Lyu J Y, Liang F Y, Han P, Huang X M
Department of otorhinolaryngology, Jiangmen Central Hospital, Jiangmen 529000, China.
Department of otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China.
Zhonghua Zhong Liu Za Zhi. 2017 May 23;39(5):384-388. doi: 10.3760/cma.j.issn.0253-3766.2017.05.013.
To evaluate the diagnostic value of the endoscopic biopsy operation to the lesions of the skull base in the patients with nasopharyngealcarcinoma after radiotherapy. From February 2006 to February 2010, 84 patients with nasopharyngeal carcinoma suffered from the lesions of the skull base after radiotherapy were included in this study. The relationship between the pathologic results of endoscopic biopsies from the skull base and the imaging results by Magnetic Resonance Imaging(MRI) was compared and discussed. The relationship between the pathologic results and more than 2-years' follow-up was also investigated. There were 71 cases with clivus, 5 cases with pterygopalatine fossa and infratemporal fossa, 4 cases with parapharyngeal space, and 4 cases with cavernous sinus. The pathologic results of endoscopic biopsies indicated that 35 cases with recurrence including 30 case with poorly differentiated squamous cell carcinomas, 5 cases with cancer nests, 49 cases with non-tumor. Chi-square test showed that there was close relationship between MRI and pathologic results (<0.05). In the patients followed up over 2 years, the pathologic results showed 28 cases with recurrence, 48 cases with non-tumor. MRI showed 36 cases with recurrence, 40 cases with non-tumor. But during follow-up, 30 cases were proved to be recurrent and 46 cases had non-tumor. However, Chi-square test showed that there was no statistically significance between the pathological results and follow-up(=0.62). The sensitivity, specificity and diagnostic accuracy of the endoscopic diagnosis were 90.0%, 97.8% and 95.0%. Chi-square test also showed that there was no statistically significance between MRI and follow-up (=0.24). The sensitivity, specificity and diagnostic accuracy of MRI were 80.0%, 73.9% and 76.0%. The endoscopic method is a specific, sensitive, safe, effective and minimally invasive in diagnosis of lesions of the skull base in postradiotherapeutic patients with nasopharyngeal carcinoma.
评估鼻内镜活检术对鼻咽癌放疗后颅底病变的诊断价值。选取2006年2月至2010年2月期间84例鼻咽癌放疗后出现颅底病变的患者，比较并探讨鼻内镜颅底活检病理结果与磁共振成像（MRI）影像学结果的关系，同时研究病理结果与2年以上随访情况的关系。其中斜坡病变71例，翼腭窝及颞下窝病变5例，咽旁间隙病变4例，海绵窦病变4例。鼻内镜活检病理结果显示，复发35例，其中低分化鳞状细胞癌30例，癌巢5例，非肿瘤49例。卡方检验显示，MRI与病理结果之间存在密切关系（<0.05）。在随访2年以上的患者中，病理结果显示复发28例，非肿瘤48例；MRI显示复发36例，非肿瘤40例。但随访期间，证实复发30例，非肿瘤46例。然而，卡方检验显示，病理结果与随访之间无统计学意义（=0.62）。鼻内镜诊断的敏感性、特异性和诊断准确性分别为90.0%、97.8%和95.0%。卡方检验还显示，MRI与随访之间无统计学意义（=0.24）。MRI的敏感性、特异性和诊断准确性分别为80.0%、73.9%和76.0%。鼻内镜方法在鼻咽癌放疗后患者颅底病变诊断中具有特异性、敏感性、安全性、有效性和微创性。
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