正电子发射体层摄影术诊断头颈部恶性肿瘤颈部淋巴结转移的临床价值探讨

目的 与CT、MRI和临床触诊比较,评价正电子发射体层摄影术(positron-emission tomography,PET)在判断头颈部恶性肿瘤颈部淋巴结转移中的应用价值.方法 40例头颈部恶性肿瘤患者于术前两周分别进行PET、CT或MRI检查,分别获取①PET影像;②CT或MRI影像;③临床触诊的淋巴结状况.以病理结果 为金标准,分析3种方法 判断颈部淋巴结转移的敏感性、特异性及准确率方面的差异.结果 PET在判定淋巴结转移的敏感性方面较CT、MRI和临床触诊高14.3%(P=0.648);特异性比CT或MRI和临床触诊分别高15.4%(P=0.188)和7.7%(P=0.482).PET、CT或MRI和临床触诊的准确率分别是85.0%、70.0%和75.0%.结论 PET在头颈癌颈部淋巴结转移判定中的敏感性、特异性及准确率方面略好于CT、MRI和临床触诊.虽然结果 差异无统计学意义,但PET在头颈癌淋巴结转移判定中作为一种辅助方法 有其重要的作用.

Clinical application of positron-emission tomography for the identification of cervical nodal metastases of head and neck caner compared with CT or MRI and clinical palpation

Objective To evaluate the value of positron-emission tomography(PET)for the identification of cervical nodal metastases of head and neck cancer compared with CT/MRI and clinical palpation.Methods Forty patients of head and neck cancer Lulderwent PET and CT/MRI examination 2 weeks before surgery.PET,CT/MRI and clinical palpation were interpreted separately to assess regional lymph node status.Histopathologic analysis was used as the gold standard for assessment of the lymph node involvement.Differences in sensitivity.specificity and accuracy among the imaging modalities and clinical palpation were analyzed.Results The sensitivity of PET for the identification of nodal metastases was 14.3% highor than that of CT/MRI (P=0.648)and 14.3% higher than that of clinical palpation(P=0.648),whereas the specificity of PET was 15.4% higher than that of CT/MRI(P=0.188)and 7.7% higher than that of clinical palpation(P=0.482).The accuracy of 18F-FDG PET,CT/MRI,and clinical palpation for the identifieation of cervical nodal metastases was 85.0%,70.0% and 75.0% respectively.Conclusions The sensitivity,specificity and accuracy of PET for the detection of cervical nodal metastases was higher than that of CT/MRI and clinical palpation.Although the results did not show a statistically significant difference,PET can still serve as a supplementary method for the identification of nodal metastases of head and neck cancer.