Steinkamp H J, Knöbber D, Schedel H, Mäurer J, Felix R
Strahlenklinik und Poliklinik, Universitätsklinikum Rudolf Virchow/Standort Wedding, Freie Universität Berlin.
Laryngorhinootologie. 1993 Sep;72(9):431-8. doi: 10.1055/s-2007-997931.
The ranking of postoperative palpation and sonography is examined in respect of imaging of neck lymph node enlargement and neck lymph node metastases or lymphomas, using a prospective study involving 127 patients whose head and neck tumours had already undergone treatment. These patients had been subjected to tumour aftercare for an average period of 26 months. Sonography is well suited for detecting the presence of enlarged neck lymph nodes, the accuracy being 97.5%. In this study palpation was clearly less safely defined, the accuracy being only 85%. The following results were obtained in respect of the specific imaging of metastases: sensitivity of palpation (75%) is below that of sonography (M/Q ratio) (93%). In respect of specificity palpation also yielded poorer results than sonography (M/Q ratio 94%) because of the relatively high proportion of false positive palpations (17%). The reason for this is non-differentiation between reactively enlarged lymph nodes and lymph nodes metastases. The advantage of sonography vs palpation by using the M/Q ratio is therefore the accuracy of the findings (94% sonography, 81% palpation) and hence the clear reduction in false positive and false negative findings. Furthermore, sonography can image the exact relationship to surrounding tissue and especially the vessels. The drawback of sonography is that lymph nodes < 9 mm maximal diameter cannot be assessed with the safety and accuracy mentioned above. Sonomorphological criteria such as the central marrow reflex and a widened lymphatic node cortex enhance diagnostic safety of the sonographic expansion parameters to yield an assessment of tumour status.
针对颈部淋巴结肿大、颈部淋巴结转移或淋巴瘤的成像，采用前瞻性研究，对127例已接受头颈部肿瘤治疗的患者进行术后触诊和超声检查的排名。这些患者平均接受了26个月的肿瘤随访。超声检查非常适合检测颈部淋巴结肿大的情况，准确率为97.5%。在本研究中，触诊的明确程度明显较低，准确率仅为85%。关于转移灶的特异性成像，得出以下结果：触诊的敏感性（75%）低于超声检查（M/Q比值）（93%）。在特异性方面，由于假阳性触诊比例相对较高（17%），触诊的结果也比超声检查（M/Q比值94%）差。原因是反应性肿大的淋巴结与淋巴结转移之间无法区分。因此，通过使用M/Q比值，超声检查相对于触诊的优势在于检查结果的准确性（超声检查94%，触诊81%），从而明显减少假阳性和假阴性结果。此外，超声检查可以成像与周围组织尤其是血管的确切关系。超声检查的缺点是最大直径<9mm的淋巴结无法以上述安全性和准确性进行评估。诸如中央髓质反射和淋巴结皮质增宽等超声形态学标准提高了超声扩展参数的诊断安全性，以评估肿瘤状态。
