Опухоли головы и шеи. 2016; 6: 33-38
Новые возможности ультразвуковой оценки состояния лимфатических узлов шеи при раке слизистой оболочки полости рта
https://doi.org/10.17650/2222-1468-2016-6-1-33-38Аннотация
Введение. Рак слизистой оболочки полости рта в России характеризуется высокими показателями заболеваемости (4,52) и смертности (2,44). Злокачественные опухоли области головы и шеи обладают высоким потенциалом к регионарному метастазированию, при этом состояние лимфатических узлов не только влияет на тактику лечения больных с опухолями головы и шеи, но и является наиболее значимым прогностическим фактором. При регионарном метастатическом поражении отмечается двукратное снижение 5-летней выживаемости. Таким образом, оценка путей регионарного лимфатического оттока при раке слизистой оболочки полости рта играет важную роль не только в определении прогноза заболевания, но и при выборе тактики лечения.
Цель исследования – проанализировать данные, касающиеся методов ультразвуковой оценки состояния лимфатических узлов шеи при плоскоклеточном раке слизистой оболочки полости рта, представленные в научной литературе.
Результаты. Согласно данным различных исследований стандартный метод ультразвуковой оценки состояния лимфатических узлов шеи (B-режим) характеризуется высокой чувствительностью (71,0–96,4 %) и специфичностью (46,6–91,0 %), при этом эффективность ультразвукового исследования превосходит эффективность компьютерной томографии (чувствительность – 71 %, специфичность – 87 %). Точность ультразвуковой диагностики метастазов в лимфатические узлы шеи возросла после внедрения в практику таких методик, как эластометрия и эластография (чувствительность – 59,5–98,1 %, специфичность – 53,4–100 %).
Список литературы
1. http://globocan.iarc.fr/Pages/Map.aspx.
2. Злокачественные новообразования в России в 2012 г. (заболеваемость и смертность). Под ред.: А.Д. Каприна, В.В. Старинского, Г.В. Петровой. М., 2014. [Malignant tumors in Russia in 2012 (morbidity and fatality). By eds.: А.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Мoscow, 2014. (In Russ.)].
3. Пачес А.И. Опухоли головы и шеи. М.: Медицина, 2001. [Paches А.I. Head and neck tumors. Мoscow: Meditsina, 2001. (In Russ.)].
4. Поддубная И.В. Онкология: справочник практического врача. М.: МЕДпресс-информ, 2009. С. 162–3. [Poddubnaya I.V. Оncology: practical physician’s reference book. Мoscow: МЕDpress-inform, 2009. Pp. 162–3. (In Russ.)].
5. Snow G.В., Patel P., Leemans C.R., Tiwari R. Management of cervical lymph nodes in patients with head and neck cancer. Eur Arch Otorhinolaryngol 1992;249(4):187–94.
6. Абузарова Г.Р., Алексеев Б.Я., Антипов В.А. и др. Онкология: клинические рекомендации. Под ред. В.И. Чиссова, С.Л. Дарьяловой. 2-е изд., испр. и доп. М., 2009. С. 154. [Аbuzarovа G.R., Аlexeev B.Ya., Аntipov V.А. et al. Оncology: clinical recommendations. By eds.: V.I. Chissov, S.L. Dar’yalova. 2nd revised and enlarged edition. Мoscow, 2009. P. 154. (In Russ.)].
7. Woolgar J.A., Triantafyllou A., Lewis J.S. Jr et al. Prognostic biological features in neck dissection specimens. Eur Arch Otorhinolaryngol 2013;270(5):1581–92.
8. Som P.M. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. Am J Roentgenol 1992;158(5):961–9.
9. Чиссов В.И., Трофимова Е.Ю. Ультразвуковое исследование лимфатических узлов в онкологии. М.: ООО «Фирма СТРОМ», 2003. 112 с. [Chissov V.I., Тrofimova Е.Yu. Ultrasonic examination of lymphatic nodes in oncology. Мoscow: STROM Firm LLC, 2003. 112 p. (In Russ.)].
10. Аллахвердиева Г.Ф., Синюкова Г.Т., Шолохов В.Н., Романов И.С. Возможности комплексного ультразвукового исследования в диагностике метастатического поражения лимфатических узлов шеи. Ультразвуковая и функциональная диагностика 2005;(1):18–22. [Аllakhverdievа G.F., Sinyukovа G.Т., Sholokhov V.N., Romanov I.S. Potentials of the comprehensive ultrasonic examination in the diagnosis of the metastatic lesion of neck lymphatic nodes. Ul’trazvukovaya i funktsional’naya diagnostika = Ultrasonic and Functional Diagnostics 2005;(1):18–22. (In Russ.)].
