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目的探讨彩色多普勒超声与触诊对鼻咽癌N分期诊断结果的差异性。方法对163例病理确诊的初诊鼻咽癌患者行颈部彩色多普勒血流显像(CDFI)检查,测量指标为受检淋巴结的纵径、横径比值(L/T)及其血流参数,并选择部分受检淋巴结在超声定位下行穿刺活检。结果CDFI联合细胞穿刺检查使常规临床分期发生了较大的变化,66例N0患者有29例(43.94%)升级为N1;47例N1患者有5例(10.64%)降级为N0;44例N2患者有8例(18.18%)降级为N1;69例单侧淋巴结转移患者有18例(26.09%)为双侧转移。临床触诊的淋巴结大小较CDFI检查大(P<0.001)。L/T值、收缩期血流速度、舒张末期血流速度和阻力指数(RI)在良、恶性淋巴结之间的差异有显著性意义(P<0.001)。以L/T<2.0和RI>0.6分别作为诊断恶性淋巴结的标准时,二者的准确率、敏感性和特异性分别为86.9%、81.5%,90.4%、88.8%和77.5%、74.6%,均高于以淋巴结横径>7.0mm为标准时的诊断效率。结论CDFI联合细胞穿刺检查比临床触诊能更准确地判断转移淋巴结,从而为鼻咽癌的临床N分期提供可靠依据,使预后及放射治疗计划发生改变。
Objective To explore the difference of N stage staging of nasopharyngeal carcinoma between color Doppler sonography and palpation. Methods A total of 163 pathologically diagnosed nasopharyngeal carcinoma patients underwent color Doppler flow imaging (CDFI) of the neck. The measurement indexes were the longitudinal diameter and transverse diameter ratio (L / T) of the examined lymph nodes and their blood flow Parameters, and select part of the examined lymph nodes in the ultrasound biopsy biopsy. Results The clinical staging of CDFI combined with cell puncture changed greatly. Among 66 patients with N0, 29 (43.94%) were upgraded to N1, 5 (10.64%) of 47 patients with N1 were degraded to N0, 44 Eight of the patients (18.18%) were downgraded to N1; 18 of 69 (26.09%) patients with unilateral lymph node metastases were bilateral metastases. The size of clinically palpated lymph nodes was larger than that of CDFI (P <0.001). L / T value, systolic blood flow velocity, end diastolic blood flow velocity and resistance index (RI) were significantly different between benign and malignant lymph nodes (P <0.001). The accuracy, sensitivity and specificity of the two methods were 86.9%, 81.5%, 90.4%, 88.8% and 77.5%, 74.6% with L / T <2.0 and RI> 0.6 respectively Higher than the lymph node diameter> 7.0mm as the standard diagnostic efficiency. Conclusions CDFI combined with cell biopsy can determine the metastatic lymph nodes more accurately than clinical palpation, so as to provide a reliable basis for the clinical N staging of nasopharyngeal carcinoma and to change the prognosis and radiotherapy plan.