Establishment of diagnostic method of small cervical lymph nodes : analysis with FDG-PET and color Doppler ultrasonography.

本文对6例口腔鳞状细胞癌46例转移性颈淋巴结进行FDG-PET堆积及转移变性的组织学观察。FDG聚集的小淋巴结表现为大面积变性，如坏死、新生血管和角化。记录53例口腔鳞状细胞癌切除淋巴结的转移、大小及内部结构等病理特征。38%的转移性淋巴结和0.3%的非转移性淋巴结出现中心坏死。24%的转移性淋巴结和1%的非转移性淋巴结出现角化。77%的转移性淋巴结和7%的非转移性淋巴结肺门结构消失。转移性和非转移性淋巴结组在所有特征上的频率差异均有统计学意义（χ 2检验，P<0.01）。我们进一步研究了内部病变的频率是否因转移性淋巴结的大小而不同。最大淋巴结轴距15mm及以上组有60%出现中央坏死，小淋巴结轴距小于15mm组有27%出现中央坏死。小淋巴结组他的特征出现频率明显降低（χ 2检验，P<0.001）。最大淋巴结轴距15mm及以上组角化率为35%，小淋巴结组角化率为18%。两组之间的频率无显著差异。最大轴15mm及以上淋巴结组88%的淋巴结门结构消失，小淋巴结组71%的淋巴结门结构消失。小淋巴结组他的特征出现频率明显降低（χ 2检验，P=0.049）。我们比较了转移性和非转移性淋巴结组在彩色多普勒超声上淋巴结血流模式的频率。在18%的转移性淋巴结和62%的非转移性淋巴结中观察到肺门型。在17%的转移性淋巴结和1%的非转移性淋巴结中观察到外周模式。在31%的转移性淋巴结和1%的非转移性淋巴结中观察到内部模式。转移淋巴结组与非转移淋巴结组间各模式出现频率差异均有统计学意义（χ 2检验，P<0.01）。在上述结果的基础上，我们对转移性淋巴结的诊断标准如下：仅为中心性坏死，或宫颈IB和IIA水平小轴8mm及以上（其他水平6mm及以上），并以角化、门门结构消失或内部血流模式为特征。根据这些诊断标准，灵敏度为77%，特异性为95%，准确率为0%。少

Presence of accumulation on FDG-PET and histopathological degree of degeneration by metastasis were evaluated on 46 metastatic cervical lymph nodes in 6 patients with squamous cell carcinoma of oral cavity. The small lymph node with FDG accumulation showed wide area with degeneration, such as, necrosis, neovascularization and keratinization.The pathological evidence of metastasis, size and internal structures were recorded on the extracted lymph nodes in 53 patients with squamous cell carcinoma of oral cavity. The central necrosis was observed in 38% of metastasis lymph nodes and 0.3% of non-metastatic lymph nodes. The keratinization was observed in 24% of metastasis lymph nodes and 1% of non-metastatic lymph nodes. The disappearance of hilar structure was observed in 77% of metastasis lymph nodes and 7% of non-metastatic lymph nodes. There were significant differences in frequency with all features between metastatic and non-metastatic lymph node groups (Chi-square test, P<0.01).We ex … More amined whether the frequency with internal changes was different by size on the metastatic lymph nodes. The central necrosis was observed in 60% of group with 15mm of maximal axis and over and in 27% of small lymph node group (less than 15mm of maximal axis). The frequency of his feature significantly decreased in small lymph node group (Chi-square test, P<0.001). The keratinization was observed in 35% of group with 15mm of maximal axis and over and in 18% of small lymph node group. There was no significant difference in frequency between the two groups. The disappearance of hilar structure was observed in 88% of group with 15mm of maximal axis and over and in 71% of small lymph node group. The frequency of his feature significantly decreased in small lymph node group (Chi-square test, P=0.049).We compared the frequency of blood flow patterns of the lymph nodes on color Doppler ultrasonograms between metastatic and non-metastatic lymph node groups. The hilar pattern was observed in 18% of metastasis lymph nodes and 62% of non-metastatic lymph nodes. The peripheral pattern was observed in 17% of metastasis lymph nodes and 1% of non-metastatic lymph nodes. The internal pattern was observed in 31% of metastasis lymph nodes and 1% of non-metastatic lymph nodes. There were significant differences in the frequency with all patterns between metastatic and non-metastatic lymph node groups (Chi-square test, P<0.01).On the basis of the above-mentioned results, we made the following diagnostic criteria of a metastatic lymph node : a central necrosis alone, or 8 mm of the minor axis and over in cervical level IB and IIA(6mm and over in the other levels) and either feature of keratinization, disappearance of hilar structure or internal blood flow pattern. According to these diagnostic criteria, sensitivity 77%, specificity 95% and accuracy 0% were enough high. Less