11. Jank S., Robatscher P., Emshoff R. et al. The diagnostic value of ultrasonography to detect occult lymph node involvement at different levels in patients with squamous cell carcinoma in the maxillofacial region. Int J Oral Maxillofac Surg 2003;32(1):39–42.
12. Eichhorn T., Schwerk W., Schroeder H.G. High resolution real time sonography in tumors of the soft tissues of the neck. Laryngol Rhinol Otol (Stuttg) 1985:64(10):506–12.
13. Gritzmann N., Czembrik H., Hajek P. et al. Sonography in cervical lymph node metastases. Radiologe 1987:27(3):118–22.
14. Heppt W., Haels J., Lenarz T. et al. Detection and assessment of cervical lymph node metastases in head-neck tumors. A comparison of methods. Laringorhinootologie 1989:68(6):327–32.
15. Sumi M., Ohki M., Nakamura T. Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. AJR Am J Roentgenol 2001;176(4):1019–24.
16. Ophir J., Céspedes I., Ponnekanti H. et al. Elastography: a quantitative method for imaging the elasticity in biological tissues. Ultrason Imaging 1991;13(2):111–34.
17. Alam F., Naito K., Horiguchi J. et al. Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography. AJR Am J Roentgenol 2008;191(2):604–10.
18. Bhatia K.S., Cho C.C., Yuen Y.H. et al. Real-time qualitative ultrasound elastography of cervical lymph nodes in routine clinical practice: interobserver agreement and correlation with malignancy. Ultrasound Med Biol 2010;36(12):1990–7.
19. Lyshchik A., Higashi T., Asato R. et al. Cervical lymph node metastases: diagnosis at sonoelastography – initial experience. Radiology 2007;243(1):258–67.
20. Tan R., Xiao Y., He Q. Ultrasound elastography: Its potential role in assessment of cervical lymphadenopathy. Acad Radiol 2010;17(7):849–55.
21. Бердников С.Н., Шолохов В.Н., Патютко Ю.И. и др. Эластометрия и эластография в дифференциальной диагностике гепатоцеллюлярного рака. Анналы хирургической гепатологии 2013;(1):63–9. [Berdnikov S.N., Sholokhov V.N., Patyutko Yu.I. et al. Elastometry and elastography in the differential diagnostics of the hepatocellular carcinoma. Annaly khirurgicheskoy gepatologii = Аnnals of Surgical Hepatology 2013;(1):63–9. (In Russ.)].
22. Бердников С.Н., Шолохов В.Н., Патютко Ю.И. и др. Сравнительный анализ данных эластографии и эластометрии объемных образований печени с данными, полученными при исследовании удаленного макропрепарата. Анналы хирургической гепатологии 2013;(3):54–61. [Berdnikov S.N., Sholokhov V.N., Patyutkо Yu.I. et al. Сomparative analysis of the elastography and elastometry data of mass liver lesions with data, obtained at the examination of the extracted gross specimen. Annaly khirurgicheskoy gepatologii = Аnnals of Surgical Hepatology 2013;(3):54–61. (In Russ.)].
23. Бердников С.Н., Шолохов В.Н., Патютко Ю.И. и др. Эластометрия и эластография в дифференциальной диагностике гиперэхогенных образований печени. Анналы хирургической гепатологии 2014;(3):40–6. [Berdnikov S.N., Sholokhov V.N., Patyutkо Yu.I. et al. Elastometry and elastography in the differential diagnostics of liver hyperechoic formations. Annaly khirurgicheskoy gepatologii = Аnnals of Surgical Hepatology 2014;(3):40–6. (In Russ.)].
24. Teng D.K., Wang H., Lin Y.Q. et al. Value of ultrasound elastography in assessment of enlarged cervical lymph nodes. Asian Pac J Cancer Prev 2012;13(5):2081–5.
25. Choi Y.J., Lee J.H., Lim H.K. et al. Quantitative shear wave elastography in the evaluation of metastatic cervical lymph nodes. Ultrasound Med Biol 2013;39(6): 935–40.
Head and Neck Tumors (HNT). 2016; 6: 33-38
Up-to-date opportunities of cervical lymph nodes ultrasound investigation in patients, suffering from oral cavity cancer
https://doi.org/10.17650/2222-1468-2016-6-1-33-38Abstract
Background. Incidence of oral cancer in Russia is 4.52 and mortality – 2.44. Head and neck cancer is characterized by the high risk of development of metastases in regional lymph nodes. Lymph nodes status exerts influence on the treatment plan and appears to be the major predictive factor. Regional metastases result into two-fold decrease of five-year survival. Therefore, evaluation and treatment of metastatic lymph nodes is of prime importance.
Objective. The aim of this manuscript was to illustrate and summarize publications devoted to modern methods of ultrasound evaluation of cervical lymph node status in patients with squamous cell carcinoma of the oral cavity.
