鼻咽癌颈部转移性淋巴结的超声观察及预测近期放化疗效应的研究
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摘要
目的:观察鼻咽癌颈部转移性淋巴结的二维声像图及彩色多普勒血流特征,于治疗中连续监测,了解颈淋巴结转移灶在治疗中的变化,并探讨超声在预测鼻咽癌颈部转移性淋巴结近期放化疗效应中的应用价值。
研究对象与方法:2007年10月至2008年2月我院经鼻咽活检病理证实为鼻咽癌的初治患者36例,二维及彩色多普勒超声共观察其颈部转移性淋巴结69枚,记录淋巴结部位、形态、内部回声、血流分布、血流分级,测量其大小、纵横比、收缩期峰值流速(PS)、阻力指数(RI),于化疗后、放疗10次、20次及放疗结束时追踪观察其中25例放化疗患者的43枚淋巴结,并分别以淋巴结大小、治疗中淋巴结血流变化分组,比较组间淋巴结退缩率的差异。
结果:1.治疗前观察鼻咽癌颈部转移性淋巴结69枚,多为椭圆形、类圆形低回声(61/69),部分边界不清(8/69),纵横比平均1.95±0.54,小于2者有41枚(59.4%),多淋巴门消失,部分淋巴结内可见偏心型淋巴门、灶性高回声、液性暗区或囊性变等回声改变,血流分级多以Ⅱ～Ⅲ级为主(57/69,85.5%),PS平均25.3±15.4cm/s,RI平均0.715±0.142,淋巴结径线≥4cm组较＜4cm组血供丰富。2.追踪观察43枚淋巴结转移灶发现:治疗中,相同时间淋巴结转移灶短径较长径退缩明显(P＜0.05),放疗结束时血流分级多为0～Ⅰ级(67.7%,29/43),RI由治疗前0.711±0.142下降为0.440±0.272(P＜0.05);淋巴结径线≥4cm组中80%(12/15)的淋巴结退缩程度为优,径线＜4cm组中仅46.4%(13/28)的淋巴结退缩程度为优,两者有明显差异(P＜0.05),但各组内不同血流分级的淋巴结间退缩程度差异无显着性(P＞0.05)。治疗中血流减少组淋巴结退缩率明显高于血流改善组及血流无明显变化组(P＜0.05)。
结论:1.鼻咽癌颈部转移性淋巴结的声像图具有一定的特征,表现为内部回声多变,血流丰富,多数为高速高阻,治疗后转移性淋巴结短径较长径消退明显,放疗10次时部分淋巴结血流较治疗前更丰富,但放疗结束时血流明显减少;
2.放疗10次时血流减少的淋巴结退缩更明显,超声对治疗前鼻咽癌颈部转移淋巴结大小、血流分级的观察及对治疗中血供变化的监测,有可能作为初步预测近期放化疗效果的指标之一。
Objective:1.To decect the characteristic of metastatic cervical lymph nodes from nasopharyngeal carcinoma(NPC)by ultrasonography and color Doppler flow imaging.2.To observe the changes of these malignant nodes follow-up during therapy period,and to investigate the value of ultrasonography in predicting short-term effect of chemoradiotherapy of metastatic cervical lymph nodes from NPC.
Method:36 patients confirmed as nesopharyngeal poorly differentiated squamous-cell carcinoma pathologically by biopsy were included,and their 69 metastatic cervical lymph nodes were studied by tow-dimensional ultrasonography and color Doppler flow imaging with a 5-12 MHz high-resolution linear transducer(Philips iU 22,Netherlands). The characteristic of malignant nodes,such as position,shape,size, long/short axis ratio(L/S),inner echo,vascular distribution,blood supply grading,peak systolic velocity(PS)and resistivity index(RI),were recorded before treatment.In 25 patients,all of whom underwent chemoradiotherapy,their 43 lymph nodes were examined repeatedly after chemotherapy and approximately every 2 weeks during radiotherapy.And these follow-up malignant nodes were divided into groups according to the size and the pattern of blood flow change respectively,then the regression rate of metastatic nodes of different groups was compared.
