad水平分别为(4.73±0.49)μg/L、(2.40±0.26) mIU/L、(109.64±13.47) ng/mL,均高于对照组[(1.69±0.18)μg/L、(1.28±0.13) mIU/L、(57.63±5.89) ng/mL],差异均有统计学意义(P<0.05)。颈部LNM、无颈部LNM患者例数分别为19例、65例。颈部LNM患者病灶多发、最大直径≥5 mm、形态不规则、结节突破甲状腺包膜、淋巴结肿大及淋巴结不均匀强化等比例均大于无颈部LNM患者,差异均有统计学意义(P<0.05);颈部LNM、无颈部LNM患者微钙化比例比较,差异无统计学意义(P>0.05)。颈部LNM患者血清Gal-3、TSH、E-cad水平均高于无颈部LNM患者,差异均有统计学意义(P<0.05)。经Pearson相关分析,病灶多发、最大直径≥5 mm、形态不规则、结节突破甲状腺包膜及淋巴结不均匀强化及血清Gal-3、TSH、E-cad水平与PTMC颈部LNM呈正相关(P<0.05)。淋巴结肿大、病灶微钙化与PTMC颈部LNM不相关(P>0.05)。结论 PTMC颈部LNM具有典型的MSCT特征及血清Gal-3、TSH、E-cad水平异常升高,且部分MSCT特征及血清Gal-3、TSH、E-cad与PTMC颈部LNM具有明显的相关性。

CT灌注成像检查应用于宫颈癌分期及淋巴结转移的诊断价值分析

目的:探究CT灌注成像检查在宫颈癌分期、淋巴结转移诊断中的价值。方法:选择2021年7月—2023年8月临沂市中心医院收治的宫颈癌患者80例,所有患者均行CT灌注成像检查。以病理学检查结果为“金标准”,分析CT灌注成像的检查结果,对比不同宫颈癌分期患者CT灌注参数水平,对比淋巴结转移及未转移患者CT灌注参数,分析CT灌注参数在诊断宫颈癌淋巴结转移中的应用价值。结果:经CT灌注成像检查在宫颈癌分期中诊断准确率为92.50%(74/80)。Ⅲ期宫颈癌患者BF水平低于Ⅱ期及Ⅰ期,PS水平高于Ⅱ期及Ⅰ期,差异有统计学意义(P<0.001)。无淋巴结转移的宫颈癌患者BF水平高于发生淋巴结转移患者,PS水平低于发生淋巴结转移患者,差异有统计学意义(P<0.001)。CT灌注参数中BF诊断价值较高,灵敏度为0.862,特异度为0.682,AUC为0.843;PS诊断价值略低,灵敏度为0.672,特异度为0.818,AUC为0.817。结论:CT灌注成像检查在明确宫颈癌分期及淋巴结转移中具有较高的临床应用价值,通过分析各指标水平变化以判断患者分期状况及淋巴转移情况,可为临床诊疗提供有效参考,具有较高的临床推广应用价值。

CT灌注成像和增强扫描在诊断胃癌淋巴结转移中的价值

目的:探讨CT灌注成像和增强扫描对胃癌淋巴结转移的诊断价值。方法:选取长治医学院附属和济医院胃癌患者65例,术前均行腹部CT平扫、CT灌注成像和增强扫描,记录淋巴结的形态学参数(长径、短径、短长径比)、增强参数(平扫和动、静脉期CT值)及灌注参数[血容量(BV)、血流量(BF)、表面通透性(PS)和平均通过时间(MTT)],绘制受试者工作特征曲线(ROC),评价各参数对淋巴结转移的诊断效能。结果:65例胃癌患者中,病理结果发现转移性淋巴结103枚,非转移性淋巴结76枚,转移性淋巴结的短径、短长径比、平扫CT值、动脉期CT值、静脉期CT值、PS和BF均显著高于非转移性淋巴结(P<0.05),二者的长径、BV和MTT比较,差异无统计学意义(P>0.05)。ROC曲线结果显示,短径、短长径比、平扫CT值、动脉期CT值、静脉期CT值、PS和BF诊断转移性淋巴结的曲线下面积(AUC)分别为0.592,0.847,0.683,0.811,0.747,0.844和0.898;与单独参数相比,短长径比+动脉期CT值+PS三项联合的诊断效能最大。结论:CT灌注成像联合增强扫描可有效加强对胃癌淋巴结转移的诊断价值。

A review of clinical and histological parameters associated with contralateral neck metastases in oral squamous cell carcinoma

Oral squamous cell carcinoma （OSCC） has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases （CLNM） in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy （aRT） and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.

