Mo Ligen, Kuang Guoqian, Huang Guangwu, Yang Rongning
Department of Head and Neck Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, 530021, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2007 Dec;21(24):1124-6.
To investigate the effects of situation of misdiagnosis of nasopharyngeal carcinoma (NPC) on distant metastasis.
The history of diagnosis and treatment of 85 newly diagnosed cases with nasopharyngeal carcinoma were studied by using itemized questionnaire purposely; 433 patients with different prognosis were analyzed retrospectively for the misdiagnoses and mistreatment, including surgical biopsy in the neck.
(1) The rate of misdiagnosis of 85 patients was 72.64%, and the percentage decreased as the level of the hospitals increased; the majority of the patients (77.36%) were diagnoses within 1 month after the first symptom had appeared; the number of diseases misdiagnosed was 20, most common of which were lymphnoditis, tuberculosis of lymph node and secretory tympanitis; (2) Our data showed that among 433 patients analysed retrospectively, 60 cases had undergone surgical biopsy in the neck, 75% of whom had never received nasopharyngeal biopsy; 43 cases had underwent nasopharyngeal biopsy after the pathological diagnosis as metastatic carcinoma of neck biopsy (71.67%) and the rest (20.0%) received radiotherapy directly or after negative nasopharyngeal biopsy for merely 1 to 4 times; of those 43 cases who were diagnosed as NPC by nasopharyngeal biopsy, 79.17% got positive results at first sampling. (3) Rate of misdiagnosis and mistreatment including surgical biopsy in the neck of patients who had been tumor-free for 5 years or above was significantly lower than that of those who experienced distant metastasis after or before treatment (P < 0.05).
Misdiagnosis and mistreatment including biopsy by surgery of neck is common even in high-grade hospitals; it is doctor that is responsible for this situation; the high occurrence rate of misdiagnosis and mistreatment, biopsy by neck surgery, especially the delayed treatment after the neck biopsy are the factors that contribute to distant metastasis of NPC.
探讨鼻咽癌（NPC）误诊情况对远处转移的影响。
采用专项问卷对85例新诊断的鼻咽癌患者的诊治史进行研究；对433例不同预后的患者进行回顾性分析，包括颈部手术活检的误诊和误治情况。
（1）85例患者的误诊率为72.64%，误诊率随医院级别升高而降低；大多数患者（77.36%）在出现首发症状后1个月内确诊；误诊疾病有20种，最常见的是淋巴结炎、淋巴结结核和分泌性中耳炎；（2）我们的数据显示，在回顾性分析的433例患者中，60例接受了颈部手术活检，其中75%从未接受过鼻咽活检；43例在颈部活检病理诊断为转移性癌后进行了鼻咽活检（71.67%），其余（20.0%）直接或在鼻咽活检阴性仅1至4次后接受了放疗；在这43例经鼻咽活检诊断为NPC的患者中，79.17%首次采样结果为阳性。（3）5年及以上无瘤患者的误诊和误治率，包括颈部手术活检，明显低于治疗后或治疗前发生远处转移的患者（P<0.05）。
即使在高级别医院，包括颈部手术活检在内的误诊和误治也很常见；这种情况应由医生负责；误诊和误治的高发生率、颈部手术活检，尤其是颈部活检后的延迟治疗是导致NPC远处转移的因素。