Results:1.Before treatment,the majority of malignant nodes(61/69) from NPC were hypoechoic,round or elliptical,and the minority(8/69) with illdefined borders.The mean L/S was 1.95±0.54,and 41(59.4%)of 69 malignant nodes had an L/S less than 2.In most malignant nodes,the central echogenic hilum was absent.But displaced echogenic hilum, intranodal demarcated echogenic focus which suggested coagulation necrosis and intranodal cystic necrosis was observed in partial malignant nodes.Color Doppler flow signals were scored asⅡ～Ⅲin 57(85.5%) of 69 malignant nodes,and the malignant nodes of size-more-than 4cm group had more abundant blood supply.The mean PS was 25.3±15.4 cm/s,and the mean RI was 0.715±0.142.
2.During treatment,the regression rate of short axis was bigger than that of long axis.After radiotherapy,the blood supply decreased and the mean RI was 0.440±0.272(0.711±0.142 before treatment).12(80%)of 15 malignant nodes in size-bigger-than 4cm group showed good regression, while 13(46.4%)of 28 in size-shorter-than 4cm group showed good regression.But no statistical significance was observed in regression rate of different blood flow grades.The regression rate in the blood-flow-decreasing group was bigger than that in the blood-flow-increasing group and the same-blood-supply group.
Conclusion:1.On graspable sonography,metastatic cervical lymph nodes from NPC are usually hypoechoic with various apperences.On color Doppler,metastatic nodes usually show abundant blood supply and tend to have high RI and PS value.During treatment,the regression rate of short axis was bigger than that of long axis,and an increase in blood flow 2 weeks after irradiation(20Gy)was observed in partial malignant nodes,but after radiation therapy a reduction in intranodal vascularity was found in all metastatic nodes.
2.These malignant nodes,in which blood flow markedly decreased 2 weeks after irradiation,has quicker regression rate.This study suggests that ultrasonography maybe have a role in the follow-up of metastatic nodes from NPC receiving chemoradiotherapy.The size and the blood flow of metastatic nodes before therapy and the changes of blood flow in the therapy period may play a role in the evaluation of nodal short-term response to chemoradiotherapy.
研究对象与方法:2007年10月至2008年2月我院经鼻咽活检病理证实为鼻咽癌的初治患者36例,二维及彩色多普勒超声共观察其颈部转移性淋巴结69枚,记录淋巴结部位、形态、内部回声、血流分布、血流分级,测量其大小、纵横比、收缩期峰值流速(PS)、阻力指数(RI),于化疗后、放疗10次、20次及放疗结束时追踪观察其中25例放化疗患者的43枚淋巴结,并分别以淋巴结大小、治疗中淋巴结血流变化分组,比较组间淋巴结退缩率的差异。
结果:1.治疗前观察鼻咽癌颈部转移性淋巴结69枚,多为椭圆形、类圆形低回声(61/69),部分边界不清(8/69),纵横比平均1.95±0.54,小于2者有41枚(59.4%),多淋巴门消失,部分淋巴结内可见偏心型淋巴门、灶性高回声、液性暗区或囊性变等回声改变,血流分级多以Ⅱ～Ⅲ级为主(57/69,85.5%),PS平均25.3±15.4cm/s,RI平均0.715±0.142,淋巴结径线≥4cm组较＜4cm组血供丰富。2.追踪观察43枚淋巴结转移灶发现:治疗中,相同时间淋巴结转移灶短径较长径退缩明显(P＜0.05),放疗结束时血流分级多为0～Ⅰ级(67.7%,29/43),RI由治疗前0.711±0.142下降为0.440±0.272(P＜0.05);淋巴结径线≥4cm组中80%(12/15)的淋巴结退缩程度为优,径线＜4cm组中仅46.4%(13/28)的淋巴结退缩程度为优,两者有明显差异(P＜0.05),但各组内不同血流分级的淋巴结间退缩程度差异无显着性(P＞0.05)。治疗中血流减少组淋巴结退缩率明显高于血流改善组及血流无明显变化组(P＜0.05)。
结论:1.鼻咽癌颈部转移性淋巴结的声像图具有一定的特征,表现为内部回声多变,血流丰富,多数为高速高阻,治疗后转移性淋巴结短径较长径消退明显,放疗10次时部分淋巴结血流较治疗前更丰富,但放疗结束时血流明显减少;
2.放疗10次时血流减少的淋巴结退缩更明显,超声对治疗前鼻咽癌颈部转移淋巴结大小、血流分级的观察及对治疗中血供变化的监测,有可能作为初步预测近期放化疗效果的指标之一。
Objective:1.To decect the characteristic of metastatic cervical lymph nodes from nasopharyngeal carcinoma(NPC)by ultrasonography and color Doppler flow imaging.2.To observe the changes of these malignant nodes follow-up during therapy period,and to investigate the value of ultrasonography in predicting short-term effect of chemoradiotherapy of metastatic cervical lymph nodes from NPC.
