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目的:比较临床触诊、B超和磁共振(MRI)诊断口咽鳞癌颈淋巴结转移的准确性,分析B超、MRI在口咽鳞癌颈淋巴结转移术前评估中的临床价值。方法:对20例口咽鳞癌患者的100个颈部分区行术前临床触诊、B超和MRI检查,以术后病理诊断为金标准,双盲法分析临床触诊、B超和MRI所见,将其结果在SPSS13.0软件中分别采用χ2检验或Fisher确切概率法进行统计学处理。结果:术后病理证实16个区存在淋巴结转移,临床触诊检出其中的7个区(敏感度43.8%,特异度96.4%,准确度88.0%);B超确诊其中的10个区(敏感度60.0%,特异度97.6%,准确度92.0%),可以发现33.3%的临床触诊隐匿性转移区;MRI确诊其中的13个区(敏感度81.3%,特异度96.4%,准确度94.0%);可以发现66.7%的临床触诊隐匿性转移区。B超联合MRI检出其中的13个区(敏感度81.3%,特异度95.2%,准确度93.0%)。结论:B超或MRI评价口咽鳞癌颈淋巴结转移的敏感度、准确度均优于临床触诊,B超联合MRI的可靠性并不优于单独使用MRI,但两者存在互补性。
OBJECTIVE: To compare the accuracy of clinical palpation, B- and MRI in diagnosing cervical lymph node metastasis of oropharyngeal squamous cell carcinoma, and to analyze the clinical value of B-ultrasound and MRI in the preoperative evaluation of cervical lymph node metastasis of oropharyngeal squamous cell carcinoma. Methods: 100 cases of oropharyngeal squamous cell carcinoma of the neck were examined by preoperative palpation, B ultrasound and MRI. The postoperative pathological diagnosis was gold standard. The double-blind method was used to analyze the clinical palpation, B- and MRI See, the results in the SPSS13.0 software were used χ2 test or Fisher exact probability method for statistical analysis. Results: Lymph node metastasis was confirmed in 16 regions by pathology, of which 7 were detected by palpation (sensitivity 43.8%, specificity 96.4%, accuracy 88.0%); 10 of them were diagnosed by B ultrasound 33.0% of the clinical palpation occult metastases were detected in 13 areas (sensitivity 81.3%, specificity 96.4%, accuracy 94.0% ); 66.7% of clinical palpation occult metastases were found. Thirteen of them were detected by B-ultrasonography (sensitivity 81.3%, specificity 95.2%, accuracy 93.0%). Conclusion: The sensitivity and accuracy of B-ultrasound or MRI in evaluating cervical lymph node metastasis of oropharyngeal squamous cell carcinoma are better than those of clinical palpation. The reliability of B-ultrasound combined with MRI is not superior to MRI alone, but the two are complementary.