cervical lymph nodes

颈淋巴结
  • 文章类型: Case Reports
    具有特殊病理特征的颈部淋巴结原发性恶性肿瘤在临床上相对少见,关于这些肿瘤的报道很少。对其发病机理的确切依据知之甚少,和他们的诊断可能是具有挑战性的。此外,迄今为止,尚未为受影响的患者建立经过临床验证的治疗方法.
    这里,我们描述了一例65岁的男性患者,他的颈部右侧有多个外侧和锁骨上淋巴结肿大,表现为与高热和良性白细胞增多相关的大肿块.他没有表现出任何相关的先前历史。放射学评估显示,该病变是原发性肿瘤,此后已扩散到肝脏。组织学评估无法明确分类该肿瘤的病理特征。没有任何相关的形态学发现,免疫组织化学结果的特异性不足以阐明这些细胞的起源.当将其与淋巴造血系统的类似肉瘤区分开来时,发现它不是典型的组织细胞或树突状细胞肿瘤。该患者的治疗是在多学科咨询后进行的,包括一个疗程的环磷酰胺加阿霉素,长春新碱,和地塞米松方案和两个疗程的环磷酰胺加吡柔比星,长春新碱,和地塞米松方案。然而,肿瘤对这种治疗表现出最小的反应。虽然提出了放射治疗,患者对该方法缺乏信心并拒绝治疗.他最终出现了严重的肿瘤相关并发症。在本报告的讨论部分,我们详细地分析了发病机理,诊断,以及对这种罕见恶性肿瘤的参考治疗。
    这是描述这种恶性肿瘤的第一份报告,我们希望这些发现的发表能够导致对这种肿瘤的认识,同时支持在受影响患者的诊断和治疗方面获得更多经验的努力。
    UNASSIGNED: Primary malignancies of the cervical lymph nodes with special pathological characteristics are relatively uncommon in clinical settings, and there have been few reports on these tumors. The precise basis for their pathogenesis is poorly understood, and their diagnosis can be challenging. In addition, no clinically validated treatments have been established to date for affected patients.
    UNASSIGNED: Here, we describe a case of a 65-year-old male patient who exhibited the enlargement of several lateral and supraclavicular lymph nodes on the right side of his neck that presented as a large mass associated with a high fever and benign leukocytosis. He did not exhibit any relevant prior history. Radiological assessment revealed that this lesion was the primary tumor and that it has since spread to the liver. Histological assessment was unable to definitively classify the pathological characteristics of this tumor. Without any relevant morphological findings, immunohistochemical outcomes were not sufficiently specific to clarify the origin of these cells. When distinguishing it from similar sarcomas of the lymphohematopoietic system, it was found to not be typical of a histiocytic or dendritic cell tumor. Treatment to this patient was performed following multidisciplinary consultation and consisted of one course of a cyclophosphamide plus doxorubicin, vincristine, and dexamethasone regimen and two courses of the cyclophosphamide plus pirarubicin, vincristine, and dexamethasone regimen. However, the tumor exhibited minimal response to such treatment. While radiotherapy was proposed, the patient lacked confidence in the approach and declined treatment. He eventually developed severe tumor-associated complications. In the discussion section of this report, we detail and analyze the pathogenesis, diagnosis, and referential treatments of this rare malignancy.
    UNASSIGNED: This is the first report describing such a malignancy, and we hope that the publication of these findings can lead to the recognition of this tumor while supporting efforts to acquire greater experience in the diagnosis and treatment of affected patients.
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  • 文章类型: Case Reports
    背景:由于细菌鉴定技术的进步,非结核分枝杆菌(NTM)检出率呈上升趋势。与结核分枝杆菌不同,NTM的临床症状不易被发现,临床疗效和预后有一定的异质性。报告2022年7月安徽省胸科医院诊断的1例颈部淋巴结结核分枝杆菌。
    方法:经检查,体重为67.5公斤的病人,是人类免疫缺陷病毒阴性,健康,没有高血压,糖尿病,心脏病等基础疾病镜下分析显示肉芽肿性炎症伴淋巴细胞凝固性坏死,不排除肺结核。颈部和胸部的普通计算机断层扫描扫描显示存在单个灰黄色和灰褐色组织,其尺寸为形式10.5cm×3.0cm×1.5cm的顶部。经过我们医院的病理会诊,确诊为NTM感染.