双能量CT在颈部淋巴结病变评估中的研究进展

头颈部淋巴结病变的早期发现及定性诊断至关重要,有助于临床及时采取干预措施及制定治疗方案,延缓或终止疾病进展。目前双能量CT的多组图像,如虚拟平扫图像、碘图、虚拟单能量图像、光谱亨斯菲尔德单位衰减曲线及混合图像等已逐步用于评估头颈部淋巴结病变,为淋巴结病变的定性、分期及病理分型提供了诸多量化指标。本文就双能量CT的多组后处理图像及相关参数在颈部淋巴结病变评估中的研究进展作一综述。

头颈CTA联合全脑CT灌注扫描对缺血性脑卒中侧支循环的评估价值

目的研究缺血性脑卒中侧支循环运用头颈CT血管成像(CTA)联合全脑CT灌注扫描的评估价值。方法50例缺血性脑卒中患者,均接受头颈CTA联合全脑CT灌注扫描,按照检查结果分为侧支循环良好组和侧支循环不良组,各25例。比较两组梗死灶个数以及梗死区、半暗带区的脑血流动力学参数[脑血容量(CBV)、对比剂峰值时间(TTP)、平均通过时间(MTT)、脑血流量(CBF)]。结果侧支循环不良组梗死区和半暗带区CBV、TTP、MTT、CBF分别为(0.82±0.33)ml/100 g、(26.02±6.45)s、(10.23±0.85)s、(7.62±1.35)ml/(100 g·min)和(1.57±0.51)ml/100 g、(17.97±3.20)s、(5.47±1.22)s、(18.56±5.03)ml/(100 g·min),梗死灶个数为(28.00±8.10)个;侧支循环良好组梗死区和半暗带区CBV、TTP、MTT、CBF分别为(1.02±0.26)ml/100 g、(23.30±1.46)s、(7.14±0.28)s、(16.48±3.19)ml/(100 g·min)和(2.29±0.59)ml/100 g、(10.53±3.06)s、(3.80±1.02)s、(27.59±5.63)ml/(100 g·min),梗死灶个数为(15.00±8.05)个。侧支循环不良组梗死区和半暗带区CBV、CBF均低于侧支循环良好组,TTP、MTT均高于侧支循环良好组,差异具有统计学意义(P<0.05);侧支循环不良组梗死灶个数多于侧支循环良好组,差异有统计学意义(P<0.05)。结论对缺血性脑卒中患者运用头颈CTA联合全脑CT灌注扫描,可以帮助医务人员评估侧支循环情况,具有较好的预后判断价值。

胸部CT灌注成像对肺癌淋巴结转移的预测价值

目的探讨胸部CT灌注成像对肺癌淋巴结转移的预测价值。方法收集120例肺癌患者的临床资料,有淋巴结转移70例,无淋巴结转移50例。对所有肺癌患者进行CT平扫和多层螺旋CT灌注扫描。比较有淋巴结转移和无淋巴结转移患者的胸部CT灌注成像参数,并分析胸部CT灌注成像参数中的表面通透性和灌注值预测淋巴结转移的价值。结果有淋巴结转移患者肿瘤直径大于无淋巴结转移患者,周围型肺癌和鳞状上皮细胞癌比例均低于无淋巴结转移患者,差异均有统计学意义(P<0.05)。有淋巴结转移患者表面通透性和灌注值均明显高于无淋巴结转移患者,差异均有统计学意义(P<0.01)。表面通透性预测肺癌淋巴结转移的灵敏度、特异度、准确度分别为77.80%、84.00%、75.00%,曲线下面积为0.796;灌注值预测肺癌淋巴结转移的灵敏度、特异度、准确度分别为60.00%、70.00%、78.00%,曲线下面积为0.692。结论胸部CT灌注成像可有效预测肺癌淋巴结转移情况,具有临床指导意义。

CT全脑灌注联合头颈部CT血管造影诊断缺血性脑卒中的临床价值

目的探究CT全脑灌注联合头颈部CT血管造影诊断缺血性脑卒中的临床价值。方法选取2019年5月至2020年12于本院接受检查的85例疑似缺血性脑卒中患者作为研究对象。患者均接受头颈部CT血管造影、CT全脑灌注诊断,以病理检查为金标准,比较CT全脑灌注、头颈部CT血管造影、CT全脑灌注联合头颈部CT血管造影的诊断符合率、灵敏度、特异度、阳性预测值、阴性预测值、漏诊率和误诊率。结果病理检查结果显示,85例患者中阳性62例,阴性23例。联合诊断符合率、灵敏度、特异度、阳性预测值、阴性预测值均高于CT全脑灌注、头颈部CT血管造影,漏诊率、误诊率均低于CT全脑灌注、头颈部CT血管造影,差异有统计学意义(P<0.05);CT全脑灌注与头颈部CT血管造影符合率、灵敏度、特异度、阳性预测值、阴性预测值、漏诊率、误诊率比较差异无统计学意义。结论在缺血性脑卒中诊断中采用CT全脑灌注联合头颈部CT血管造影,能有效提高诊断符合率、灵敏度和特异度,应用价值显著。

