Department of Internal Medicine II, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania;
Rom J Morphol Embryol. 2020 Apr-Jun;61(2):433-439. doi: 10.47162/RJME.61.2.12.
The presence of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymphadenopathy (N0) remains controversial. Neck palpation, as the method used in tumor, node, metastasis (TNM) staging, has limitations and can provide false negative results in some cases. Lymph node metastases are associated with a reduced survival rate but at the same time, neck dissection for the patient with N0 neck is not without risks or complications.
In prospective study, we compared palpation, ultrasonography (US) examination of the neck and histopathological examination in patients with cancers of the pharynx and larynx.
PATIENTS, MATERIALS AND METHODS: Forty-six patients with cancers of the pharynx and larynx that presented with a N0 neck were prospectively analyzed. They were divided in two groups: 23 patients operated with an external approach including the control of the lymph node areas, and a second group of 23 patients operated using endoscopy and carbon dioxide (CO2) laser, no neck dissection - "watchful waiting policy". All patients have had a flexible endoscopy of the pharynx and larynx, US of the neck and all received surgical treatment for their primary tumor. Imaging was performed in selected cases. All the removed lymph nodes were sent for histopathology. US was also used as a follow-up method. The US features of the examined lymph nodes were: diameters [longitudinal (L) and transverse (T)]; the ratio of the two diameters (L∕T); shape; lymph node area; central hypodensity; regular∕irregular margins; aspect (homogeneous or not).
US has detected 25 lymph nodes in the open surgery group and intraoperatively, we excised 31 (sensitivity of 80.6%). Ten lymph nodes showed metastases, with 100% accuracy of US, which have been confirmed both pathologically and immunohistochemically. US in the second group - patients treated with CO2 laser - detected at four patients 10 cervical lymph nodes that did not presented any malignant features. At recurrence alone, the US confirmed 100% presence of nodes metastases.
US was superior to palpation and this method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis (N0).
转移性颈淋巴结的存在对治疗计划和预后评估至关重要。对于临床颈淋巴结阴性（N0）的头颈部癌症患者的治疗仍然存在争议。颈部触诊是肿瘤、淋巴结、转移（TNM）分期中使用的方法，存在局限性，在某些情况下可能会得出假阴性结果。淋巴结转移与降低的生存率相关，但同时，对于 N0 颈部的患者进行颈部解剖并非没有风险或并发症。
在前瞻性研究中，我们比较了触诊、颈部超声（US）检查和组织病理学检查在咽和喉癌患者中的应用。
患者、材料和方法：46 例患有咽和喉癌且颈淋巴结阴性（N0）的患者前瞻性分析。他们被分为两组：23 例患者采用外部入路手术，包括控制淋巴结区域，另一组 23 例患者采用内镜和二氧化碳（CO2）激光手术，不进行颈部解剖-“观察等待政策”。所有患者均进行了咽和喉的软式内镜检查、颈部 US 检查，并均接受了原发性肿瘤的手术治疗。在选择的情况下进行了影像学检查。所有切除的淋巴结均进行了组织病理学检查。US 也被用作随访方法。检查的淋巴结的 US 特征包括：直径[纵向（L）和横向（T）]；两个直径的比值（L∕T）；形状；淋巴结面积；中央低回声；规则∕不规则边缘；外观（均匀或不均匀）。
在开放性手术组中，US 检测到 25 个淋巴结，术中切除了 31 个（敏感性为 80.6%）。10 个淋巴结显示转移，US 的准确率为 100%，这在组织病理学和免疫组织化学检查中均得到了证实。在接受 CO2 激光治疗的第二组患者中，US 在 4 例患者中检测到 10 个颈淋巴结，这些淋巴结无恶性特征。在复发时，US 100%证实存在淋巴结转移。
US 优于触诊，可作为术前评估无可触及转移（N0）患者的诊断工具。
