| OBJECTIVEFor the staging of cervical lymph nodes in patients with laryngeal cancer and hypopharyngeal cancer,color Doppler ultrasound was used to diagnosis the presence of lymph node metastasis,and compared with neck enhanced CT,neck palpation,and postoperative pathological examination to determine the accuracy of color Doppler ultrasound in distinguishing cervical lymph node metastasis from laryngeal carcinoma and hypopharyngeal carcinoma.METHODSThe clinical data of 73 patients(96 sides)with laryngeal carcinoma and hypopharyngeal carcinoma who underwent cervical lymph node dissection in our department of Otorhinolaryngology from March 1,2019 to January 30,2020 were collected.The results of cervical palpation,color Doppler ultrasound and enhanced CT were recorded before operation.Perform bilateral palpation of lymph nodes on both sides of the neck and record the zoning,activity,hardness and size of the lymph nodes.Color Doppler ultrasound examination to record the long axis length and short axis length,shape,echo,cortical status,medullary demarcation of lymph nodes,structure of lymphatic gate,blood flow,etc.Neck enhancement CT to observe the long axis length and short axis length,shape,echo,internal enhancement and edge enhancement of lymph nodes,etc.Three examination methods were used to make qualitative diagnosis of cervical lymph nodes.Taking postoperative pathological examination as the gold standard,the accurate data of the above inspection methods were analyzed by chi-square test,Fisher's exact test,McNemar test,Kappa consistency test.RESULTOf the 73 patients(96 sides),71 were male and 2 were female,aged 61.8 ± 10.0 years,including 26 with laryngeal cancer and 47 with hypopharyngeal cancer.All patients had no distant metastasis,which was M0 stage.Patients with laryngeal cancer:0%in Tis stage(0/26 cases),11.5%in T1 stage(3/26 cases),26.9%in T2 stage(7/26 cases),50%in T3 stage(13/26 cases),and 11.5%in T4 stage;(3/26 cases)42.3%in NO stage,26.9%in N1 stage,and 30.8%in N2 stage.Patients with hypopharyngeal cancer:4.3%in Tis stage,10.6%in T1 stage,34.0%in T2 stage,44.7%in T3 stage,6.4%in T4 stage,29.8%in NO stage,17.0%in N1 stage,and 53.2%in N2 stage.Take the postoperative pathological examination as the gold standard.For laryngeal and hypopharyngeal cancer,the sensitivity of ultrasound to diagnose cervical lymph node metastasis is 90.7%(49/54),specificity is 85.7%(36/42),false positive rate is 14.3%,false negative rate is 9.3%Ultrasound is consistent with pathological results and has statistical significance(Kappa=0.767,P<0.001).The sensitivity of ultrasound diagnosis of cervical lymph node metastasis in laryngeal cancer is 88.2%(15/17),specificity is 91.3%(21/23),false positive rate is 11.8%,false negative rate is 8.7%;The sensitivity of ultrasound diagnosis of cervical lymph node metastasis in hypopharyngeal carcinoma was 91.9%(34/37),the specificity was 78.9%(15/19),the false positive rate was 21.1%,and the false negative rate was 8.1%.For laryngeal and hypopharyngeal cancer,the sensitivity of cervical enhanced CT to diagnose cervical lymph node metastasis is 81.1%(43/53),the specificity is 63.4%(26/41),the false positive rate is 36.6%,and the false negative rate is 18.9%.Sensitivity:Ultrasonography(90.7%)was higher than intensive CT(81.1%),but the difference was not statistically significant(P=0.774);Specificity:Ultrasonography(85.7%)was significantly higher(P?0.022<0.05)than enhanced CT(63.4%).The sensitivity of cervical palpation to judge cervical lymph node metastasis was 59.3%(32/54),the specificity was 95.2%(40/42),the false positive rate was 4.8%,and the false negative rate was 40.7%.The sensitivity of ultrasound examination was significantly higher than that of cervical palpation(P<0.001),but the specificity difference was not statistically significant(P=0.289).CONCLUSION1.Color Doppler ultrasonography has high sensitivity and specificity for the diagnosis of cervical metastatic lymph nodes in laryngeal carcinoma and hypopharyngeal carcinoma,which has important guiding significance for clinical diagnosis.2.The results of color Doppler ultrasonography have certain reference value for the judgment of the tumor stage of laryngeal and hypopharyngeal cancer patients and the formulation of surgical plans.Because of its non-invasive,portable,repeatable and other advantages,it can be used as a common clinical examination method for laryngeal carcinoma and hypopharyngeal carcinoma.3.Compared with enhanced cervical CT,color Doppler ultrasound has certain advantages in diagnosis of cervical metastatic lymph nodes in laryngeal carcinoma and hypopharyngeal carcinoma,to a certain extent,it can replace enhanced CT to protect patients from radiation and reduce costs.And it can be used as an important method of follow-up observation. |
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