Strassen Ulrich, Geisweid Christina, Hofauer Benedikt, Knopf Andreas
Department of Otorhinolaryngology/Head and Neck Surgery, Technical University of Munich, Munich, Germany.
Laryngoscope. 2018 Apr;128(4):859-863. doi: 10.1002/lary.26837. Epub 2017 Aug 22.
OBJECTIVES/HYPOTHESIS: The spectrum of differential diagnosis in cervical lymphadenopathy is extremely broad. In lymphoma and inflammatory diseases, surgical approaches are restricted to diagnostic lymph extirpation, whereas metastatic outgrowth into regional lymph nodes usually requires neck dissection. Lymph node surgery has to manage the balancing act between sufficient radicality and preservation of functional structures. The current study, therefore, aimed to identify parameters to differentiate between lymph nodes of lymphatic and metastatic origin.
Single-center, retrospective cohort study.
Clinical and sonographic parameters from all patients who underwent diagnostic cervical lymphadenectomy from 2010 to 2015 (N = 262) were included in this retrospective analysis. Parameters with significant differences between the two subgroups were utilized to create a clinical algorithm to distinguish between cervical lymphadenopathy of lymphatic and metastatic genesis.
Statistically significant differences between the two subgroups could be shown for clinical (gender, age, nicotine/alcohol abuse, B symptoms, history of cutaneous melanoma, or lymphoma) and ultrasonographic parameters (string-of-beads confirmation, bilaterality, homogenous echostructure, localization in level I, long-to-short axis ratio, and hilar vascularity). The proposed algorithm yielded a sensitivity of 92.4% for metastatic disease.
The implemented algorithm based on ultrasonographic and clinical criteria contributes to one-step surgical approaches that guarantee a sufficient radicality with a minimum of functional loss.
目的/假设：颈部淋巴结病的鉴别诊断范围极为广泛。在淋巴瘤和炎症性疾病中，手术方法仅限于诊断性淋巴结切除，而区域淋巴结的转移灶通常需要进行颈部清扫术。淋巴结手术必须在足够的根治性和功能结构保留之间找到平衡。因此，本研究旨在确定区分淋巴源性和转移性淋巴结的参数。
单中心回顾性队列研究。
本回顾性分析纳入了2010年至2015年期间接受诊断性颈部淋巴结切除术的所有患者（N = 262）的临床和超声参数。利用两个亚组之间存在显著差异的参数创建一种临床算法，以区分淋巴源性和转移性颈部淋巴结病。
两个亚组在临床（性别、年龄、吸烟/酗酒、B症状、皮肤黑色素瘤或淋巴瘤病史）和超声参数（串珠征确认、双侧性、均匀回声结构、I区定位、长短轴比和门部血管）方面存在统计学显著差异。所提出的算法对转移性疾病的敏感性为92.4%。
基于超声和临床标准实施的算法有助于采用一步手术方法，在功能损失最小的情况下保证足够的根治性。
4。《喉镜》，2018年，第128卷，第859 - 863页。
