高频超声诊断下咽鳞癌淋巴结转移的临床研究

doi:10.6040/j.issn.1673-3770.0.2022.180

摘要/Abstract

摘要： 目的探讨高频超声在诊断下咽鳞癌颈淋巴结转移的应用价值。方法收集于耳鼻咽喉科接受颈淋巴结清扫术的47例下咽鳞状细胞癌患者的临床资料,以病理检查结果为金标准,对颈部触诊、颈部强化CT、高频超声检查结果,以kappa值反映三种方法结果与金标准的一致程度,以灵敏度、特异度评价三种检查方法的诊断效果;用Pearson χ2检验比较三种方法的灵敏度和特异度。结果研究纳入下咽癌患者47例,所有患者均无远处转移病灶。三种检查方法,超声检查与病理检查的一致性最好(Kappa=0.718)。以术后病理检查结果为准,对于下咽癌颈淋巴结转移,超声诊断的灵敏度最高(91.9%)、高于触诊,差异有统计学意义;超声灵敏度也有高于强化CT(78.9%)的趋势,但差异无统计学意义。在特异度方面,触诊最高(94.74%)、超声(78.95%)次之、强化CT(61.11%)最低,三者的差异均无统计学意义。结论对于诊断下咽癌颈淋巴结转移,高频超声检查具有较高的灵敏度及特异度,可为临床诊断及所采用的手术方式提供重要信息,因其无创、便携、可重复等优点,可作为监测下咽癌颈部淋巴结转移的重要辅助手段。

关键词: 高频超声, 下咽癌, 强化CT, 淋巴结转移, 触诊

Abstract: Objective To evaluate the clinical value of high-frequency ultrasound in the diagnosis of cervical lymph node metastasis in hypopharyngeal squamous cell carcinoma. Methods Forty-seven patients with hypopharyngeal cancer who underwent neck lymph node dissection in the Department of Otolaryngology in Qilu Hospital of Shandong University were recruited. The postoperative pathological results were used as the gold standard. The Kappa value was used to reflect consistency between the results of the three methods and the gold standard, and sensitivity and specificity were used to evaluate the diagnostic effect of the three methods; Pearson's chi-square test was used to compare the sensitivity and specificity of the three methods. Results A total of 47 patients with hypopharyngeal cancer, all of whom had no distant metastasis, were included in the study. Among the three methods, the consistency between ultrasound and pathological examination was highest(Kappa=0.718). According to the postoperative pathological examination results, the sensitivity of ultrasound in the diagnosis of cervical lymph node metastasis in hypopharyngeal cancer was highest(91.9%). The sensitivity was higher than that of palpation, and the difference was statistically significant. The sensitivity of ultrasound also tended to be higher than that of enhanced CT(78.9%), but the difference was not statistically significant. Palpation showed the highest specificity(94.74%), followed by ultrasound(78.95%)and enhanced CT(61.11%); however, the difference was not statistically significant. Conclusion High-frequency ultrasonography has high sensitivity and specificity in the diagnosis of cervical metastatic lymph nodes in hypopharyngeal carcinoma, which has important implications for clinical diagnosis. As it is non-invasive, portable, and repeatable, high-frequency ultrasound can be used as a common clinical examination method for cervical lymph node metastasis in hypopharyngeal carcinoma.

Key words: High-frequency ultrasound, Hypopharyngeal carcinoma, Lymph node metastasis, Enhanced CT, Palpation

中图分类号:

R739.63

陈东彦,钱晔,魏东敏,李文明,夏同良,雷大鹏,潘新良. 高频超声诊断下咽鳞癌淋巴结转移的临床研究[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 18-23.

CHEN Dongyan, QIAN Ye, WEI Dongmin, LI Wenming, XIA Tongliang, LEI Dapeng, PAN Xinliang. Clinical value of high-frequency ultrasound in the diagnosis of lymph node metastasis in hypopharyngeal squamous cell carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(5): 18-23.

