1298例鼻咽癌区域淋巴结转移的影像学分析  

Magnetic resonance imaging analysis of regional lymph node metastasis in 1 298cases of nasopharyngeal carcinoma

作　　者：吕君[1] 王仁生[1] 覃玉桃[1] 杜清华[1] 张婷婷[1] 

机构地区：[1]广西医科大学第一附属医院(西院)放疗科,南宁530007

出　　处：《临床耳鼻咽喉头颈外科杂志》2012年第18期769-772,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：广西医疗卫生重点科研基金资助(No:重2010011)

摘　　要：目的:探讨鼻咽癌区域淋巴结转移的影像学特点,为其临床分期、治疗及预后判定提供依据。方法:收集2009-01-2011-06期间我科1 298例经病理证实、行MRI检查的首诊鼻咽癌患者的影像学资料,并根据RTOG(2006版)影像学颈部淋巴结分区标准确定淋巴结位置,分析淋巴结在各区分布特点及跳跃性转移情况,同时分析不同T分期各区淋巴结转移率及淋巴结不同直径之间包膜受侵的差异。结果:1 298例中,1 067例(82.2%)出现转移淋巴结,分布如下:Ⅰb区20例(1.5%),Ⅱa区604例(46.5%),Ⅱb区883例(68.0%),Ⅲ区330例(25.4%),Ⅳ区78例(6.0%),Ⅴa区162例(12.5%),Ⅴb区49例(3.8%),咽后967例(74.5%),跳跃性转移9例(0.69%)。各区共检出转移淋巴结2 464个,其中包膜外侵1 589个(64.52%),包膜外侵比例随淋巴结直径增大而增大(P<0.05)。淋巴结转移与T分期之间无明确相关性。结论:鼻咽癌区域淋巴结转移以Ⅱ区和咽后淋巴结最多见;Ⅰ区转移率极低;跳跃性转移极为少见。淋巴结包膜外侵比例与最大径呈正相关。T分期和各区淋巴结转移之间无相关性。Objective： Regional nodal metastasis in nasopharyngeal carcinoma plays an important role in the definition of radiotherapy area and clinical stage. It is also one of the main factors influencing prognosis. This study was designed to explore the pattern of metastatic lymph nodes for patients with nasopharyngeal carcinoma, which might provide a basis for clinical treatment and research. Method： From Jan. 2009 to Jul. 2011,1 298 histologically diagnosed nasopharyngeal carcinoma patients had routine MRI scan before radiotherapy in The First -Affiliated Hospital of Guangxi Medical University. Diagnostic radiologists and radiation oncologists together assessed the nodal distribution according to the guideline CT-based delineation of lymph node levels. Then, Chi-square test was used to analyze the correlations between T stage and nodal metastasis rate and between nodal diameter and nodal extracapsular invasion. Result： Of 1 298 patients, 1 067 （82.2 % ） had nodal involvement. The distributions were as.. 20 in level I b,604 in level Ⅱ a,883 in level Ⅱb,330 in levelⅢ ,78 in level IV, 162 in level Va,49 in level Vb,967 in retropharynx. Leap metastasis rate was 0.69%. In these patients,a total of 2 464 positive nodes,including 1 589 （64.52%） extra capsular spread nodes, were detected. The rate of nodal extracapsular invasion was higher when the axial diameter increased. No significant correlation was found between T stage and nodal involvement. Conclusion：The levelⅡand retropharyngeal node are the most frequently involved regions. They have similar metastatic rate and are both the first echo node to metastases of nasopharyngeal carcinoma. Level I metastasis is very low. There is a positive correlation between the proportion of extracapsular spread of metastatic lymph nodes and the axial diameter of lymph nodes. The cervical node involvement of nasopharyngeal carcinoma spread orderly down the neck,and the incidence of skip metastasis is rare. There is no significant difference between T stag and nodal

关 键 词：鼻咽肿瘤 淋巴结 磁共振成像 

分 类 号：R445[医药卫生—影像医学与核医学]