Cheng Ping-Chia, Chang Chih-Ming, Liao Li-Jen, Hsieh Chen-Hsi, Shueng Pei-Wei, Cheng Po-Wen, Lo Wu-Chia
Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan (R.O.C.).
Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.).
Open Med (Wars). 2023 Apr 12;18(1):20230682. doi: 10.1515/med-2023-0682. eCollection 2023.
In this study, we determined the diagnostic performance of adding ultrasound (US) with/without fine-needle aspiration cytology (FNAC) to computed tomography (CT)/magnetic resonance imaging (MRI) in evaluating neck lymphadenopathy (LAP) in patients with head and neck cancer treated with irradiation. We included 269 patients who had neck LAP after radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) resulting from cancers of the head and neck region between October 2008 and September 2018. The diagnostic methods consisted of the following: 1) CT/MRI alone, 2) CT/MRI combined with a post-RT US predictive model, and 3) CT/MRI combined with US + FNAC. We compared their diagnostic performance using receiver operating characteristic (ROC) curves. In total, 141 (52%) malignant and 128 (48%) benign LAPs were observed. Regarding the diagnostic accuracy, the area under the ROC curves was highest for the combined CT/MRI and US + FNAC (0.965), followed by the combined CT/MRI and post-RT US predictive model (0.906) and CT/MRI alone (0.836). Our data suggest that the addition of a US examination to CT/MRI resulted in higher diagnostic performance than CT/MRI alone in terms of diagnosing recurrent or persistent nodal disease during the evaluation of LAP in patients with irradiation-treated head and neck cancer.
在本研究中，我们确定了在对头颈部癌接受放疗的患者进行颈部淋巴结病（LAP）评估时，在计算机断层扫描（CT）/磁共振成像（MRI）基础上添加超声（US）（无论有无细针穿刺细胞学检查（FNAC））的诊断性能。我们纳入了2008年10月至2018年9月期间因头颈部区域癌症接受放疗（RT）或同步放化疗（CCRT）后出现颈部LAP的269例患者。诊断方法包括以下几种：1）单纯CT/MRI，2）CT/MRI联合放疗后超声预测模型，3）CT/MRI联合超声+FNAC。我们使用受试者操作特征（ROC）曲线比较了它们的诊断性能。总共观察到141例（52%）恶性和128例（48%）良性LAP。关于诊断准确性，CT/MRI联合超声+FNAC的ROC曲线下面积最高（0.965），其次是CT/MRI联合放疗后超声预测模型（0.906）和单纯CT/MRI（0.836）。我们的数据表明，在对头颈部癌接受放疗的患者进行LAP评估时，在CT/MRI基础上添加超声检查在诊断复发或持续性淋巴结疾病方面比单纯CT/MRI具有更高的诊断性能。