    结论:本病例报告及改善NTM的临床流行病学研究对改善临床治疗决策具有重要的指导意义。
    BACKGROUND: Owing to the advancement in bacterial identification techniques, the detection rate of non-tuberculous mycobacterium (NTM) has been on the rise. Different from Mycobacterium tuberculosis, the clinical symptoms of NTM are not easily detected, and the clinical efficacy and prognosis are somewhat heterogeneous. To report a case of Mycobacterium gordoniasis of cervical lymph node diagnosed in Anhui Chest Hospital in July 2022.
    METHODS: Upon examination, the patient who weighed 67.5 kg, was human immunodeficiency virus negative, healthy, without hypertension, diabetes, heart disease and other basic diseases microscopic analysis revealed granulomatous inflammation with coagulation necrosis in the lymphocyte, and tuberculosis was not ruled out. Plain computed tomography scans of the neck and chest indicated the presence of a single grayish-yellow and grayish-brown tissue, the dimensions of which was top of form 10.5 cm × 3.0 cm × 1.5 cm. After pathological consultation in our hospital, the diagnosis was confirmed as NTM infection.
    CONCLUSIONS: This case report and the clinical epidemiological research on improving NTM have important guiding significance for improving decision-making in clinical treatments.
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  • 文章类型: Journal Article
    良性恶性颈淋巴结病(CLA)的术前分化对于确定是否需要手术干预至关重要。本研究旨在评估超声(US)的诊断性能,细针穿刺细胞学(FNAC),以及它们与CLA术后组织病理学诊断的结合。
    在2021年4月至2023年5月的一项回顾性研究中,对214例CLA患者进行了术前US和FNAC评估。形态学参数,包括组织边缘,血管,和脂肪肺门回声,进行回顾性收集和分析。美国的诊断效力,FNAC,并将其联合使用与术后组织病理学结果进行比较。
    在最后的组织病理学检查中,185例(86.4%)为良性,29例(13.6%)被确定为恶性。美国的特点,脂肪的门,回声,血管分布模式在表征CLA模式方面具有最高的诊断准确性,值为88.3%,85.5%,85.0%,分别。受试者工作特征(ROC)曲线显示,联合使用所有US参数的曲线下面积(AUC)值为0.883(95%CI:0.832-0.923;P<0.0001),与单个参数相比,具有更好的灵敏度(93.10%)和特异性(68.65%)。整体灵敏度,特异性,FNAC的准确率为97.3%,82.8%,和95.3%,分别。此外,US参数和FNAC一起显示出明显更高的AUC值0.924(95%CI:0.880-0.956;P<0.0001),并实现了86.21%的灵敏度和88.65%的特异性。
    US和FNAC的结合使用提供了高灵敏度,特异性,以及表征CLA模式的诊断准确性。在有限资源设置中,这种方法是可行的,侵入性较小,并且具有成本效益,从而使明确的管理策略和避免额外的手术干预。
    UNASSIGNED: The preoperative differentiation of benign form malignant cervical lymphadenopathy (CLA) is crucial in determining the need for surgical intervention. This study aims to assess the diagnostic performance of ultrasonography (US), fine-needle aspiration cytology (FNAC), and their combination with the postoperative histopathological diagnoses of CLA.
    UNASSIGNED: In a retrospective study between April 2021 and May 2023, 214 patients with CLA were assessed with preoperative US and FNAC. The morphological parameters, including tissue margins, vascularity, and fatty hilum echogenicity, were collected and analyzed retrospectively. The diagnostic efficacies of US, FNAC, and their combined use were compared to the postoperative histopathological findings.
    UNASSIGNED: In the final histopathological examination, 185 cases (86.4%) were found to be benign, while 29 cases (13.6%) were determined to be malignant. The US features of fatty hilum, echogenicity, and vascularity pattern had the highest diagnostic accuracy in characterizing CLA patterns, with values of 88.3%, 85.5%, and 85.0%, respectively. The receiver operating characteristic (ROC) curve showed a significantly higher area under the curve (AUC) value of 0.883 (95% CI: 0.832-0.923; P<0.0001) for the combined use of all US parameters with better sensitivity (93.10%) and specificity (68.65%) than individual parameters. The overall sensitivity, specificity, and accuracy of FNAC were 97.3%, 82.8%, and 95.3%, respectively. Additionally, US parameters and FNAC together showed a significantly higher AUC value of 0.924 (95% CI: 0.880-0.956; P<0.0001) and achieved a sensitivity of 86.21% and specificity of 88.65%.