Method:36 patients confirmed as nesopharyngeal poorly differentiated squamous-cell carcinoma pathologically by biopsy were included,and their 69 metastatic cervical lymph nodes were studied by tow-dimensional ultrasonography and color Doppler flow imaging with a 5-12 MHz high-resolution linear transducer(Philips iU 22,Netherlands). The characteristic of malignant nodes,such as position,shape,size, long/short axis ratio(L/S),inner echo,vascular distribution,blood supply grading,peak systolic velocity(PS)and resistivity index(RI),were recorded before treatment.In 25 patients,all of whom underwent chemoradiotherapy,their 43 lymph nodes were examined repeatedly after chemotherapy and approximately every 2 weeks during radiotherapy.And these follow-up malignant nodes were divided into groups according to the size and the pattern of blood flow change respectively,then the regression rate of metastatic nodes of different groups was compared.
Results:1.Before treatment,the majority of malignant nodes(61/69) from NPC were hypoechoic,round or elliptical,and the minority(8/69) with illdefined borders.The mean L/S was 1.95±0.54,and 41(59.4%)of 69 malignant nodes had an L/S less than 2.In most malignant nodes,the central echogenic hilum was absent.But displaced echogenic hilum, intranodal demarcated echogenic focus which suggested coagulation necrosis and intranodal cystic necrosis was observed in partial malignant nodes.Color Doppler flow signals were scored asⅡ～Ⅲin 57(85.5%) of 69 malignant nodes,and the malignant nodes of size-more-than 4cm group had more abundant blood supply.The mean PS was 25.3±15.4 cm/s,and the mean RI was 0.715±0.142.
2.During treatment,the regression rate of short axis was bigger than that of long axis.After radiotherapy,the blood supply decreased and the mean RI was 0.440±0.272(0.711±0.142 before treatment).12(80%)of 15 malignant nodes in size-bigger-than 4cm group showed good regression, while 13(46.4%)of 28 in size-shorter-than 4cm group showed good regression.But no statistical significance was observed in regression rate of different blood flow grades.The regression rate in the blood-flow-decreasing group was bigger than that in the blood-flow-increasing group and the same-blood-supply group.
Conclusion:1.On graspable sonography,metastatic cervical lymph nodes from NPC are usually hypoechoic with various apperences.On color Doppler,metastatic nodes usually show abundant blood supply and tend to have high RI and PS value.During treatment,the regression rate of short axis was bigger than that of long axis,and an increase in blood flow 2 weeks after irradiation(20Gy)was observed in partial malignant nodes,but after radiation therapy a reduction in intranodal vascularity was found in all metastatic nodes.
2.These malignant nodes,in which blood flow markedly decreased 2 weeks after irradiation,has quicker regression rate.This study suggests that ultrasonography maybe have a role in the follow-up of metastatic nodes from NPC receiving chemoradiotherapy.The size and the blood flow of metastatic nodes before therapy and the changes of blood flow in the therapy period may play a role in the evaluation of nodal short-term response to chemoradiotherapy.
引文
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