参考文献

[1] 王欢, 高骞, 于亚峰. 长链非编码RNA在下咽鳞状细胞癌发病机制中的作用[J]. 国际耳鼻咽喉头颈外科杂志, 2022, 46(1): 36-40. doi:10.3760/cma.j.issn.1673-4106.2022.01.009. WANG Huan, GAO Qian, YU Yafeng. Role of long noncoding RNA in the pathogenesis of hypopharyngeal squamous cell carcinoma[J]. International Journal of Otolaryngology-Head and Neck Surgery, 2022, 46(1): 36-40. doi:10.3760/cma.j.issn.1673-4106.2022.01.009.
[2] Yuan X, Hsueh CY, Zhang M, et al. A nomogram for predicting occult lymph node metastasis in early hypopharyngeal cancer with cN0[J]. Eur Arch Otorhinolaryngol, 2021, 278(9): 3515-3522. doi:10.1007/s00405-021-06648-1.
[3] Abdeyrim A, He S, Zhang Y, et al. Prognostic value of lymph node ratio in laryngeal and hypopharyngeal squamous cell carcinoma: a systematic review and meta-analysis[J]. J Otolaryngol Head Neck Surg, 2020, 49(1): 31. doi:10.1186/s40463-020-00421-w.
[4] 姜凡, 陈庆, 赵强, 等. 高频超声与喉镜、CT在喉癌中的应用探讨[J]. 临床医学影像杂志, 1996(4): 239-240. JIANG Fan, CHEN Qing, ZHAO Qiang, et al. Application of high frequency ultrasound, laryngoscope and CT in laryngeal carcinoma[J]. Journal of China Clinic Medical Imaging, 1996(4): 239-240.
[5] 刘彬, 宫凤玲, 孙川, 等. CT平扫与对比增强扫描对下咽癌的诊断价值及对下咽癌侵犯周围结构的影像表现分析[J]. 实用癌症杂志, 2018, 33(3): 398-400. doi:10.3969/j.issn.1006-6586.2017.12.028. LIU Bin, GONG Fengling, SUN Chuan, et al. Analysis of the application value of plain CT scan and contrast-enhanced scan in the diagnosis of hypopharyngeal carcinoma and clinical manifestation of its adjacent structure[J]. The Practical Journal of Cancer, 2018, 33(3): 398-400. doi:10.3969/j.issn.1006-6586.2017.12.028.
[6] 魏巍巍. 螺旋CT三期增强扫描及其MPR、透明化VRT后处理技术在下咽癌中的应用价值研究[D]. 济南: 山东中医药大学, 2014.
[7] 赵杰, 黄岸瑞, 林惠兰, 等. CT仿真内镜技术在喉癌及下咽癌术前评估中的应用[J]. 中国继续医学教育, 2018, 10(2): 70-72. doi:10.3969/j.issn.1674-9308.2018.02.036. ZHAO Jie, HUANG Anrui, LIN Huilan, et al. Application of CT virtual endoscopy in preoperative evaluation of laryngeal carcinoma and hypopharyngeal carcinoma[J]. China Continuing Medical Education, 2018, 10(2): 70-72. doi:10.3969/j.issn.1674-9308.2018.02.036.
[8] Hsiao TY, Wang CL, Chen CN, et al. Noninvasive assessment of laryngeal phonation function using color Doppler ultrasound imaging[J]. Ultrasound Med Biol, 2001, 27(8): 1035-1040. doi:10.1016/s0301-5629(01)00399-4.
[9] 李永猛, 任光国. 彩色多普勒超声与CT检查术前评估食管癌颈部淋巴结转移的研究进展[J]. 中华消化外科杂志, 2015, 14(12): 1056-1059. doi:10.3760/cma.j.issn.1673-9752.2015.12.017. LI Yongmeng, REN Guangguo. Research progress of ultrasonography and computed tomography in the preoperative assessment of cervical lymph nodes metastases of esophageal cancer[J]. Chinese Journal of Digestive Surgery, 2015, 14(12): 1056-1059. doi:10.3760/cma.j.issn.1673-9752.2015.12.017.
[10] Guo JN, Song LH, Yu PY, et al. Ultrasound elastic parameters predict central lymph node metastasis of papillary thyroid carcinoma[J]. J Surg Res, 2020, 253: 69-78. doi:10.1016/j.jss.2020.03.042.