    UNASSIGNED: The combined use of US and FNAC provides high sensitivity, specificity, and diagnostic accuracy in characterizing CLA patterns. In limited-resources settings, this approach is feasible, less invasive, and cost-effective, thereby enabling clear management strategies and avoiding additional surgical interventions.
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  • 文章类型: Journal Article
    背景:F-18-氟脱氧葡萄糖(FDG)PET/CT通常用于分期,评估大多数儿科恶性肿瘤的治疗反应和随访。颈淋巴结可累及一些儿科恶性肿瘤,但非恶性颈部淋巴结的摄取增加在该人群中并不例外。本研究的目的是确定儿科人群非恶性颈部淋巴结最大摄取的预测因素。
    方法:回顾性分析了191例没有颈部淋巴结恶性受累的儿童患者的FDGPET/CT研究。最热的颈淋巴结(SUVmaxCLN)的最大标准摄取值,以及人口统计,记录技术和成像变量.使用线性回归模型估计这些变量对SUVmaxCLN的预测作用。
    结果:在136/191项研究中观察到宫颈淋巴结中FDG活性增加(71%)。平均SUVmaxCLN为2.2±1.3。同侧腭扁桃体SUVmax,平均肝脏摄取,和治疗状态都是SUVmaxCLN的统计学显著预测因子。然而,在多元回归分析中,只有同侧腭扁桃体SUVmax被发现是显著的。此外,在所有研究的50%中,SUVmaxCLN大于平均肝脏摄取。这个比例在年幼的孩子中更高,达到77%的六岁以下儿童的研究。
    结论:同侧腭扁桃体的SUVmax是儿童非恶性颈部淋巴结最大摄取值的强预测指标。非恶性颈部淋巴结的摄取强度通常高于儿童的肝脏摄取,这种趋势在年轻患者中增加。
    在TRN0209-22-HMO下的内部医院登记处,日期为23.04.2022。
    BACKGROUND: F-18-flurodeoxyglucose (FDG) PET/CT is routinely used for staging, evaluation of response to treatment and follow-up of most pediatric malignancies. Cervical lymph nodes can be involved in some pediatric malignancies, but increased uptake in non-malignant cervical lymph nodes is not exceptional in this population. The aim of the present study is to identify predictors of the maximum uptake in non-malignant cervical lymph nodes in the pediatric population.
    METHODS: 191 FDG PET/CT studies of pediatric patients without malignant involvement of cervical lymph nodes were retrospectively reviewed. The maximal Standard Uptake Value in the hottest cervical lymph node (SUVmaxCLN), as well as demographic, technical and imaging variables were recorded. The predictive effect of those variables on SUVmaxCLN was estimated using linear regression models.
    RESULTS: Increased FDG activity in cervical nodes was observed in 136/191 studies (71%). The mean SUVmaxCLN was 2.2 ± 1.3. Ipsilateral palatine tonsil SUVmax, mean liver uptake, and treatment status were all statistically significant predictors of SUVmaxCLN. However, in multivariate regression analysis, only ipsilateral palatine tonsil SUVmax was found to be significant. In addition, SUVmaxCLN was greater than the mean liver uptake in 50% of all studies. This proportion was higher in younger children, reaching 77% of studies of children younger than six years.
    CONCLUSIONS: SUVmax in ipsilateral palatine tonsil is a strong predictor of the maximal uptake value of non-malignant cervical lymph nodes in children. The intensity of uptake in non-malignant cervical lymph nodes is frequently higher than liver uptake in children, and this tendency increases for younger patients.
    UNASSIGNED: In the internal hospital registry under TRN 0209-22-HMO on date 23.04.2022.