颈部淋巴结病变CT灌注成像

目的探讨CT灌注在区分颈部淋巴结病变中的临床价值。资料与方法对51例颈部淋巴结病变患者行CT灌注成像,包括淋巴瘤9例,甲状腺癌转移9例,甲状腺癌外的其他头颈鳞癌转移22例,淋巴结炎8例,结核3例。分析和比较不同病理类型淋巴结病变曲线和灌注参数特点。结果不同病理类型淋巴结病变CT灌注曲线(TDC)走势不同,淋巴结转移瘤以"速升速降"型为主,淋巴瘤TDC曲线低平,而慢性淋巴结炎以低平和缓升型为主。甲状腺癌转移淋巴结高灌注(PF)(127.04±65.78)ml.100g-1.min-1,淋巴瘤为低灌注(PF)(32.1±20.9)ml.100g-1.min-1,与淋巴结炎、其他头颈鳞癌转移瘤之间(PF)差异有统计学意义。结论不同病理类型的恶性淋巴结的TDC走势和灌注特点不同,利用CT灌注结合CT形态学表现可以帮助区分不同病理类型的淋巴结。

颌面颈部肿瘤的CT灌注成像

CT灌注成像用于颌面颈部肿瘤的评价尚少见。本文通过对51例(53侧)腮腺肿瘤的CT灌注检查探讨了颌面颈部肿瘤的CT灌注成像的技术和应用价值,并提出在该检查过程中应注意:①谨慎选择合理的肿瘤输入动脉作采样;②不同的肿瘤采样方法会导致不同的CT灌注结果,应当合理使用。笔者认为CT灌注检查对鉴别颌面颈部良性肿瘤和恶性肿瘤、区分肿瘤组织与其周围正常组织均具有一定的辅助诊断价值。

双能量CT成像鉴别诊断颈部鳞癌转移淋巴结与淋巴结结核

目的探讨双源CT双能量成像技术在颈部鳞癌转移淋巴结与淋巴结结核鉴别诊断中的价值。资料与方法选取经病理证实为颈部鳞癌转移淋巴结、淋巴结结核的25例患者,共62枚颈部肿大淋巴结,均行双能量动脉期增强扫描。测量两种不同病理性质淋巴结实质碘覆盖值,观察能谱曲线变化趋势并比较两种不同病理性质淋巴结能谱曲线斜率,分析碘覆盖值和能谱曲线的斜率鉴别两种病变的诊断敏感度和特异度。结果 62枚淋巴结中,鳞癌转移性淋巴结32枚,淋巴结结核30枚。鳞癌转移淋巴结的碘覆盖平均值、曲线平均斜率与淋巴结结核比较,差异有统计学意义（t=3.806、3.698,P〈0.05）。在60-180 keV范围内,随着单能keV值的升高,鳞癌转移淋巴结与淋巴结结核CT值逐渐递减,且ke V值越高,CT值降低的幅度越小,其能谱曲线在60-180 keV下均呈下降型。碘覆盖值曲线下面积为0.756,对鉴别两种病变的诊断敏感度为56%,特异度为80%;能谱曲线的斜率曲线下面积为0.898,对鉴别两种病变的诊断敏感度为76%,特异度为85%。结论动脉期碘覆盖值及能谱曲线斜率对颈部鳞癌转移淋巴结与淋巴结结核的影像鉴别诊断均有一定的意义,且能谱曲线斜率对其鉴别诊断优于碘覆盖值。

颈部淋巴结结核的CT及B超表现

目的：复习１４例以头颈部肿物就医，组织学诊断为颈淋巴结结核的ＣＴ及Ｂ超表现，旨在提高对颈淋巴结结核的影像学诊断的认识。材料与方法：女性患者１３例，男性１例。ＣＴ平扫１例，直接增强扫描１３例，Ｂ超扫描８例。结果：以内颈链下组及锁骨上下区受累最常见（９２．８％），均为多个淋巴结同时受累（１００％），病变部分或全部与邻近肌肉粘连者７８．０％，ＣＴ增强扫描分３型：Ⅰ型：均匀等密度强化；Ⅱ型：薄环形周边强化，中央低密度相互融合时呈花环状；Ⅲ型：不均质强化。各种类型可同时存在。Ⅰ型２例，Ⅰ＋Ⅲ型２例，Ⅰ＋Ⅱ＋Ⅲ型７例，Ⅱ＋Ⅲ型２例。Ｂ超扫描８例病变均呈低回声，４例回声不均。结论：影像学检查能清晰地显示颈淋巴结结核病变的数目、部位、形态的特征，表现为病变数目多，常融合成团，侵犯区域多以及多种病理改变同时存存在。

