窄带成像内镜在原发灶不明的颈部转移性鳞癌诊断中的作用  

Value of narrow band imaging endoscopy in the detection of unknown primary site with cervical lymph node metastasis of squamous cell carcinoma

作　　者：倪晓光[1] 程荣荣[1] 赖少清[1] 张蕾[1] 贺舜[1] 张月明[1] 王贵齐[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院内镜科,100021

出　　处：《中华肿瘤杂志》2013年第9期698-702,共5页Chinese Journal of Oncology

基　　金：首都卫生发展科研专项项目（首发2011-2005-06）

摘　　要：目的探讨窄带成像（NBI）内镜在寻找颈部淋巴结转移性鳞癌隐匿性原发灶中的作用。方法选择2009年6月至2011年12月以颈部淋巴结转移性鳞癌为主诉就诊的患者，常规检查（CT、MRI及内镜）未发现原发灶，使用NBI内镜进行鼻咽喉部检查，观察NBI内镜对原发灶的检出能力。结果在53例原发灶不明的颈部淋巴结转移性鳞癌中，NBI内镜对隐匿性原发灶的检出率为47．2％（25／53），明显优于影像学检查和普通内镜检查（0，P〈0．001）。检查的原发灶均具有病变小且浅表的特点，在NBI内镜下，黏膜表面的微血管具有典型的特点，鼻咽部浅表癌病变表面可见细树枝状或扭曲线条状的新生血管，口咽、下咽和喉部浅表癌黏膜表面的血管形态表现出排列紧密的棕色斑点。结论NBI内镜通过判断黏膜表面微血管的形态来发现病灶，能明显提高对颈部淋巴结转移性鳞癌隐匿性原发灶的检出能力。Objective To investigate the value of narrow band imaging （NBI） endoscopy in the detection of unknown primary tumor site with cervical lymph node metastases of squamous cell carcinoma. Methods Fifty-three patients with cervical lymph node metastases of squamous cell carcinoma treated in our department between June 2009 and December 2011 were enrolled in this study. Their primary tumor site was not detected by routine computed tomography, magnetic resonance imaging and laryngoscopy. The nasopharyngolarynx was examined by NBI endoscopy to explore the primary tumor site. Results A total of 53 cases with cervical lymph node metastasis of squamous cell carcinoma from an unknown primary were examined under NBI endoscopy. The primary tumor site was confirmed by NBI examination in 47.2% （25/53） of patients, significantly better than routine radiology and endoscopy （0 ,P 〈 0.001 ）. These primary tumors were small and superficial, with characteristic mucosal vascular morphologies. The superficial nasopharyngeal carcinomas under NBI examination showed the superficial thin branch-like or torturous line microvessels. The notable characteristics of the squamous cell carcinoma of oropharynx, hypopharynx and larynx was the well demarcated brownish area and scattered brown dots. Conchmion The NBI endoscopy can provide better visualization of the morphology of superficial mucosal vasculature and improve the ability to detect possible primary cancer in patients with primary unknown cervical lymph node metastasis.

关 键 词：窄带成像 内窥镜检查 肿瘤转移 肿瘤 未知原发灶 淋巴结转移 

分 类 号：R739.91[医药卫生—肿瘤]