Dabirmoghaddam Payman, Sharifkashany Shervin, Mashali Leila
Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Radiol. 2014 Aug;11(3):e7928. doi: 10.5812/iranjradiol.7928. Epub 2014 Aug 1.
In head and neck cancer patients, diagnosis of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymph node (N0) remains controversial. While routine neck treatment would result in overtreatment in many patients, observation may delay the diagnosis and decrease the patients' survival.
To gain insights into the unclear questions regarding the value of diagnostic modalities in patients with N0 neck, this study was designed to compare the diagnostic efficacy of palpation, ultrasonography (US) and ultrasound-guided fine needle aspiration (USGFNA) in detecting cervical lymph node metastasis.
Forty-two patients with head and neck cancer who underwent US and USGFNA prior to elective neck dissection were studied. Histopathologic findings of the neck specimens were compared with each diagnostic technique.
Of the 53 neck dissection specimens, histopathology showed metastases in 16 cases. The overall accuracy of USGFNA, US and palpation was 96%, 68% and 70%, respectively. The specificity of USGFNA was superior to palpation and US alone. USGFNA had the highest sensitivity, predictive value and accuracy in detecting cervical metastases compared with other performed tests.
In our study, USGFNA was superior to palpation and US in detecting metastasis in clinically negative necks. This method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis, but further investigations are needed before this modality could be considered as an alternative to elective neck dissection.
在头颈癌患者中，转移性颈部淋巴结病的诊断对于治疗方案规划和预后评估至关重要。对头颈癌伴临床阴性颈部淋巴结（N0）患者的治疗仍存在争议。虽然常规颈部治疗会导致许多患者过度治疗，但观察可能会延迟诊断并降低患者生存率。
为深入了解关于N0颈部患者诊断方法价值的不明问题，本研究旨在比较触诊、超声（US）和超声引导下细针穿刺抽吸（USGFNA）在检测颈部淋巴结转移方面的诊断效能。
研究了42例在择期颈部清扫术前接受US和USGFNA检查的头颈癌患者。将颈部标本的组织病理学结果与每种诊断技术进行比较。
在53例颈部清扫标本中，组织病理学显示16例有转移。USGFNA、US和触诊的总体准确率分别为96%、68%和70%。USGFNA的特异性优于单独的触诊和US。与其他所进行的检查相比，USGFNA在检测颈部转移方面具有最高的敏感性、预测价值和准确性。
在我们的研究中，USGFNA在检测临床阴性颈部的转移方面优于触诊和US。该方法可推荐作为术前评估无可触及转移患者的诊断工具，但在该方法可被视为择期颈部清扫的替代方法之前，还需要进一步研究。
