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

本文对6例口腔鳞癌患者46个颈淋巴结转移灶的FDG-PET显像及病理组织学检查结果进行了分析。对53例口腔鳞癌患者的淋巴结进行病理学检查，观察淋巴结转移情况、淋巴结大小及内部结构。转移淋巴结和非转移淋巴结的中心坏死率分别为38%和0.3%。24%转移淋巴结角化，1%非转移淋巴结角化。77%的转移淋巴结和7%的非转移淋巴结的肺门结构消失。淋巴结转移组与非转移组之间所有特征的出现率有显著性差异（χ 2检验，P<0.01）。 ...更多信息 观察转移淋巴结大小不同，其内部改变的频率是否不同。淋巴结最大径大于等于15 mm组的中央坏死率为60%，小淋巴结最大径小于15 mm组的中央坏死率为27%。小淋巴结组His特征出现频率明显降低（χ 2检验，P<0.001）。最大径15 mm及以上组角化发生率为35%，小淋巴结组角化发生率为18%。两组之间的频率没有显著差异。最大径15 mm及以上组88%肝门结构消失，小淋巴结组71%肝门结构消失。小淋巴结组淋巴结的血流频谱出现率明显低于非转移淋巴结组（χ 2检验，P=0.049）。18%的转移淋巴结和62%的非转移淋巴结可见肺门型。17%的转移淋巴结和1%的非转移淋巴结中观察到周围型。31%的转移淋巴结和1%的非转移淋巴结中观察到内部模式。转移性淋巴结组与非转移性淋巴结组之间所有类型的频率差异均有统计学意义（卡方检验，P<0.01）。根据上述结果，我们制定了以下转移性淋巴结的诊断标准：仅中央坏死，或颈椎节段IB和IIA短轴8 mm及以上（其他节段> 6 mm）和角化、肺门结构消失或内部血流模式。根据这些诊断标准，敏感性为77%，特异性为95%，准确性为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