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目的:通过分析颈淋巴结转移与其临床特点的关系,对可能有助于判断颈淋巴结转移的临床指标进行评价。方法:比较170例舌鳞癌患者临床分期与病理分期的符合率,分析淋巴结的数目、最大淋巴结长径、最大淋巴结所在区域及淋巴结实质的影像学表现与颈淋巴结转移的关系。结果:颈淋巴结临床N分期与病理N分期的总符合率为60%,其中N1～N3期病例的符合率仅为17.6%(12/68)。多个淋巴结肿大患者的颈淋巴结转移率高于单个淋巴结肿大者;最大淋巴结长径≥2cm患者的颈淋巴结转移率高于<2cm患者;临床最大淋巴结在同侧Ⅰ区组与同侧Ⅱ、Ⅲ区组患者的颈淋巴结转移率差异有统计学意义,P<0.05;在影像学(CT为主)上表现淋巴结实质异常,发生颈淋巴结转移的概率较高。结论:临床N分期与病理N分期的总符合率比较低。若舌癌患者在术前颈部检查中发现肿大淋巴结数目≥2、最大淋巴结长径≥2cm或淋巴结实质异常时,发生颈淋巴结转移的概率均>50%。因此,具有以上指标之一的舌鳞癌患者行颈淋巴结清除是安全的。
OBJECTIVE: To evaluate clinical characteristics of cervical lymph node metastasis by analyzing the relationship between cervical lymph node metastasis and clinical features. Methods: The clinical staging and pathological staging of 170 cases of tongue squamous cell carcinoma were compared. The number of lymph nodes, the length of the largest lymph node, the region of the largest lymph node and the relationship between lymph node metastasis and lymph node metastasis were analyzed. Results: The total coincidence rate of clinical N staging and pathological N staging of cervical lymph nodes was 60%. The coincidence rate of N1 ~ N3 cases was only 17.6% (12/68). The rate of cervical lymph node metastasis in multiple lymph nodes was higher than that in single lymph nodes. The metastasis rate of cervical lymph nodes in patients with the largest lymph node> 2cm was higher than <2cm. The largest clinical lymph nodes in ipsilateral group Ⅰ and ipsilateral Ⅱ , And the difference of cervical lymph node metastasis in group Ⅲ was statistically significant (P <0.05). In imaging (CT-based), there was abnormal parenchymal lymph node and the probability of cervical lymph node metastasis was higher. Conclusion: The total coincidence rate of clinical N stage and pathological N stage is relatively low. If the tongue cancer patients in the preoperative neck examination found that the number of enlarged lymph nodes ≥ 2, the largest lymph node diameter ≥ 2cm or abnormal lymph node mass, the probability of cervical lymph node metastasis were> 50%. Therefore, patients with TSCC who have one of the above criteria are safe for cervical lymph node dissection.