Tan Ann, Adelstein David J, Rybicki Lisa A, Saxton Jerrold P, Esclamado Ramon M, Wood Benjamin G, Lorenz Robert R, Strome Marshall, Carroll Marjorie A
Taussig Cancer Center, Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH 44195, USA.
Arch Otolaryngol Head Neck Surg. 2007 May;133(5):435-40. doi: 10.1001/archotol.133.5.435.
To report our experience using the neck examination, computed tomography (CT), and positron emission tomography (PET) to clinically evaluate node-positive patients with head and neck squamous cell cancer for residual neck node disease after definitive chemoradiotherapy.
Retrospective review of all Cleveland Clinic patients with head and neck squamous cell cancer and N2 or N3 neck node involvement at presentation who were treated with definitive concurrent chemoradiotherapy and who underwent clinical restaging after treatment using the neck examination, CT, and PET.
Tertiary care referral institution.
Forty-eight patients with 72 positive necks at diagnosis were followed up for a median of 20 months.
Palpable nodes on examination, nodes larger than 1 cm, nodes with central necrosis on CT, or any hypermetabolic lymph nodes on PET were considered clinical evidence of residual nodal disease. The true rate of pathologic involvement was determined by histologic examination after planned neck dissection or if regional recurrence developed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for all 3 clinical assessment tools.
Planned neck dissection was performed in 33 necks and was positive for residual neck node disease in 5 necks. A delayed neck dissection was performed in 5 necks and was positive in 3 necks. The positive predictive value was low for all 3 clinical assessment tools. The addition of PET did not significantly improve the negative predictive value or positive predictive value of CT and the clinical examination.
Residual neck node disease after definitive chemoradiotherapy was infrequent and was not well predicted by PET. A positive PET finding in this setting is of little utility. Although a negative PET finding was highly predictive for control of neck disease after chemoradiotherapy, it added little to the clinical neck examination and CT.
报告我们运用颈部检查、计算机断层扫描（CT）和正电子发射断层扫描（PET）对确诊为头颈部鳞状细胞癌且颈部淋巴结阳性的患者进行临床评估，以判断其在根治性放化疗后颈部淋巴结是否存在残留病灶的经验。
对所有克利夫兰诊所就诊的头颈部鳞状细胞癌患者进行回顾性研究，这些患者初诊时颈部淋巴结为N2或N3受累，接受了根治性同步放化疗，并在治疗后通过颈部检查、CT和PET进行临床再分期。
三级医疗转诊机构。
48例患者在诊断时有72个阳性颈部淋巴结，中位随访时间为20个月。
检查时可触及的淋巴结、直径大于1 cm的淋巴结、CT显示有中央坏死的淋巴结或PET显示的任何高代谢淋巴结均被视为残留淋巴结疾病的临床证据。病理受累的真实发生率通过计划的颈部清扫术后的组织学检查确定，或者在出现区域复发时确定。计算了所有3种临床评估工具的敏感性、特异性、阳性预测值、阴性预测值和准确性。
对33个颈部进行了计划的颈部清扫，其中5个颈部残留颈部淋巴结疾病呈阳性。对5个颈部进行了延迟颈部清扫，其中3个颈部呈阳性。所有3种临床评估工具的阳性预测值均较低。PET的加入并未显著提高CT和临床检查的阴性预测值或阳性预测值。
根治性放化疗后残留颈部淋巴结疾病并不常见，PET对其预测效果不佳。在这种情况下，PET阳性结果用处不大。虽然PET阴性结果对放化疗后颈部疾病的控制具有高度预测性，但它对临床颈部检查和CT的补充作用不大。