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  • 文章类型: Journal Article
    背景:本研究旨在比较[68Ga]Ga-DOTA-FAPI-04和[18F]FDGPET/CT显像对扁桃体癌患者原发灶和转移淋巴结的诊断价值。
    方法:回顾性纳入21例扁桃体癌患者,这些患者在我们中心两周内接受了[68Ga]Ga-DOTA-FAPI-04和[18F]FDGPET/CT扫描。使用Mann-WhitneyU检验比较了两种示踪剂的最大标准化摄取值(SUVmax)和肿瘤背景比(TBR)。此外,灵敏度,特异性,并分析了两种方法诊断转移性淋巴结的准确性。
    结果:在检测原发性病变时,[68Ga]Ga-DOTA-FAPI-04PET/CT(20/22)的效率高于[18F]FDGPET/CT(9/22)。尽管[68Ga]Ga-DOTA-FAPI-04摄取(SUVmax,5.03±4.06)低于[18F]FDG摄取(SUVmax,7.90±4.84,P=0.006),[68Ga]Ga-DOTA-FAPI-04改善了原发性肿瘤和对侧正常扁桃体组织之间的区别。[68Ga]Ga-DOTA-FAPI-04PET/CT的TBR(3.19±2.06)显著高于[18F]FDGPET/CT(1.89±1.80)(p<0.001)。在淋巴结分析中,[68Ga]Ga-DOTA-FAPI-04和[18F]FDGPET/CT之间的SUVmax和TBR没有显着差异(7.67±5.88vs.8.36±6.15,P=0.498和5.56±4.02。4.26±3.16,P=0.123)。[68Ga]Ga-DOTA-FAPI-04PET/CT诊断颈部淋巴结转移的特异性和准确性均高于[18F]FDGPET/CT(均P<0.05)。
    结论:与[18F]FDG相比,[68Ga]Ga-DOTA-FAPI-04的可用性提高了[18F]FDG的原发灶检出率和颈部转移淋巴结的诊断准确性,从而补充了[18F]FDG的诊断结果。
    BACKGROUND: This study aimed to compare the diagnostic value of [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT imaging for primary lesions and metastatic lymph nodes in patients with tonsil cancer.
    METHODS: Twenty-one tonsil cancer patients who underwent [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT scans within two weeks in our centre were retrospectively enrolled. The maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR) of the two tracers were compared by using the Mann‒Whitney U test. In addition, the sensitivity, specificity, and accuracy of the two methods for diagnosing metastatic lymph nodes were analysed.
    RESULTS: In detecting primary lesions, the efficiency was higher for [68 Ga]Ga-DOTA-FAPI-04 PET/CT (20/22) than for [18F]FDG PET/CT (9/22). Although [68 Ga]Ga-DOTA-FAPI-04 uptake (SUVmax, 5.03 ± 4.06) was lower than [18F]FDG uptake (SUVmax, 7.90 ± 4.84, P = 0.006), [68 Ga]Ga-DOTA-FAPI-04 improved the distinction between the primary tumor and contralateral normal tonsillar tissue. The TBR was significantly higher for [68 Ga]Ga-DOTA-FAPI-04 PET/CT (3.19 ± 2.06) than for [18F]FDG PET/CT (1.89 ± 1.80) (p < 0.001). In lymph node analysis, SUVmax and TBR were not significantly different between [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT (7.67 ± 5.88 vs. 8.36 ± 6.15, P = 0.498 and 5.56 ± 4.02 vs. 4.26 ± 3.16, P = 0.123, respectively). The specificity and accuracy of [68 Ga]Ga-DOTA-FAPI-04 PET/CT were higher than those of [18F]FDG PET/CT in diagnosing metastatic cervical lymph nodes (all P < 0.05).
    CONCLUSIONS: The availability of [68 Ga]Ga-DOTA-FAPI-04 complements the diagnostic results of [18F]FDG by improving the detection rate of primary lesions and the diagnostic accuracy of cervical metastatic lymph nodes in tonsil cancer compared to [18F]FDG.
