中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2023, Vol. 21 ›› Issue (2): 168-174.doi: 10.19438/j.cjoms.2023.02.012

• 论著 • 上一篇    下一篇

超声造影对口腔颌面部鳞癌颈部转移性淋巴结的诊断价值评价

柳江龙1,2, 贾芳3, 王晓荣3, 热伊莱·阿不都克热木1,2, 吾尔古丽·阿力甫1,2, 买买提吐逊·吐尔地1,2   

  1. 1.新疆医科大学第一附属医院（附属口腔医院） 口腔颌面创伤正颌外科,新疆 乌鲁木齐 830054;
    2.新疆维吾尔自治区口腔医学研究所,新疆 乌鲁木齐 830054;
    3.新疆医科大学第一附属医院 腹部超声科,新疆 乌鲁木齐 830054
  • 收稿日期:2022-10-22 修回日期:2022-11-30 出版日期:2023-03-20 发布日期:2023-06-12
  • 通讯作者: 买买提吐逊·吐尔地,E-mail：maimaitituxun@aliyun.com
  • 作者简介:柳江龙（1996-）,男,在读硕士研究生,E-mail：liujianglong422@126.com

Diagnostic value of contrast-enhanced ultrasound in cervical lymph node metastasis from oral and maxillofacial squamous cell carcinoma

LIU Jiang-long1,2, JIA Fang3, WANG Xiao-rong3, REYILAI Abudukeremu1,2, WUERGULI Alifu1,2, MAIMAITITUXUN Tuerdi1,2   

  1. 1. Department of Oral and Maxillofacial Trauma and Orthognathic Surgery, First Affiliated Hospital (Stomatological Hospital) of Xinjiang Medical University. Urumqi 830054;
    2. Institute of Stomatology, Xinjiang Uygur Autonomous Region. Urumqi 830054;
    3. Department of Abdominal Ultrasound, First Affiliated Hospital of Xinjiang Medical University. Urumqi 830054, Xinjiang Uygur Autonomous Region, China
  • Received:2022-10-22 Revised:2022-11-30 Online:2023-03-20 Published:2023-06-12

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摘要： 目的： 探讨超声造影（contrast-enhanced ultrasound,CEUS）对口腔颌面部鳞癌颈部转移性淋巴结的诊断价值。方法： 选择41例接受手术治疗并行颈淋巴清扫术的口腔颌面部鳞癌患者,术前均行常规超声及CEUS检查颈部淋巴结。按术后病理诊断结果分为转移组和非转移组,评价2组淋巴结常规超声和CEUS影像特征的差异,并采用多因素Logistic回归模型分析转移性淋巴结的相关危险因素。应用受试者工作特征（ROC）曲线评价2种检查对口腔颌面部鳞癌颈部转移性淋巴结的诊断价值。数据采用SPSS 25.0软件包进行统计学分析。结果： 病理检出17例患者共29个转移性淋巴结,24例患者共28个非转移性淋巴结。转移组常规超声表现为长短径之比（L/S）≤2、形态不规整、淋巴门结构异常、内部回声不均匀、周边型或混合型血流,与非转移组有统计学差异（P<0.05）。转移组与非转移组的灌注模式、灌注类型比较,差异有统计学意义（P<0.05）。常规超声表现为形态不规整、淋巴门结构异常、内部回声不均匀、周边型或混合型血流;CEUS表现为向心型或混合型、有不规则灌注缺损的不均匀增强型或微弱增强型为转移性淋巴结的相关危险因素（P<0.05）。常规超声、CEUS诊断口腔颌面部鳞癌颈部转移性淋巴结的灵敏度分别为65.5%、79.3%,特异度分别为71.4%、82.1%,阳性预测值分别为70.4%、82.1%,阴性预测值分别为66.7%、79.3%,ROC曲线下面积分别为0.685、0.807。结论： CEUS在口腔颌面部鳞癌颈部转移性淋巴结的诊断中比常规超声具有更高的临床价值。

关键词: 口腔颌面部鳞癌, 转移性淋巴结, 超声造影, 影像特征, 诊断价值

Abstract: PURPOSE: To investigate the diagnostic value of contrast-enhanced ultrasound（CEUS） for cervical lymph node metastasis from oral and maxillofacial squamous cell carcinoma. METHODS: Forty-one patients with oral and maxillofacial squamous cell carcinoma who underwent surgery and neck dissection were selected, and all patients were examined preoperatively with both conventional ultrasound and CEUS. The postoperative pathological diagnosis was used to divide the metastatic and non-metastatic group, the differences in conventional ultrasound and CEUS imaging characteristics of lymph nodes between the two groups were evaluated and multifactorial logistic regression models were used to analyze the risk factors associated with metastatic lymph nodes. The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of the two tests for cervical lymph node metastasis from oral and maxillofacial squamous cell carcinoma. SPSS 25.0 software package was used for data analysis. RESULTS: Pathological diagnosis was made in 17 patients with a total of 29 metastatic lymph nodes and in 24 patients with a total of 28 non-metastatic lymph nodes. Conventional ultrasound in the metastatic group showed L/S≤2, irregular morphology, abnormal lymphatic hilum, inhomogeneous echo inside, and peripheral or mixed blood flow, which were significantly different from the non-metastatic group (P<0.05). The difference in perfusion pattern and perfusion type between the metastatic and non-metastatic groups was statistically significant(P<0.05). Conventional ultrasound showed irregular morphology, abnormal lymphatic hilum, inhomogeneous echo inside, peripheral type or mixed blood flow. CEUS showed centripetal or mixed type, inhomogeneous enhancement with irregular perfusion defect type or faint enhancement type were associated risk factors for metastatic lymph nodes(P<0.05). The sensitivity of conventional ultrasound and CEUS for the diagnosis of cervical lymph node metastasis from oral and maxillofacial squamous cell carcinoma was 65.5% and 79.3%, respectively; the specificity was 71.4% and 82.1%, respectively; the positive predictive value was 70.4% and 82.1%, respectively; the negative predictive value was 66.7% and 79.3%, respectively; and the area under the ROC curve was 0.685 and 0.807, respectively. CONCLUSIONS: CEUS has higher clinical value than conventional ultrasound in the diagnosis of cervical lymph node metastasis from oral and maxillofacial squamous cell carcinoma.

Key words: Oral and maxillofacial squamous cell carcinoma, Cervical lymph node metastasis, Contrast-enhanced ultrasound, Imaging features, Diagnostic value

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