中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2025, Vol. 23 ›› Issue (6): 592-599.doi: 10.19438/j.cjoms.2025.06.009

• 论著 • 上一篇    下一篇

超声和增强CT在头颈部鳞癌颈淋巴结转移中的诊断效能比较及预测模型建立

施燕妮1, 尹建新2, 凌霄1, 王宏伟3, 王磊4, 秦兴军1   

  1. 1.上海交通大学医学院附属第九人民医院 口腔颌面-头颈肿瘤科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室, 上海市口腔医学研究所,上海 200011;
    2.上海交通大学医学院附属第九人民医院 超声医学科, 3.口腔颅颌面科,上海 200011;
    4.柏林自由大学 生物化学系,德国 柏林 14195
  • 收稿日期:2025-01-06 修回日期:2025-07-16 出版日期:2025-11-20 发布日期:2025-12-04
  • 通讯作者: 秦兴军,E-mail：qinxj1989@sina.com
  • 作者简介:施燕妮（1999-）,女,硕士,E-mail：sjtushiyanni@126.com

Comparison of diagnostic efficacy and establishment of predictive model between ultrasound and enhanced CT in cervical lymph node metastasis of head and neck squamous cell carcinoma

Shi Yanni1, Yin Jianxin2, Ling Xiao1, Wang Hongwei3, Wang Lei4, Qin Xingjun1   

  1. 1. Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology. Shanghai 200011;
    2. Ultrasound Diagnosis Department, 3. Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China;
    4. Institut für Biochemie, Freie Universität Berlin. Berlin 14195, Germany;
  • Received:2025-01-06 Revised:2025-07-16 Online:2025-11-20 Published:2025-12-04

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摘要： 目的：比较超声和增强CT在头颈部鳞状细胞癌（头颈部鳞癌,head and neck squamous cell carcinoma,HNSCC）患者颈部淋巴结转移的诊断效能,并建立预测模型以提高早期诊断的准确性。方法：选取2022年11月—2024年4月上海交通大学医学院附属第九人民医院接受颈淋巴清扫术的原发HNSCC患者125例,收集其超声和增强CT数据及原发灶和淋巴结转移情况等术后病理信息,按7∶3比例随机分为模型组和验证组。在建模阶段,采用多因素logistic回归模型筛选出颈淋巴结转移的预测因素,并构建列线图。采用ROC曲线下面积和校准曲线评估模型的区分度和校准度,采用临床决策曲线评估模型的临床应用价值。结果：多因素logistic回归模型结果显示,淋巴结最大径、原发灶浸润深度、肿瘤细胞分化程度以及患者年龄对颈淋巴结转移的诊断具有显著影响（P<0.05）。基于这些危险因素建立风险列线图预测模型,ROC曲线下面积和校准曲线显示模型的区分度和准确度良好。临床决策曲线分析显示,模型在较大的阈值内具有一定临床实用性。结论：超声对HNSCC患者颈淋巴结转移的诊断价值优于增强CT。本研究构建的HNSCC颈淋巴结转移列线图模型预测效果良好,可为临床预测HNSCC颈淋巴结转移提供参考。

关键词: 头颈部鳞癌, 超声, 增强CT, 颈淋巴结转移, 诊断模型

Abstract: PURPOSE: To compare the diagnostic efficacy of ultrasound and enhanced CT in the diagnosis of cervical lymph node metastasis in patients with head and neck squamous cell carcinoma(HNSCC), and establish a predictive model to improve the accuracy of early diagnosis. METHODS: A total of 125 patients with primary HNSCC who underwent neck lymph node dissection at Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from November 2022 to April 2024 were selected. Their ultrasound and enhanced CT data, as well as information on primary lesion pathology and cervical lymph node metastasis, were collected and randomly divided into a modeling group and a validation group in a 7∶3 ratio. In the modeling phase, a multi-factor logistic regression model was used to screen for predictive factors of cervical lymph node metastasis, and a column chart was constructed based on these variables. The area under the ROC curve and calibration curve were used to evaluate the discrimination and calibration of the model. The clinical application value of the model was evaluated using clinical decision curves. RESULTS: The results of multiple logistic regression model showed that the maximum diameter of lymph nodes, the depth of primary lesion infiltration, the degree of differentiation, and the age of the patients had a significant impact on the diagnosis of cervical lymph node metastasis (P<0.05). Based on these risk factors, a risk column chart prediction model was established, and the area under the ROC curve and calibration curve showed good discrimination and accuracy of the model. Clinical decision curve analysis showed that the model has certain clinical practicality within a large threshold. CONCLUSIONS: Overall, ultrasound is superior to enhanced CT in the diagnosis of cervical lymph node metastasis in patients with head and neck squamous cell carcinoma. The column chart model of cervical lymph node metastasis constructed in this study has a good predictive effect and can provide reference for clinical prediction of lymph node metastasis in head and neck squamous cell carcinoma.

Key words: Head and neck squamous cell carcinoma, Ultrasonography, Enhanced CT, Cervical lymph node metastasis, Diagnostic model

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