Akoğlu Ertap, Dutipek Murat, Bekiş Recep, Değirmenci Berna, Ada Emel, Güneri Ataman
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Mustafa Kemal University, Ankakya, Hatay, Turkey.
J Otolaryngol. 2005 Dec;34(6):384-94. doi: 10.2310/7070.2005.34605.
To determine the predictive value of different imaging methods,-computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and single-photon emission tomography (SPECT),-for cervical node metastasis.
Prospective clinical trial.
An academic otolaryngology department.
Twenty-three consecutive patients with head and neck malignancy were prospectively evaluated for the presence of cervical lymphadenopathy. All patients underwent clinical, CT, MRI, US, and SPECT examinations. Neck dissection was performed for 31 neck sides, and the results of the preoperative evaluation were confirmed by the surgical and histopathologic findings.
The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for each method and a comparison of the methods was done.
The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT, MRI, US, and SPECT were 77.7%, 85.7%, 91.3%, 66.6%, and 80.4%; 59.2%, 92.8%, 94.1%, 54.1%, and 70.7%; 81.4%, 64.2%, 81.4%, 64.2%, and 75.6%; 55.5%, 92.8%, 93.7%, 52.0%, and 68.2%, respectively. Both CT and US were found to be superior to clinical examination. There was no statistically significant difference between US and CT. US was found to be superior to MRI and SPECT in detecting cervical node metastasis. CT was also superior to SPECT.
Our data show that, despite high specificity rates, especially with SPECT, none of the currently available imaging methods are reliable in evaluating the occult regional metastasis because the negative predictive values of all of these methods are rather low.
确定不同成像方法——计算机断层扫描（CT）、磁共振成像（MRI）、超声检查（US）和单光子发射断层扫描（SPECT）——对颈部淋巴结转移的预测价值。
前瞻性临床试验。
一个学术性耳鼻喉科科室。
对23例连续的头颈部恶性肿瘤患者进行前瞻性评估，以确定是否存在颈部淋巴结病。所有患者均接受了临床、CT、MRI、US和SPECT检查。对31个颈部侧面进行了颈淋巴结清扫术，术前评估结果通过手术和组织病理学检查得以证实。
计算每种方法的敏感性、特异性、阳性预测值、阴性预测值和准确性，并对这些方法进行比较。
CT、MRI、US和SPECT的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为77.7%、85.7%、91.3%、66.6%和80.4%；59.2%、92.8%、94.1%、54.1%和70.7%；81.4%、64.2%、81.4%、64.2%和75.6%；55.5%、92.8%、93.7%、52.0%和68.2%。发现CT和US均优于临床检查。US和CT之间无统计学显著差异。在检测颈部淋巴结转移方面，US优于MRI和SPECT。CT也优于SPECT。
我们的数据表明，尽管特异性率较高，尤其是SPECT，但目前可用的成像方法在评估隐匿性区域转移方面均不可靠，因为所有这些方法的阴性预测值都相当低。