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  • 文章类型: Case Reports
    该病例报告描述了治疗患有BCOR重排肉瘤的老年糖尿病患者所面临的诊断和治疗挑战。一种罕见的,侵袭性恶性肿瘤.病人表现为颈部肿胀,最初怀疑是高级别淋巴瘤,但后来发现是未分化的小圆细胞肉瘤。PET-CT进一步检查发现下腹部有肿块,导致我们重新考虑非霍奇金淋巴瘤的先前诊断。随后从腹部沉积物中进行的活检显示具有差异的高级圆形细胞肉瘤,包括BCOR-CCNB3融合/BCOR-ITD肉瘤,CIC-DUX4融合肉瘤,和EWSR-非ETS融合肉瘤.来自专门的肿瘤病理学实验室的第二种意见证实了BCOR重排肉瘤的诊断。患者接受了剖腹探查术和分流造口,但术后出现并发症。由于晚期和广泛的转移,由于治疗效果不佳,患者选择了支持治疗.此病例强调了提高认识和进行进一步研究以改善BCOR重排肉瘤等罕见恶性肿瘤的管理的重要性。
    This case report describes the diagnostic and therapeutic challenges faced in managing an elderly diabetic man with BCOR-rearranged sarcoma, a rare, aggressive malignancy. The patient presented with neck swelling, initially suspected to be a high-grade lymphoma but later found to be undifferentiated small round cell sarcoma. Further investigations with PET-CT revealed a mass in the lower abdomen, leading us to reconsider the prior diagnosis of non-Hodgkins\' lymphoma. Subsequent biopsies from an abdominal deposit indicated a high-grade round cell sarcoma with differentials including BCOR-CCNB3 fusion/BCOR-ITD sarcoma, CIC-DUX4 fusion sarcoma, and EWSR-non-ETS fusion sarcoma. A second opinion from a dedicated oncopathology lab confirmed the diagnosis of BCOR-rearranged sarcoma. The patient underwent exploratory laparotomy and diversion stoma but developed complications post-surgery. Due to the advanced stage and extensive metastases, the patient opted for supportive care due to poor outcomes with treatment. This case underscores the importance of raising awareness and conducting further research to improve the management of rare malignancies like BCOR-rearranged sarcoma.
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  • 文章类型: Journal Article
    探讨颈部淋巴结肿大的多模态超声(MMUS)特征,并评估其在颈部淋巴结良恶性鉴别诊断中的价值。
    回顾性分析了2020年3月至2022年10月在杭州红十字会医院就诊的169例颈部淋巴结肿大患者。所有患者均接受常规超声检查(CUS),超声造影(CEUS),和实时弹性成像(RTE),分为训练集和验证集。应用单变量分析筛选出具有统计学意义的参数,通过多因素Logistic回归分析构建CUS模型和MMUS模型。建立受试者操作特征(ROC)曲线,曲线下面积(AUC)用于比较CUS模型和MMUS模型以评估MMUS的值。
    纳入研究的169例患者的颈部169个淋巴结。169名入选患者被分为训练集(132名患者)和验证集(37名患者)。在训练集中,单因素分析显示长径/短径(L/S)差异有统计学意义,边界,margin,hilus,真皮髓质边界,血流类型,增强模式,增强类型,和RTE评分(均p<0.05)。多因素Logistic分析表明,L/S,血流类型,增强方式和增强类型与恶性淋巴结相关(均p<0.05)。AUC的比较表明,MMUS模型的判别能力优于CUS模型,在训练集(p=0.004)和验证集(p<0.001)中。
    在这项研究中,MMUS显示出比CUS更高的诊断效率。超声特征,如L/S,血流类型,增强模式,增强类型有助于区分良性和恶性淋巴结病。超声造影可大大提高颈部恶性淋巴结超声诊断的敏感性和特异性。RTE评分对颈部恶性淋巴结的诊断价值有限。
    UNASSIGNED: To investigate the multimodal ultrasound(MMUS) features of cervical lymphadenopathy and to assess its value in the differential diagnosis of benign and malignant cervical lymph nodes.
    UNASSIGNED: A retrospective analysis of 169 patients with cervical lymph node enlargement who attended Hangzhou Red Cross Hospital from March 2020 to October 2022. All patients underwent conventional ultrasound (CUS), contrast-enhanced ultrasound (CEUS), and real-time elastography (RTE), and were divided into training set and validation set. Univariate analysis was applied to screen out statistically significant parameters, and CUS model and MMUS model were constructed by multifactorial logistic regression analysis. The receiver operator characteristic (ROC) curve was established, and the area under the curve (AUC) was used to compare CUS model with MMUS model to assess the value of MMUS.
    UNASSIGNED: Of the cervical 169 lymph nodes in 169 patients included in the study. The 169 enrolled patients were divided into a training set (132 patients) and a validation set (37 patients). In the training set, univariate analysis showed statistically significant differences in long diameter/short diameter(L/S), border, margin, hilus, dermal medulla boundary, blood flow type, enhancement mode, enhancement type, and RTE score (all p< 0.05). Multifactor logistic analysis showed that L/S, blood flow type, enhancement mode and enhancement type were correlates of malignant lymph nodes (all p< 0.05). The comparison of AUC demonstrated that the discriminative ability of the MMUS model was superior to using the CUS model, both in the training set(p = 0.004) and validation set (p<0.001).