[11] 高晓倩, 姜震, 耿琛琛, 等. 术前超声评估分化型甲状腺癌颈部淋巴结转移[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 135-139. doi:10.6040/j.issn.1673-3770.0.2018.443. GAO Xiaoqian, JIANG Zhen, GENG Chenchen, et al. Preoperative ultrasonography in detecting cervical lymph node metastasis in differentiated thyroid cancer[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(1): 135-139. doi:10.6040/j.issn.1673-3770.0.2018.443.
[12] Pehlivan M, Gurbuz M, Cingi C, et al. Diagnostic role of ultrasound elastography on lymph node metastases in patients with head and neck cancer[J]. Braz J Otorhinolaryngol, 2019, 85(3): 297-302. doi:10.1016/j.bjorl.2018.01.002.
[13] van Overhagen H, Brakel K, Heijenbrok MW, et al. Metastases in supraclavicular lymph nodes in lung cancer: assessment with palpation, US, and CT[J]. Radiology, 2004, 232(1): 75-80. doi:10.1148/radiol.2321030663.
[14] Wagner JM, Alleman AM. Ultrasonography of cervical lymph nodes[J]. Radiol Clin North Am, 2019, 57(3): 485-500. doi:10.1016/j.rcl.2019.01.005.
[15] 中华耳鼻咽喉头颈外科杂志编辑委员会头颈外科组, 中华医学会耳鼻咽喉头颈外科学分会头颈外科学组. 下咽癌外科手术及综合治疗专家共识[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(1): 16-24. doi:10.3760/cma.j.issn.1673-0860.2017.01.004.
[16] Cooper JS, Porter K, Mallin K, et al. National Cancer Database report on cancer of the head and neck: 10-year update[J]. Head Neck, 2009, 31(6): 748-758. doi:10.1002/hed.21022.
[17] 姜超, 周炫辰, 韩杰, 等. IVc期下咽癌特征分析及列线图预后模型构建[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 49-54. doi:10.6040/j.issn.1673-3770.0.2021.278. JIANG Chao, ZHOU Xuanchen, HAN Jie, et al. Prevalence and prognostic nomogram for IVc stage hypopharyngeal carcinoma patients: a SEER population-based analysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 49-54. doi:10.6040/j.issn.1673-3770.0.2021.278.
[18] Kwon DI, Miles BA, Education Committee of the American Head and Neck Society(AHNS). Hypopharyngeal carcinoma: do You know your guidelines? [J]. Head Neck, 2019, 41(3): 569-576. doi:10.1002/hed.24752.
[19] De Virgilio A, Iocca O, Malvezzi L, et al. The emerging role of robotic surgery among minimally invasive surgical approaches in the treatment of hypopharyngeal carcinoma: systematic review and Meta-analysis[J]. J Clin Med, 2019, 8(2): E256. doi:10.3390/jcm8020256.
[20] 陶磊, 周梁, 张明, 等. 下咽癌预后改变及原因分析: 单中心2003—2007年与2010—2014年两个五年间数据对比[J]. 中华耳鼻咽喉头颈外科杂志, 2020(2): 116-124. doi:10.3760/cma.j.issn.1673-0860.2020.02.007. TAO Lei, ZHOU Liang, ZHANG Ming, et al. Changing trend in prognosis of primary hypopharyngeal carcinoma and reason analysis: date comparison of 2003-2007 and 2010-2014 in a single centre[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2020(2): 116-124. doi:10.3760/cma.j.issn.1673-0860.2020.02.007.
