Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Oral Oncol. 2012 May;48(5):450-5. doi: 10.1016/j.oraloncology.2011.12.003. Epub 2012 Jan 4.
The presence of paratracheal lymph node (PTLN) metastasis harbours a worse prognosis. Uniform guidelines on PTLN dissection are missing, mainly because of the value of diagnostic techniques for the detection of PTLN metastasis are not clear. This study is performed to identify CT and MRI criteria for detection of PTLN metastasis. 149 patients who underwent laryngectomy and a PTLN dissection between 1990 and 2010 were included. Patient, tumour, treatment and follow up data were collected. On computed tomography (CT) and magnetic resonance imaging (MRI) different test criteria were examined. Considering PTLN with a maximal axial diameter of ≥5 mm as positive predicts PTLN metastasis best: sensitivity and specificity 70% and 36% (CT) and 50% and 71% (MRI). Other risk factors for PTLN metastasis were subglottic extension of the tumour (sensitivity is 45%) and clinical positive neck status (sensitivity is 59%). When at least one of these risk factors was present and the status of PTLN was considered positive, a high sensitivity (90% for CT and 100% for MRI) and a lower specificity (19% for CT and 32% for MRI) was found. If at least one of the risk factors such as subglottic extension, clinical positive neck and PTLN with a maximal axial diameter of ≥5 mm is present, sensitivity and negative predictive value for the prediction of PTLN metastasis are high, but the specificity is low. These risk factors can be used to select laryngectomy patients for PTLN dissection.
存在气管旁淋巴结（PTLN）转移预示着预后更差。目前尚缺乏关于 PTLN 解剖的统一指南，主要是因为诊断技术检测 PTLN 转移的价值尚不清楚。本研究旨在确定 CT 和 MRI 检测 PTLN 转移的标准。1990 年至 2010 年间，共有 149 例患者接受了喉切除术和 PTLN 解剖，收集了患者、肿瘤、治疗和随访数据。在计算机断层扫描（CT）和磁共振成像（MRI）上检查了不同的测试标准。考虑到 PTLN 的最大轴向直径≥5mm 为阳性，可最好地预测 PTLN 转移：CT 的敏感性和特异性分别为 70%和 36%，MRI 的敏感性和特异性分别为 50%和 71%。PTLN 转移的其他危险因素包括肿瘤声门下延伸（敏感性为 45%）和临床阳性颈部状态（敏感性为 59%）。当存在至少一个这些危险因素且 PTLN 状态被认为是阳性时，CT 的敏感性（90%）和 MRI 的敏感性（100%）较高，特异性（CT 为 19%，MRI 为 32%）较低。如果至少存在声门下延伸、临床阳性颈部和 PTLN 最大轴向直径≥5mm 等危险因素，那么预测 PTLN 转移的敏感性和阴性预测值较高，但特异性较低。这些危险因素可用于选择接受 PTLN 解剖的喉切除术患者。