    UNASSIGNED: In this study, MMUS shows higher diagnostic efficiency than CUS. Ultrasound features such as L/S, blood flow type, mode of enhancement, type of enhancement are helpful in distinguishing benign and malignant lymphadenopathy. The addition of CEUS can greatly improve the sensitivity and specificity of ultrasonic diagnosis of malignant cervical lymph nodes. RTE score is of limited value in the diagnosis of malignant cervical lymph nodes.
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  • 文章类型: Journal Article
    目的:动态18F-FDGPET-CT扫描可准确量化18F-FDG的摄取,已成功应用于各种恶性肿瘤的诊断和疗效评估。能否准确区分鼻咽癌的良恶性淋巴结尚无定论。本研究的主要目的是通过分析揭示动态PET-CT在鼻咽癌颈淋巴结转移中的诊断价值。
    方法:我们首先搜索对静态PET-CT感兴趣的颈部淋巴结,测量了他们的SUV-Max值,并在治疗前后的磁共振图像中发现相应的淋巴结。根据治疗前后淋巴结大小变化分为有效组或无效组。如果治疗前后淋巴结的最大直径和最大垂直横径的乘积的变化大于或等于50%,他们将被包括在有效组中。如果变化小于50%,他们将被包括在无效组中。在动态PET-CT上测量它们的Ki值,并在不同条件下进行比较。然后,我们进行了各因素与Ki值的相关性分析.最后,进行诊断测试以比较Ki和SUV-Max的敏感性和特异性。
    结果:我们纳入51例鼻咽癌患者不同部位的67个颈淋巴结,根据治疗前的变化分为有效组和无效组。有效组包括50个淋巴结,而无效组包括17。SUV-Max中有效组和无效组之间存在差异(p<0.001),Ki-Mean,和Ki-Max值。当SUV-Max≤4.5时,两组Ki-Mean和Ki-Max差异无统计学意义(p>0.05)。当SUV-Max≤4.5且治疗前淋巴结<1.0cm时,有效组的Ki-Mean(0.00910)和Ki-Maximum(0.01004)值显著高于无效组(Ki-Mean=0.00716,Ki-Max=0.00767)(p<0.05).当SUV-Max≤4.5时,治疗前淋巴结<1.0cm,EBVDNA复制正常,有效组Ki-Mean(0.01060)和Ki-Max(0.01149)仍显著高于无效组(Ki-Mean=0.00670,Ki-Max=0.00719)(p<0.05)。不同因素之间的相关性分析(SUV-Max,T-stage,正常的EB病毒DNA复制,年龄,和治疗前淋巴结<1.0cm)和Ki值显示SUV-Max和治疗前淋巴结<1.0cm与Ki-Mean和Ki-Max相关。进行诊断测试;SUV-Max值的AUC值为0.8259(95%置信区间:0.7296-0.9222),Ki-Mean的AUC值为0.8759(95%置信区间:0.7950-0.9567),Ki-Max的AUC值为0.8859(95%置信区间:0.8089-0.9629)。经过比较,发现Ki-Mean和SUV-Max之间的AUC值没有显着差异(p=0.220>0.05),Kimax和SUV-Max之间的AUC值也没有显着差异(p=0.159>0.05)。通过计算Youden指数,我们确定了最佳临界值。结果发现SUV-Max的敏感性为100%,特异性为66%,Ki-Mean的敏感性为100%,特异性为70%,Ki-Max的敏感性为100%,特异性为72%。经过卡方分析,发现Ki-Mean和SUV-Max之间的特异性没有显着差异(p=0.712),Ki-Max和SUV-Max之间的特异性也没有显着差异(p=0.755)。
    结论:动态PET-CT对鼻咽癌颈淋巴结转移具有重要的诊断价值。特别是对于小型SUV的价值,淋巴结不符合治疗前的转移标准,EBVDNA复制正常.虽然诊断的准确性,灵敏度,动态PET-CT的特异性与传统静态PET-CT无显著差异,动态PET-CT具有更准确的趋势。
    OBJECTIVE: Dynamic 18F-FDG PET-CT scanning can accurately quantify 18F-FDG uptake and has been successfully applied in diagnosing and evaluating therapeutic effects in various malignant tumors. There is no conclusion as to whether it can accurately distinguish benign and malignant lymph nodes in nasopharyngeal cancer. The main purpose of this study is to reveal the diagnostic value of dynamic PET-CT in cervical lymph node metastasis of nasopharyngeal cancer through analysis.
