鼻咽癌颈部淋巴结转移的MRI分析  

MRI Features of Metastatic Lymph Node in Nasopharyngeal Carcinoma

作　　者：蓝燚锋 卢烈静 高明[2] 梁碧玲[2] 马云彪[1] 

机构地区：[1]广东省佛山市南海区第六人民医院放射科,广东佛山528248 [2]中山大学附属第二医院放射科,广东广州510120

出　　处：《罕少疾病杂志》2015年第1期27-29,38,共4页Journal of Rare and Uncommon Diseases

摘　　要：目的探讨鼻咽癌颈部淋巴结转移的基本规律。方法收集2012年1月至2013年8月经病理证实的初诊的鼻咽癌148例,全部经鼻咽部及颈部MRI扫描,颈部淋巴结的分区引用鼻咽癌08分期标准,比较各分区之间淋巴结转移率的差异,同时分析不同原发部位肿瘤颈部转移淋巴结在各区分布特点及跳跃性转移情况。结果 148例鼻咽癌其中非角化型鳞状细胞癌137例,角化型鳞状细胞癌10例,基底细胞型鳞状细胞癌1例。病灶局限左或右侧壁18例,局限顶后壁9例,同时累及侧壁及顶后壁的广泛病灶112例,原发病灶不明显9例。143例(96.6%)伴淋巴结转移,咽后淋巴结转移124例(83.8%),颈部淋巴结转移117例(79.1%),其中26例(17.6%)仅有咽后淋巴结转移,19例(12.8)仅有颈部淋巴结转移,98例(66.2%)为咽后及颈部淋巴结均有转移。在各区的分布是Ia区0组,Ib区7组,IIa区94组,IIb区105组,III区62组,IV区25组,Va区11组,Vb区14组,咽后区202组,腮腺淋巴结转移7组。2例(1.3%)出现远处转移,其中肝转移1例,多处骨转移1例。2例(1.3%)发生跳跃性转移。结论鼻咽癌淋巴结转移率高,以咽后淋巴结、颈上深组(II区)淋巴结转移最多见。淋巴结转移首站与早期局限性病灶位置有关,原发或累及顶后壁病灶比单纯侧壁病灶的咽后部淋巴结转移率高。局限于鼻咽部单侧病灶可出现双侧或对侧颈淋巴结转移。转移路径与解剖上鼻咽部的淋巴回流路径一致,跳跃性转移率低。Objective To explore the distribution rule of metastatic lymph node in nasopharyngeal carcinoma （NPC）. Methods 148 cases with NPC confirmed by pathology or clinical methods in our hospital from Jan. 2012 to Aug. 2013 underwent MR/scanning with plain and contrast enhanced sequences. The distribution of lymph node was divided according to RTOG guidelines proposed in 2008.The differences rates of lymph nodes metastases were analyzed. The distribution law of metastatic lymph node of different primary sites and the skip metastasis were also analyzed. Results 148 cases with NPC included the primary left wall of the nasopharyngeal （n= 12）, the right wall （n=6）,superior/ posterior wall （n=9）, the extensive regain （n=112）, and 9 without obvious lesion. 143 out of 148 patients（96.6%） had lymph node involvement, with 124 cases involved the RN node, 117cases involved the neck node, and with 26 cases （17.6%） in RN alone, 19（12.8%） in neck node alone, and 98（66.2%） both necks and RN node. The cases of lymph node metastasis in Ia, Ib, IIa, IIb, Ill, IV, Va, Vb, RN were 0, 7, 94, 105, 62, 25, 11,14,202,7 respectively. 2 cases（1.3%） were found distant metastasis,one was the liver, the other was the bones. Skip metastasis was found in 2 cases （1.3%）. Conclusions The incidence of lymph node metastasis is high in nasopharyngeal carcinoma, the RN and IIb lymph nodes were most likely to be involved.There was significant difference in RN metastasis between the primary tumor being located merely on the superior/posterior wall and lateral wall. The lesions limited or involved the superior/ posterior had a higher probability in metastasizing. The primary lesion limited at the unilateral wall can metastase to the offside or bilateral lymph nodes. Distribution rule of metastatic lymph node was corresponding to the rule of lymphatic drainage, Skip metastasis rate was very low.

关 键 词：鼻咽肿瘤 淋巴结 磁共振成像 

分 类 号：R733.4[医药卫生—肿瘤]