Ge Xi Feng, Li Lei, Cui Li Gang, Xue Heng
Department of Ultrasound, Third Hospital,Beijing 100191,China.
Department of General Surgery,Peking University,Third Hospital,Beijing 100191,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2018 Oct 30;40(5):680-684. doi: 10.3881/j.issn.1000-503X.10275.
Objective To investigate the diagnostic value of elasticity contrast index(ECI)in the differential diagnosis between benign and malignant cervical lymph nodes.Methods Cervical lymph nodes of 48 patients were examined by traditional ultrasound and ECI in Peking University Third Hospital between December 2016 and April 2017. Patients were further divided into free-hand group and non-free-hand group according to the use of manual compression or not. With pathological or clinical follow-up results as the gold standard,we compared the diagnostic values of traditional ultrasound,ECI,and their combination in the differential diagnosis between benign and malignant lymph nodes.Results Totally 138 lymph nodes were collected from 46 patients,among which 76 were benign and 62 were malignant. The ECI value of malignant lymph nodes(1.69±0.89)were significantly higher than that of benign lymph nodes(1.32±0.87)(t=-2.46,P=0.015).The area under receiver operating characteristic(ROC)curve for traditional ultrasound in discrimination of malignant cervical lymph nodes with benign ones was 0.899,with an optimal cut-off value of 7,which had a sensitivity of 93.5% and a specificity of 84.2%. The area under ROC curve for ECI was 0.649,with an optimal cut-off value of 1.25,which had a sensitivity of 59.7% and a specificity of 60.5%. For their combination,the area under ROC curve was 0.724,with a sensitivity of 93.5% and a specificity of 51.3%. In the group without using free-hand technique,the mean ECI value was 1.77±0.94 for malignant nodes,which was significantly higher than that(1.26±0.81)for benign nodes(t=-3.09,P=0.003). In the group requiring free-hand technique,the ECI value for malignant nodes was 1.33(1.01,1.44),showing no significant difference with benign ones[1.32(0.78,2.18);z=-0.20,P=0.843].Conclusions Conventional ultrasound has higher diagnostic value than ECI and their combination in differentiating benign and malignant lymph nodes. The role of ECI in evaluating other organs requires further investigations.
目的 探讨弹性对比指数（ECI）在宫颈良恶性淋巴结鉴别诊断中的价值。方法 2016年12月至2017年4月在北京大学第三医院对48例患者的颈部淋巴结进行传统超声和ECI检查。根据是否使用手法压迫将患者进一步分为手法组和非手法组。以病理或临床随访结果作为金标准，比较传统超声、ECI及其联合应用在良恶性淋巴结鉴别诊断中的价值。结果 共收集46例患者的138个淋巴结，其中良性76个，恶性62个。恶性淋巴结的ECI值（1.69±0.89）明显高于良性淋巴结（1.32±0.87）（t=-2.46，P=0.015）。传统超声鉴别宫颈恶性淋巴结与良性淋巴结的受试者操作特征（ROC）曲线下面积为0.899，最佳截断值为7，灵敏度为93.5%，特异度为84.2%。ECI的ROC曲线下面积为0.649，最佳截断值为1.25，灵敏度为59.7%，特异度为60.5%。二者联合应用时，ROC曲线下面积为0.724，灵敏度为93.5%，特异度为51.3%。在不使用手法技术的组中，恶性淋巴结的平均ECI值为1.77±0.94，明显高于良性淋巴结（1.26±0.81）（t=-3.09，P=0.003）。在需要手法技术的组中，恶性淋巴结的ECI值为1.33（1.01，1.44），与良性淋巴结[1.32（0.78，2.18）]无明显差异（z=-0.20，P=0.843）。结论 在鉴别良恶性淋巴结方面，传统超声比ECI及其联合应用具有更高的诊断价值。ECI在评估其他器官中的作用需要进一步研究。