[21] 徐伟, 吕正华, 洒娜, 等. 264例下咽癌治疗与预后分析[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(5): 346-351. doi:10.3760/cma.j.issn.1673-0860.2018.05.004. XU Wei, LÜ Zhenghua, SA Na, et al. Treatment and prognosis of 264 patients with hypopharyngeal carcinoma[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2018, 53(5): 346-351. doi:10.3760/cma.j.issn.1673-0860.2018.05.004.
[22] 陶磊, 周梁, 吴海涛, 等. 154例cN0/cN1下咽鳞状细胞癌颈淋巴清扫效果及预后分析[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(4): 272-279. doi:10.3760/cma.j.issn.1673-0860.2019.04.007. TAO Lei, ZHOU Liang, WU Haitao, et al. Outcome of neck dissection for 154 CN0/cN1 patients with squamous cell carcinoma of hypopharynx and prognostic analysis[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2019, 54(4): 272-279. doi:10.3760/cma.j.issn.1673-0860.2019.04.007.
[23] 中国抗癌协会食管癌专业委员会, 中国下咽与食管癌协同诊疗工作组. 下咽与食管多原发癌筛查诊治中国专家共识[J]. 中华外科杂志, 2020, 58(8): 589-595. doi:10.3760/cma.j.cn112139-20200311-00210.
[24] 顾玉江, 胡颖. 彩色多普勒超声诊断喉癌的有效性及准确性探究[J]. 中国医学文摘(耳鼻咽喉科学), 2021, 36(1): 72-73, 78. doi:10.19617/j.issn1001-1307.2021.01.72. GU Yujiang, HU Ying. Study on the effectiveness and accuracy of color Doppler ultrasound in diagnosing laryngeal cancer[J]. Chinese Medical Digest(Otorhinolaryngology), 2021, 36(1): 72-73, 78. doi:10.19617/j.issn1001-1307.2021.01.72.
[25] 赵汉学, 朱强, 夏春霞, 等. 下咽癌的超声影像表现及其与CT对照[J]. 中国超声医学杂志, 2008, 24(10): 942-944. doi:10.3969/j.issn.1002-0101.2008.10.025. ZHAO Hanxue, ZHU Qiang, XIA Chunxia, et al. Ultrasonographic features of hypoplaaryngeal cancer: comparison with CT[J]. Chinese Journal of Ultrasound in Medicine, 2008, 24(10): 942-944. doi:10.3969/j.issn.1002-0101.2008.10.025.
[26] Esen G. Ultrasound of superficial lymph nodes[J]. Eur J Radiol, 2006, 58(3): 345-359. doi:10.1016/j.ejrad.2005.12.039.
[27] 董梦丽, 周梦倩, 张露, 等. 下咽癌颈淋巴结转移的规律及其对预后的影响[J]. 中国肿瘤临床, 2018, 45(9): 462-467. doi:10.3969/j.issn.1000-8179.2018.09.275. DONG Mengli, ZHOU Mengqian, ZHANG Lu, et al. Cervical lymph node metastasis regularity of hypopharyngeal carcinoma and its influence on prognosis[J]. Chinese Journal of Clinical Oncology, 2018, 45(9): 462-467. doi:10.3969/j.issn.1000-8179.2018.09.275.
[28] 王冬青, 马彦丽, 翟利民, 等. 81例下咽癌淋巴结转移情况分析[J]. 中华肿瘤防治杂志, 2018, 25(22): 1573-1577. doi:10.16073/j.cnki.cjcpt.2018.22.007. WANG Dongqing, MA Yanli, ZHAI Limin, et al. Analysis of lymph node metastasis for eighty-one hypopharyngeal carcinoma[J]. Chinese Journal of Cancer Prevention and Treatment, 2018, 25(22): 1573-1577. doi:10.16073/j.cnki.cjcpt.2018.22.007.
[29] 吕正华, 徐伟, 洒娜, 等. 咽后淋巴清扫在下咽癌治疗中的意义[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(5): 359-363. doi:10.3760/cma.j.issn.1673-0860.2018.05.006. LÜ Zhenghua, XU Wei, SA Na, et al. Significance of retropharyngeal node dissection in treatment of hypopharyngeal carcinoma[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2018, 53(5): 359-363. doi:10.3760/cma.j.issn.1673-0860.2018.05.006.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed