Gobbi Paolo G, Broglia Chiara, Carnevale Maffè Gabriella, Ruga Alberto, Molinari Ermete, Ascari Edoardo
Medicina Interna e Oncologia Medica, Università di Pavia, IRCCS Policlinico S. Matteo, Italy.
Haematologica. 2002 Nov;87(11):1151-6.
Superficial lymph nodes in lymphoma management are usually evaluated by physical examination. However the accuracy of this assessment has not been thoroughly tested and so it remains debated whether physical examination can meet the international requirements for clinical evaluation and response assessment.
Palpatory size estimates of lymph nodes in 97 lymphoma patients were separately compared with ultrasonographic (US) measurements in cervical, supraclavicular, axillary and inguinal regions. Comparisons were made between the products of lymph node cross-sectional diameters, whose changes are critical to assess response. Statistical analysis was carried out by simple linear regression, in which the palpatory estimate was entered as the mean of the measurements separately taken by two different clinicians and the dependent variable was the US measurement.
Physical examination tended to underestimate the lymph node size in all regions but appeared to be closely related to US measurements. However, while R2 was very high for cervical and inguinal lymph nodes (0.902 and 0.802, respectively), it was disappointingly low for lymph nodes in supraclavicular and axillary regions (0.529 and 0.368, respectively).
This indicates that, with the current response criteria, pre- and post-treatment evaluation of cervical and inguinal lymph nodes makes substantial errors in 20-30% of cases when left to physical examination alone. Errors are even more numerous in supraclavicular and axillary regions. Thus, physical evaluation of superficial lymph nodes should be integrated by US or other imaging techniques for accurate fulfilment of the current standardized guidelines for response assessment.
在淋巴瘤的治疗中，浅表淋巴结通常通过体格检查进行评估。然而，这种评估的准确性尚未得到充分验证，因此体格检查是否能够满足临床评估和反应评估的国际要求仍存在争议。
分别将97例淋巴瘤患者颈部、锁骨上、腋窝和腹股沟区域淋巴结的触诊大小估计值与超声（US）测量值进行比较。对淋巴结横截面积乘积进行比较，其变化对于评估反应至关重要。采用简单线性回归进行统计分析，其中触诊估计值取两位不同临床医生分别测量值的平均值，因变量为US测量值。
体格检查在所有区域均倾向于低估淋巴结大小，但似乎与US测量值密切相关。然而，虽然颈部和腹股沟淋巴结的R2值非常高（分别为0.902和0.802），但锁骨上和腋窝区域淋巴结的R2值却低得令人失望（分别为0.529和0.368）。
这表明，按照当前的反应标准，仅依靠体格检查对颈部和腹股沟淋巴结进行治疗前和治疗后的评估，在20% - 30%的病例中会出现较大误差。在锁骨上和腋窝区域，误差更为常见。因此，浅表淋巴结的体格评估应结合US或其他成像技术，以准确满足当前反应评估的标准化指南要求。