B超、增强CT及增强MRI诊断舌癌颈部转移性淋巴结的价值比较

目的评估和比较术前B超、增强CT及增强MRI对舌鳞状细胞癌颈部淋巴结转移的诊断及临床应用价值。方法收集26例经病理活检证实的舌癌患者,术前按颈部解剖分为152区,对颈部各区淋巴结均行增强CT、增强MRl及B超检查,与术后病理结果进行对比分析。结果 26例患者的152个颈部分区中共分离出淋巴结1037枚,其中病理阳性淋巴结83枚。增强CT共检出28个阳性区,其中真阳性15个;增强MRI共检出28个阳性区,其中真阳性18个;B超共检出34个阳性区,其中真阳性24个。增强CT、增强MRI及B超的灵敏度分别为31.9%、38.3%和50.1%,特异度分别为87.6%、90.5%和90.5%,准确率分别为70.4%、74.3%和78.3%。结论舌癌患者术前通过行增强CT、增强MRI及B超检查均有助于辨别颈部淋巴结有无转移,B超可考虑为首选的影像学方法。

多层螺旋CT对颈部恶性淋巴结病变鉴别诊断的价值

目的:使用多层螺旋CT(MSCT)的体部灌注软件,测量和评价淋巴结转移瘤和淋巴瘤之间及其与肌肉CT灌注值的差异和相关性。方法:采用SiemensSomatoVolumeZoom4四层螺旋CT体部灌注技术(每圈1s),5mm层厚,4层,120kV,60mA;采用高压注射器注射非离子型对比剂40ml(碘浓度300mg/ml),流速4ml/s,延迟5s,数据采集40s。在工作站MV300,用SiemensPerfusionCT/VAIIA软件进行后处理(去卷积算法),分别测量40例淋巴结转移瘤和22例淋巴瘤患者的血流量(bloodflow,BF),对照组选择50例正常体检者,测定其颈部或体部肌肉血流量,并进行统计学分析。结果:40例淋巴转移瘤BF平均值为(0.50±0.16)ml/(min·ml),22例淋巴瘤BF值为(0.71±0.18)ml/(min·ml),肌肉BF值为(0.20±0.09)ml/(min·ml),分析显示淋巴结转移瘤、淋巴瘤BF均显著高于肌肉(P<0.001);淋巴瘤BF高于淋巴结转移瘤(P<0.05)。结论:MSCT灌注成像法对恶性淋巴结病变的鉴别诊断具有临床应用价值。

Predictors of occult lymph node metastasis in cutaneous head and neck melanoma

Objective:To use the Surveillance,Epidemiology,and End Results(SEER)database to verify the findings of a recent National Cancer Database(NCDB)study that identified factors predicting occult nodal involvement in cutaneous head and neck melanoma(CHNM)while identifying additional predictors of occult nodal metastasis and comparing two distinct cancer databases.Methods:Cases of CHNM in the SEER database diagnosed between 2004 and 2014 were identified.Demographic information and oncologic data were obtained.Univariate and multivariate analysis were performed to identify factors associated with pathologic nodal positivity.Results:There were 34002 patients with CHNM identified.Within this population,16232 were clinically node-negative,1090 of which were found to be pathologically node-positive.On multivariate analysis,factors associated with an increased risk of occult nodal metastasis included increasing depth of invasion(stepwise increase in adjusted odds ratio[OR]),nodular histology(aOR:1.47[95%CI:1.21-1.80]),ulceration(aOR:1.74[95%CI:1.48-2.05]),and mitoses(aOR:1.86[95%CI:1.36-2.54]).Factors associated with a decreased risk of occult nodal metastasis included female sex(aOR:0.80[0.67-0.94])and desmoplastic histology(aOR:0.37[95%CI:0.24-0.59]).Between the SEER database and the NCDB,factors associated with occult nodal involvement were similar except for nodular histology and female sex,which did not demonstrate significance in the NCDB.Conclusion:Regarding clinically node-negative CHNM,the SEER database and the NCDB have similarities in demographic information but differences in baseline population sizes and tumor characteristics that should be considered when comparing findings between the two databases.