Baatenburg de Jong R J, Knegt P, Verwoerd C D
Department of Otolaryngology and Head and Neck Surgery, University Hospital Leiden, The Netherlands.
Cancer. 1993 Apr 1;71(7):2312-8. doi: 10.1002/1097-0142(19930401)71:7<2312::aid-cncr2820710723>3.0.co;2-#.
With modern diagnostic imaging techniques, the head and neck oncologist is faced with increasing information on the status of neck nodes of patients with head and neck cancer. It is often difficult to include this new diagnostic information in clinical management because strategies of neck treatment date from times when only clinical examination was available. Computed tomography, magnetic resonance imaging, and ultrasonography (US) may provide information on the status of neck nodes. In the University Hospital Leiden and the University Hospital Rotterdam, US of the neck, when combined with ultrasonographic fine-needle aspiration biopsy (US-UGF-NAB), has proved to be an accurate diagnostic test for nodal disease. The combined procedure is characterized by high sensitivity and specificity. Therefore, this technique is suited for detecting, demonstrating, and excluding nodal metastases. This article will discuss how to interpret the new diagnostic information supplied by US-UGFNAB. A different approach in the clinical management of the neck, based on techniques from the field of clinical decision analysis, will be presented. It is concluded that US-UGFNAB is a promising concept of methodic use of both cytologic examination and an imaging technique in the examination of patients with squamous cell carcinoma of the upper aerodigestive tract. Application of the test may produce an accurate classification of patients with a head and neck tumor and change indications for elective and therapeutic neck treatment.
借助现代诊断成像技术，头颈肿瘤学家面对的头颈部癌患者颈部淋巴结状况信息越来越多。由于颈部治疗策略可追溯到仅能进行临床检查的时代，因此将这些新的诊断信息纳入临床管理往往很困难。计算机断层扫描、磁共振成像和超声检查（US）可能提供颈部淋巴结状况的信息。在莱顿大学医学中心和鹿特丹大学医学中心，颈部超声检查结合超声引导下细针穿刺活检（US-UGF-NAB）已被证明是一种用于诊断淋巴结疾病的准确检测方法。该联合检查方法具有高敏感性和特异性。因此，这项技术适用于检测、显示和排除淋巴结转移。本文将讨论如何解读US-UGF-NAB提供的新诊断信息。基于临床决策分析领域的技术，将提出一种不同的颈部临床管理方法。得出的结论是，US-UGF-NAB是一种在检查上消化道鳞状细胞癌患者时系统运用细胞学检查和成像技术的有前景的方法。该检测方法的应用可能对头颈部肿瘤患者进行准确分类，并改变选择性和治疗性颈部治疗的指征。
