Wong Kai-Pun, Woo Jung-Woo, Youn Yeo-Kyu, Chow Felix Che-Lok, Lee Kyu Eun, Lang Brian Hung-Hin
Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Surgery. 2014 Dec;156(6):1590-6; discussion 1596. doi: 10.1016/j.surg.2014.08.061. Epub 2014 Nov 11.
During examination of the vocal cords (VC) using transcutaneous laryngeal ultrasonography (TLUSG), 3 sonographic landmarks (namely, false VC [FC], true VC [TC], and arytenoids [AR]) are often seen. However, it remains unclear which landmark provides a more reliable assessment and whether seeing more landmarks improves the diagnostic accuracy and reliability.
We evaluated prospectively 245 patients from 2 centers. One assessor from each center performed all TLUSG examinations and their findings were validated by direct laryngoscopy. All 3 sonographic landmarks were routinely visualized whenever possible. The rate of visualization and diagnostic accuracy between the 3 landmarks were compared.
Eighteen patients suffered postoperative VC palsy (VCP). Both centers had comparable visualization or assessability rate of ≥ 1 sonographic landmark (94.9 and 95.3%; P = 1.000) and 100% sensitivity on postoperative TLUSG. The rates of FC, TC, and AR visualization were 92.7%, 36.7%, and 89.8%, respectively. The sensitivity, specificity, and diagnostic accuracy and the proportion of true positives, false positives, and true negatives between using 1, 2, landmarks and 3 landmarks were comparable (P > .05).
Each sonographic landmark had similar reliability and diagnostic accuracy. Identifying all 3 sonographic landmarks was not mandatory and visualizing normal movement in one of the sonographic landmarks would be sufficient to exclude VCP.
在使用经皮喉超声检查（TLUSG）检查声带（VC）时，经常可以看到3个超声标志（即假声带[FC]、真声带[TC]和杓状软骨[AR]）。然而，尚不清楚哪个标志能提供更可靠的评估，以及看到更多标志是否能提高诊断准确性和可靠性。
我们前瞻性地评估了来自2个中心的245例患者。每个中心的一名评估者进行了所有的TLUSG检查，其结果通过直接喉镜检查进行验证。只要有可能，所有3个超声标志都会常规显示。比较了这3个标志之间的显示率和诊断准确性。
18例患者术后出现声带麻痹（VCP）。两个中心的≥1个超声标志的显示率或可评估率相当（分别为94.9%和95.3%；P = 1.000），术后TLUSG的敏感性为100%。FC、TC和AR的显示率分别为92.7%、36.7%和89.8%。使用1个、2个标志和3个标志时的敏感性、特异性、诊断准确性以及真阳性、假阳性和真阴性比例相当（P > 0.05）。
每个超声标志具有相似的可靠性和诊断准确性。识别所有3个超声标志并非必需，在其中一个超声标志中观察到正常运动就足以排除VCP。
