实用肿瘤杂志

目的 分析术前颈部增强CT联合颈部超声（ultrasound, US）检查对头颈部鳞状细胞癌（head and neck squamous cell carcinoma, HNSCC）患者颈部淋巴结转移的诊断价值。方法 回顾性收集2021年7月至2024年7月郑州市中心医院收治的98例HNSCC患者的临床资料，根据病理检查结果将其分为淋巴结转移组（n=54）和未转移组（n=44）。比较两组增强CT和颈部US检查的图像基本特征，并计算增强CT、US和联合检查诊断HNSCC患者颈部淋巴结转移的阳性预测值、阴性预测值、敏感度、特异度和准确度。结果 在发生颈部淋巴结转移的54例患者中检出阳性淋巴结158个。US、增强CT和二者联合检查的检出率分别为73.4%、79.1%和94.9%。US检查中，转移组淋巴结有钙化灶、强回声、淋巴结边缘不清、纵横比>2和周围型血流的患者占比均高于未转移组（均P<0.05）。增强CT检查中，转移组淋巴结外形呈圆形或不规则、异质性增强或钙化、囊性或坏死改变和内部强化的患者占比均高于未转移组（均P<0.05）。二者联合诊断HNSCC患者颈部淋巴结转移的阳性预测值为0.781，阴性预测值为0.882，敏感度为92.59%，准确度为81.63%，特异度为68.18%，受试者工作特征（receiver operating characteristic, ROC）曲线下面积（area under the curve, AUC）为0.886。结论 US联合增强CT检查在HNSCC患者颈部淋巴结转移的评估中具有较好的诊断价值，可作为颈部淋巴结转移的诊断方法之一。

Objective To assess the diagnostic utility of preoperative cervical enhanced CT in conjunction with cervical ultrasound(US) for cervical lymph node metastases in patients with head and neck squamous cell carcinoma(HNSCC). Methods The clinical data of 98 HNSCC patients admitted to Zhengzhou Central Hospital from July 2021 to July 2024 were retrospectively collected. Based on the findings of the pathological investigation, the patients were divided into the metastatic group(n=54) and the non-metastatic group(n=44). The basic features of enhanced CT and US examination of the neck were compared between the two groups, and the positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of cervical enhanced CT, US, and combined examinations for diagnosing cervical lymph node metastases in HNSCC patients were calculated. Results Among 54 patients with cervical lymph node metastases, 158 positive lymph nodes were detected. The detection rates of US, enhanced CT, and the combined examinations were 73.4%, 79.1%, and 94.9%, respectively. In terms of US features, the proportions of cases with calcification, strong echoes, indistinct lymph node margins, aspect ratios >2, and peripheral blood flow in the metastatic group were all higher than those in the non-metastatic group(all P<0.05). The analysis of CT features showed that the proportions of patients with round or irregular appearance, heterogeneous enhancement or calcification, cystic or necrotic changes, and internal enhancement in the metastatic group were all higher than those in the non-metastatic group(all P<0.05). The positive predictive value, negative predictive value, sensitivity, accuracy, and specificity of the combined examinations for diagnosing cervical lymph node metastases in HNSCC patients were 0.781, 0.882, 92.59%, 81.63%, and 68.18%, respectively, and the area under the receiver operating characteristic curve was 0.886. Conclusions Cervical US combined with enhanced CT has good diagnostic value in the evaluation of cervical lymph node metastases in HNSCC patients, and can be used as one of the diagnostic methods of cervical lymph node metastases.