Souter M A, Allison R S, Clarkson J H, Cowan I A, Coates M H, Wells J E
Department of Otolaryngology Head Neck Surgery, Christchurch Hospital, Christchurch, New Zealand.
J Laryngol Otol. 2009 Jul;123(7):778-82. doi: 10.1017/S0022215109004332. Epub 2009 Jan 12.
To estimate the sensitivity and specificity of computed tomography used for the detection of extranodal spread of metastatic head and neck squamous cell carcinoma, by experienced head and neck radiologists.
Participants had undergone a neck dissection for head and neck squamous cell carcinoma, together with computed tomography scanning prior to surgery (accessible for reporting). Computed tomography images were independently examined by two experienced head and neck radiologists. Nodal involvement by squamous cell carcinoma and the presence or absence of extranodal spread were recorded. Results were compared to the histological specimen. The sensitivity, specificity and positive predictive value of using computed tomography for the detection of nodal involvement and presence or absence of extranodal spread were estimated, and 95 per cent confidence intervals were calculated.
The study analysed 149 neck dissections. When using computed tomography to detect the extranodal spread of head and neck squamous cell carcinoma, radiologists A and B had sensitivities of 66 and 80 per cent, specificities of 91 and 90 per cent, and positive predictive values of 85 and 87 per cent, respectively.
The sensitivity and specificity of radiological detection of extranodal spread from head and neck squamous cell carcinoma is not well reported in the literature. Accuracy of reporting improves in the hands of experienced head and neck radiologists. This finding has clinical implications for surgical planning and adjuvant therapy requirements.
由经验丰富的头颈放射科医生评估计算机断层扫描用于检测转移性头颈鳞状细胞癌结外扩散的敏感性和特异性。
参与者因头颈鳞状细胞癌接受了颈部清扫术，且术前进行了计算机断层扫描（可供报告使用）。计算机断层扫描图像由两位经验丰富的头颈放射科医生独立检查。记录鳞状细胞癌的淋巴结受累情况以及结外扩散的有无。将结果与组织学标本进行比较。评估使用计算机断层扫描检测淋巴结受累及结外扩散有无的敏感性、特异性和阳性预测值，并计算95%置信区间。
该研究分析了149例颈部清扫术。在使用计算机断层扫描检测头颈鳞状细胞癌的结外扩散时，放射科医生A和B的敏感性分别为66%和80%，特异性分别为91%和90%，阳性预测值分别为85%和87%。
关于头颈鳞状细胞癌结外扩散的放射学检测的敏感性和特异性在文献中报道较少。在经验丰富的头颈放射科医生手中，报告的准确性会提高。这一发现对手术规划和辅助治疗需求具有临床意义。