    METHODS: We first searched for cervical lymph nodes interested in static PET-CT, measured their SUV-Max values, and found the corresponding lymph nodes in magnetic resonance images before and after treatment. The valid or invalid groups were included according to the changes in lymph node size before and after treatment. If the change in the product of the maximum diameter and maximum vertical transverse diameter of the lymph node before and after treatment was greater than or equal to 50%, they would be included in the valid group. If the change was less than 50%, they would be included in the invalid group. Their Ki values were measured on dynamic PET-CT and compared under different conditions. Then, we conducted a correlation analysis between various factors and Ki values. Finally, diagnostic tests were conducted to compare the sensitivity and specificity of Ki and SUV-Max.
    RESULTS: We included 67 cervical lymph nodes from different regions of 51 nasopharyngeal cancer patients and divided them into valid and invalid groups based on changes before treatment. The valid group included 50 lymph nodes, while the invalid group included 17. There wer significant differences (p < 0.001) between the valid and the invalid groups in SUV-Max, Ki-Mean, and Ki-Max values. When the SUV-Max was ≤4.5, there was no significant difference in the Ki-Mean and Ki-Max between the two groups (p > 0.05). When the SUV-Max was ≤4.5 and pre-treatment lymph nodes were <1.0 cm, the valid group had significantly higher Ki-Mean (0.00910) and Ki-Maximum (0.01004) values than the invalid group (Ki-Mean = 0.00716, Ki-Max = 0.00767) (p < 0.05). When the SUV-Max was ≤4.5, the pre-treatment lymph nodes < 1.0 cm, and the EBV DNA replication normal, Ki-Mean (0.01060) and Ki-Max (0.01149) in the valid group were still significantly higher than the invalid group (Ki-Mean = 0.00670, Ki-Max = 0.00719) (p < 0.05). The correlation analysis between different factors (SUV-Max, T-stage, normal EB virus DNA replication, age, and pre-treatment lymph node < 1.0 cm) and the Ki value showed that SUV-Max and a pre-treatment lymph node < 1.0 cm were related to Ki-Mean and Ki-Max. Diagnostic testing was conducted; the AUC value of the SUV-Max value was 0.8259 (95% confidence interval: 0.7296-0.9222), the AUC value of the Ki-Mean was 0.8759 (95% confidence interval: 0.7950-0.9567), and the AUC value of the Ki-Max was 0.8859 (95% confidence interval: 0.8089-0.9629). After comparison, it was found that there was no significant difference in AUC values between Ki-Mean and SUV-Max (p = 0.220 > 0.05), and there was also no significant difference in AUC values between Ki max and SUV-Max (p = 0.159 > 0.05). By calculating the Youden index, we identified the optimal cut-off value. It was found that the sensitivity of SUV-Max was 100% and the specificity was 66%, the sensitivity of Ki-Mean was 100% and the specificity was 70%, and the sensitivity of Ki-Max was 100% and the specificity was 72%. After Chi-Square analysis, it was found that there was no significant difference in specificity between Ki-Mean and SUV-Max (p = 0.712), and there was also no significant difference in specificity between Ki-Max and SUV-Max (p = 0.755).
    CONCLUSIONS: Dynamic PET-CT has shown a significant diagnostic value in diagnosing cervical lymph node metastasis of nasopharyngeal cancer, especially for the small SUV value, and lymph nodes do not meet the metastasis criteria before treatment, and EBV DNA replication is normal. Although the diagnostic accuracy, sensitivity, and specificity of dynamic PET-CT were not significantly different from traditional static PET-CT, the dynamic PET-CT had a more accurate tendency.
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  • 文章类型: Journal Article
    探讨粗针活检组织学和细针穿刺细胞学在宫颈淋巴结病中的应用差异。
    回顾性分析2018年10月至2020年2月保定市第一中心医院收治的颈部淋巴结肿大患者80例,随机分为芯针组和细针组。芯针组患者给予芯针活检组织学检查,细针组给予细针穿刺细胞学检查,比较两组穿刺结果及手术并发症。
    芯针组和细针组诊断颈部恶性淋巴结的准确率分别为95.83%和72.22%,差异有统计学意义(χ²=4.683,p=0.030)。敏感性,特异性,核心针组的阳性预测值和阴性预测值分别为100.00%,93.75%,分别为95.83%和100.00%,而细针组为86.67%,90.00%,分别为86.67%和90.00%,两组间差异无统计学意义(p>0.05)。核心针组并发症发生率为22.50%,高于细针组的5.00%(χ²=5.165,p=0.023)。
    在诊断颈部淋巴结肿大方面,芯针活检组织学和细针穿刺细胞学没有观察到显著差异,但前者并发症发生率高。
    UNASSIGNED: To investigate the difference of application of core needle biopsy histology and fine needle aspiration cytology in cervical lymphadenopathy.
