颈部超声评价胸段食管癌颈部淋巴结转移

目的　探讨提高胸段食管癌颈部淋巴结转移诊断正确率的方法。　方法　 42例胸段食管鳞癌患者 ,术前行双侧颈部超声检查 ,转移淋巴结判定标准包括淋巴结的大小 (长径≥ 1 0mm)和形态 (短径 /长径 >0 5)。　结果　术前超声发现颈部淋巴结肿大 (短径≥ 5mm) 1 6例 ,触诊可扪及 5例。其中根据超声检查结果 9例判定为转移淋巴结 (cM1 LN) ,触诊可扪及 4例。本组 5例无法行肿瘤根治性切除者行非手术治疗 ;37例手术切除肿瘤的患者中 ,术后病理证实 6例颈部淋巴结转移(pM1 LN) ,其中 4例肿瘤侵犯食管外膜 (pT3)、2例术中发现肿瘤外侵 (pT4 ) ,并且均同时伴纵隔淋巴结转移 ,其中 4例还伴有腹腔淋巴结转移 ;1 1例pT1 、pT2 患者中无一例发现颈部淋巴结转移 (P =0 0 2 0 )。根据病理及临床治疗结果 ,超声判定颈部淋巴结转移的准确率显著高于触诊 (40 / 4 2 ,95 %比34/ 4 2 ,81 % ,P =0 0 4 3) ,敏感性亦明显高于触诊 (82 %比 36 % ,P =0 0 81 )。全组病例中 ,有 5例 (5/ 39,1 3 % )因颈部超声检查结果而改变治疗方式。　结论　超声检查判断颈部淋巴结转移的敏感性及准确率明显高于体检触诊 ,有助于提高食管癌术前分期的准确性

Ultrasound surveillance of cervical lymph node metastasis in thoracic esophageal carcinoma

Objective To improve the accuracy of preoperative evaluation of cervical lymph node metastasis in thoracic esophageal squamous carcinoma. Methods Forty two patients with thoracic esophageal squamous carcinoma underwent neck ultrasonography. Enlarged lymph nodes with their long axis greater than 10 mm and a short to long axis ratio greater than 0 5 were considered as metastatic. Results Preoperative neck ultrasonography revealed the enlarged lymph nodes in 16 patients, but only in 5 (31%) cases the nodes were palpable. Among them 9 were classified as metastatic (cM 1 LN ), including 4 patients with palpable nodes. In 5 cM 1 LN patients surgical intervention was canceled and the remaining 37 patients underwent trans thoracic esophagectomy. Cervical node metastasis (pM 1 LN ) was confirmed pathologically in 6 surgical patients, 4 with tumors invading the adventitia (pT3) and the other 2 into the surrounding structure (pT 4) (pT 1, pT 2 vs. pT 3, pT 4, P =0 020). All 6 pM 1 LN patients had concomitant mediastinal node metastasis and 4 of them had upper abdominal node metastasis Statistically significant relationship was detected between cervical and abdominal nodal status ( r =0 536, P =0 007). In comparisonwith the results of pathological examination and treatment response, the accuracy and sensitivity were 81% and 95% ( P =0 043), 36% and 82% ( P =0 081), respectively, for palpation and ultrasonography. Five out of 39 (13%) patients had their therapy changed due to ultrasonographic findings. Conclusions Neck ultrasonography for cervical lymphadenopathy is of high sensitivity and accuracy, which plays an important role in the preoperative evaluation and therapeutic decision making.