Metha Samruddhi Swapnil, Mhapuskar Amit Anil, Marathe Swati P, Metha Swapnil Suresh, Jadhav Santosh, Thakare Shweta D, Passi Deepak
Department of Oral Medicine and Radiology, Bharati Vidyapeeth Deemed to be University Dental College and Hospital, Sangli, Maharashtra, India.
Department of Oral Medicine and Radiology, Bharati Vidyapeeth Deemed to be University Dental College and Hospital, Pune, Maharashtra, India.
J Family Med Prim Care. 2019 Feb;8(2):544-549. doi: 10.4103/jfmpc.jfmpc_440_18.
To substantiate the use of ultrasonography in diagnosis of cervical lymphadenopathy in oral malignancies and to assess if ultrasonographic examination done prior to lymph node (LN) biopsy can yield important information regarding the diagnosis.
Twenty subjects with histopathologically confirmed oral malignant lesions with clinically palpable and untreated cervical LNs included into study. These patients were subjected to clinical examination (number of LNs, shape, size, location, overlying temperature, overlying skin, tenderness, consistency, and fixity to the underlying structures), and ultrasonographic evaluation (number of LNs, shape, size (mm), location, borders, matting, peripheral halo, hilum, calcification, necrosis, reticulation, and echogenicity) of the LNs, and finally, histological assessment was done after surgical excision during the course of treatment.
Predominantly male (65%) patients were having with malignant LN involvement with age group of 60-69 years, i.e., 35%. Ultrasonogram is superior to clinical examination as it detected additional 49 nodes. Malignant nodes tend to have longest axial diameter (17 mm with standard deviation of 8.7 mm). Over all 52 malignant nodes were round, whereas 35 nodes were oval in shape. Most of the nodes were detected in submandibular region. Around 61 (70.9%) nodes had sharp borders and 26 (29.9%) had smooth borders. Loss of echogenic hilus is a common feature of malignancy showing 70% sensitivity and 67% specificity. Most of malignant nodes were hypoechoic. Around 51 (58.6%) of nodes showed intranodal necrosis, whereas it was absent in 36 (41.4%) nodes. Matting and edema were present 25 (28.7%) nodes. Intranodal calcification was present in 37 nodes. Sensitivity of USG was 90%, whereas specificity was 100%.
Ultrasonographic examination of cervical LNs can yield important information regarding the diagnosis. Ultrasound examination should be done prior to FNAC and ideally an ultrasound-guided FNAC.
证实超声检查在口腔恶性肿瘤颈部淋巴结病变诊断中的应用价值，并评估在淋巴结活检前进行超声检查是否能提供有关诊断的重要信息。
纳入20例经组织病理学确诊的口腔恶性病变患者，其颈部淋巴结临床可触及且未接受治疗。对这些患者进行临床检查（淋巴结数量、形状、大小、位置、表面温度、表面皮肤、压痛、质地及与深部结构的固定情况）以及淋巴结的超声评估（淋巴结数量、形状、大小（毫米）、位置、边界、融合、周边晕、门部、钙化、坏死、网状结构及回声），最后在治疗过程中手术切除后进行组织学评估。
主要为男性（65%）患者出现恶性淋巴结受累，年龄在60 - 69岁组，占35%。超声检查优于临床检查，因为它额外检测到49个淋巴结。恶性淋巴结的长轴直径往往最长（17毫米，标准差为8.7毫米）。总体而言，52个恶性淋巴结呈圆形，而35个呈椭圆形。大多数淋巴结在下颌下区域被检测到。约61个（70.9%）淋巴结边界清晰，26个（29.9%）边界光滑。门部回声消失是恶性肿瘤的常见特征，敏感性为70%，特异性为67%。大多数恶性淋巴结为低回声。约51个（58.6%）淋巴结显示结内坏死，而36个（41.4%）淋巴结未出现。25个（28.7%）淋巴结有融合和水肿。37个淋巴结有结内钙化。超声检查的敏感性为90%，特异性为100%。
颈部淋巴结的超声检查可提供有关诊断的重要信息。应在细针穿刺抽吸活检（FNAC）前进行超声检查，理想情况下应进行超声引导下的FNAC。