    UNASSIGNED: A retrospective analysis was made on 80 patients with cervical lymphadenopathy admitted to Baoding No.1 Central Hospital from to October 2018 to February 2020, and they were randomly divided into two groups: core needle group and fine needle group. Patients in the core needle group were given core needle biopsy histology, while those in the fine needle group were given fine needle aspiration cytology, and the puncture results and surgical complications were compared between the two groups.
    UNASSIGNED: The accuracy rates of the core needle group and the fine needle group in the diagnosis of malignant cervical lymph nodes were 95.83% and 72.22% respectively, with a statistically significant difference (χ²=4.683, p=0.030). The sensitivity, specificity, positive predictive value and negative predictive value of the core needle group were 100.00%, 93.75%, 95.83% and 100.00% respectively, while those of the fine needle group were 86.67%, 90.00%, 86.67% and 90.00% respectively, with no statistically significant differences between the two groups (p>0.05). The complication rate in the core needle group was 22.50%, which was higher than the 5.00% in the fine needle group (χ²=5.165, p=0.023).
    UNASSIGNED: No significant difference was observed between core needle biopsy histology and fine needle aspiration cytology in diagnosing cervical lymphadenopathy, but the former has a high complication rate.
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  • 文章类型: Journal Article
    颈部淋巴结肿大作为转移性前列腺癌的初始表现尤其罕见,容易误诊。在目前的研究中,我们描述了我们医院的5例转移性前列腺癌,以颈部淋巴结肿大为首发症状。通过可疑淋巴结的穿刺活检证实了诊断,所有患者的血清前列腺特异性抗原(PSA)水平均超过100ng/ml。五名患者接受激素治疗;四名接受传统激素治疗,包括比卡鲁胺和戈舍瑞林;一名患者接受了包括阿比特龙和戈舍瑞林在内的激素治疗。病例1在7个月后发展为去势抵抗前列腺癌(CRPC),并在12个月后死亡。病例2因个人原因拒绝常规激素治疗,并在初次诊断后6个月死亡。在撰写本文时,案例3仍然活着。病例4服用阿比特龙,泼尼松龙和戈舍瑞林;治疗有效,患者在过去24个月中一直无症状。病例5接受激素和化疗治疗,但在诊断后8个月死亡。总之,任何出现颈部淋巴结肿大的老年男性都应考虑前列腺癌的可能性,尤其是当穿刺活检显示腺癌时.最初表现为颈淋巴结病的患者的预后通常较差。在这种情况下,基于阿比特龙的激素治疗可能会产生更好的反应。
    Cervical lymphadenopathy as the initial presentation of metastatic prostate cancer is particularly uncommon, and easily misdiagnosed. In the current study, we describe five cases of metastatic prostate cancer in our hospital that presented with cervical lymphadenopathy as an initial symptom. The diagnosis was confirmed by needle biopsy of the suspicious lymph nodes and the serum prostate specific antigen (PSA) levels of all patients exceeded 100 ng/ml. The five patients were treated with hormonal therapy; four received traditional hormonal therapy, including bicalutamide and goserelin; one patient received hormonal therapy that included abiraterone and goserelin. Case 1 developed into castration-resistant prostate cancer (CRPC) after 7 months and died after 12 months. Case 2 rejected regular hormonal therapy for personal reasons and died 6 months after the initial diagnosis. Case 3 was still alive at the time of writing. Case 4 was administered with abiraterone, prednisolone and goserelin; the treatment was effective and the patient has remained symptom-free for the last 24 months. Case 5 was treated with hormonal and chemotherapy but died 8 months after diagnosis. In conclusion, any elderly male presenting with cervical lymphadenopathy should be considered the possibility of prostate cancer, especially when the needle biopsy reveals adenocarcinoma. The prognosis for patients presented with cervical lymphadenopathy as the initial presentation is usually poor. Hormone therapy based on abiraterone may yield a better response in such cases.
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