口咽鳞癌颈淋巴结临床触诊、B超和MRI检查的对比分析

目的：比较临床触诊、B超和磁共振（MRI）诊断口咽鳞癌颈淋巴结转移的准确性,分析B超、MRI在口咽鳞癌颈淋巴结转移术前评估中的临床价值。方法：对20例口咽鳞癌患者的100个颈部分区行术前临床触诊、B超和MRI检查,以术后病理诊断为金标准,双盲法分析临床触诊、B超和MRI所见,将其结果在SPSS13.0软件中分别采用χ2检验或Fisher确切概率法进行统计学处理。结果：术后病理证实16个区存在淋巴结转移,临床触诊检出其中的7个区（敏感度43.8%,特异度96.4%,准确度88.0%）;B超确诊其中的10个区（敏感度60.0%,特异度97.6%,准确度92.0%）,可以发现33.3%的临床触诊隐匿性转移区;MRI确诊其中的13个区（敏感度81.3%,特异度96.4%,准确度94.0%）;可以发现66.7%的临床触诊隐匿性转移区。B超联合MRI检出其中的13个区（敏感度81.3%,特异度95.2%,准确度93.0%）。结论：B超或MRI评价口咽鳞癌颈淋巴结转移的敏感度、准确度均优于临床触诊,B超联合MRI的可靠性并不优于单独使用MRI,但两者存在互补性。

Cervical lymph node metastases in patients with squamous cell carcinoma of the oropharynx:Ultrasound,MRI,US/MRI versus physical palpation

PURPOSE：This study was designed to evaluate the accuracy and to identify the clinical value of ultrasound,magnetic resonance imaging（MRI） and physical palpation in the preoperative detection of cervical lymph node metastases in patients with squamous cell carcinoma of the oropharynx per level（ⅠthroughⅤ）.METHODS：Twenty patients（100 levels）were studied double-blindedly by MRI,ultrasonography and physical palpation prior to cervical lymphadenectomy,and palpation,US,MRI and US/MRI were compared for specificity,sensitivity and accuracy with Chi-square test or Fisher＇s exact test by SPSS13.0 software package.Pathologic diagnosis of the surgical specimens served as the gold standard.RESULTS：According to histologic examination of the dissected specimens,in 16 of 100 levels there were cervical lymph node metastases,7 of the 16 levels with metastatic nodes were diagnosed by manual palpation（sensitivity,43.8% ;specificity,96.4% ;accuracy,88.0%）.Cervical lymph node metastases in 10 levels were revealed by ultrasonography（sensitivity,60.0%;specificity,97.6%;accuracy,92.0%）,ultrasound discovered 33.3% of the occult metastatic nodes in this series.Lymph node metastases were diagnosed accurately in 13 levels by MRI（sensitivity,81.3%;specificity,96.4%;accuracy,94.0%）,and 66.7% of the occult metastatic nodes were found by MRI.Cervical lymph node metastases in 13 levels were revealed by US/MRI（sensitivity,81.3%;specificity,95.2%;accuracy,93.0%）.CONCLUSIONS：MRI,ultrasound examinations are superior to physical palpation in ascertaining cervical lymph node metastasis in patients with squamous cell carcinoma of the oropharynx;there is no significant difference in sensitivity or specificity among US/MRI,US and MRI,but US and MRI are complementary to each other.