超声检查在舌癌患者颈部淋巴结转移检测中的应用：早期检测标准及随访检查间隔评估
Sonography for the detection of cervical lymph node metastases among patients with tongue cancer: criteria for early detection and assessment of follow-up examination intervals.
作者信息
Yuasa K, Kawazu T, Kunitake N, Uehara S, Omagari J, Yoshiura K, Nakayama E, Kanda S
机构信息
Department of Oral and Maxillofacial Radiology, Kyushu Medical Center, New Koga Hospital, Kurume, Japan.
出版信息
AJNR Am J Neuroradiol. 2000 Jun-Jul;21(6):1127-32.
BACKGROUND AND PURPOSE
Because the presence of cervical metastasis is one of the factors influencing the outcome of patients with carcinoma of the head and neck, its early detection is potentially very important. The purpose of this study was to evaluate the characteristic changes of cervical metastasis revealed by sonography during follow-up and to assess an adequate interval for follow-up sonography of the neck among patients with tongue cancer.
METHODS
Forty-three of 44 consecutive patients with squamous cell carcinoma of the tongue, who had undergone interstitial brachytherapy, were examined with sonography of the neck during the posttherapeutic follow-up period.
RESULTS
Seventeen cervical lymph node metastases were found in 12 of 43 patients during follow-up. Of these 17 cervical metastases, 16 (94.1%) were accurately diagnosed and one (5.9%) was misdiagnosed as nonmetastatic based on sonographic findings. Sonography of the neck performed in seven patients at an interval of less than 1 month since the last follow-up imaging showed 9 (90.0%) of 10 metastases increased by up to 2 mm in short-axis diameter. Five patients who were followed up at an interval of more than 1 month since the last follow-up imaging had seven metastases increase by 3 to 8 mm in short-axis diameter or a change of echogenicity in the internal structure of lymph nodes or both. Pathologic examinations showed extranodal spread in 3 (42.9%) of these 7 metastases.
CONCLUSION
Changes both in size and internal echogenicity can occur as quickly as 2 to 4 weeks between sonographic examinations. Therefore, in high-risk patients, or in those with suspicious sonographic findings, short-interval follow-up sonographic examinations are recommended at least during the first posttherapeutic year. Our findings suggest that follow-up sonography of the neck should be performed monthly, at least during the first posttherapeutic year.
背景与目的
由于颈部转移的存在是影响头颈部癌患者预后的因素之一，其早期检测可能非常重要。本研究的目的是评估超声检查在随访期间发现的颈部转移的特征性变化，并评估舌癌患者颈部超声随访的合适间隔时间。
方法
44例连续接受间质近距离放疗的舌鳞状细胞癌患者中，43例在治疗后随访期间接受了颈部超声检查。
结果
43例患者中有12例在随访期间发现17处颈部淋巴结转移。在这17处颈部转移中，根据超声检查结果，16处（94.1%）被准确诊断，1处（5.9%）被误诊为无转移。自上次随访成像后间隔不到1个月对7例患者进行的颈部超声检查显示，10处转移中有9处（90.0%）短轴直径增加了2毫米。自上次随访成像后间隔超过1个月进行随访的5例患者有7处转移，短轴直径增加了3至8毫米，或淋巴结内部结构的回声发生改变，或两者皆有。病理检查显示，这7处转移中有3处（42.9%）存在结外扩散。
结论
超声检查之间，淋巴结大小和内部回声可能在2至4周内迅速发生变化。因此，对于高危患者或超声检查结果可疑的患者，建议至少在治疗后的第一年进行短间隔的超声随访检查。我们的研究结果表明，颈部超声随访应每月进行一次，至少在治疗后的第一年。
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