Results. Numerous studies have demonstrated, that standard ultrasound investigation (in B-mode) is characterized by high sensitivity and specificity (specificity varies from 71.0 to 96.4 %, and specificity – from 46.6 to 91.0 %, according to different studies). In addition, ultrasound efficiency exceeds that of CT. Accuracy of ultrasound as the method of cervical lymph node investigation has increased after implementation of such methods, as elastography and elastometry (this techniques allow to achieve sensitivity of 98.1 % and specificity of 100 %).
References
1. http://globocan.iarc.fr/Pages/Map.aspx.
2. Zlokachestvennye novoobrazovaniya v Rossii v 2012 g. (zabolevaemost' i smertnost'). Pod red.: A.D. Kaprina, V.V. Starinskogo, G.V. Petrovoĭ. M., 2014. [Malignant tumors in Russia in 2012 (morbidity and fatality). By eds.: A.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow, 2014. (In Russ.)].
3. Paches A.I. Opukholi golovy i shei. M.: Meditsina, 2001. [Paches A.I. Head and neck tumors. Moscow: Meditsina, 2001. (In Russ.)].
4. Poddubnaya I.V. Onkologiya: spravochnik prakticheskogo vracha. M.: MEDpress-inform, 2009. S. 162–3. [Poddubnaya I.V. Oncology: practical physician’s reference book. Moscow: MEDpress-inform, 2009. Pp. 162–3. (In Russ.)].
5. Snow G.V., Patel P., Leemans C.R., Tiwari R. Management of cervical lymph nodes in patients with head and neck cancer. Eur Arch Otorhinolaryngol 1992;249(4):187–94.
6. Abuzarova G.R., Alekseev B.Ya., Antipov V.A. i dr. Onkologiya: klinicheskie rekomendatsii. Pod red. V.I. Chissova, S.L. Dar'yalovoĭ. 2-e izd., ispr. i dop. M., 2009. S. 154. [Abuzarova G.R., Alexeev B.Ya., Antipov V.A. et al. Oncology: clinical recommendations. By eds.: V.I. Chissov, S.L. Dar’yalova. 2nd revised and enlarged edition. Moscow, 2009. P. 154. (In Russ.)].
7. Woolgar J.A., Triantafyllou A., Lewis J.S. Jr et al. Prognostic biological features in neck dissection specimens. Eur Arch Otorhinolaryngol 2013;270(5):1581–92.
8. Som P.M. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. Am J Roentgenol 1992;158(5):961–9.
9. Chissov V.I., Trofimova E.Yu. Ul'trazvukovoe issledovanie limfaticheskikh uzlov v onkologii. M.: OOO «Firma STROM», 2003. 112 s. [Chissov V.I., Trofimova E.Yu. Ultrasonic examination of lymphatic nodes in oncology. Moscow: STROM Firm LLC, 2003. 112 p. (In Russ.)].
10. Allakhverdieva G.F., Sinyukova G.T., Sholokhov V.N., Romanov I.S. Vozmozhnosti kompleksnogo ul'trazvukovogo issledovaniya v diagnostike metastaticheskogo porazheniya limfaticheskikh uzlov shei. Ul'trazvukovaya i funktsional'naya diagnostika 2005;(1):18–22. [Allakhverdieva G.F., Sinyukova G.T., Sholokhov V.N., Romanov I.S. Potentials of the comprehensive ultrasonic examination in the diagnosis of the metastatic lesion of neck lymphatic nodes. Ul’trazvukovaya i funktsional’naya diagnostika = Ultrasonic and Functional Diagnostics 2005;(1):18–22. (In Russ.)].
11. Jank S., Robatscher P., Emshoff R. et al. The diagnostic value of ultrasonography to detect occult lymph node involvement at different levels in patients with squamous cell carcinoma in the maxillofacial region. Int J Oral Maxillofac Surg 2003;32(1):39–42.
12. Eichhorn T., Schwerk W., Schroeder H.G. High resolution real time sonography in tumors of the soft tissues of the neck. Laryngol Rhinol Otol (Stuttg) 1985:64(10):506–12.
13. Gritzmann N., Czembrik H., Hajek P. et al. Sonography in cervical lymph node metastases. Radiologe 1987:27(3):118–22.
14. Heppt W., Haels J., Lenarz T. et al. Detection and assessment of cervical lymph node metastases in head-neck tumors. A comparison of methods. Laringorhinootologie 1989:68(6):327–32.
15. Sumi M., Ohki M., Nakamura T. Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. AJR Am J Roentgenol 2001;176(4):1019–24.
16. Ophir J., Céspedes I., Ponnekanti H. et al. Elastography: a quantitative method for imaging the elasticity in biological tissues. Ultrason Imaging 1991;13(2):111–34.
17. Alam F., Naito K., Horiguchi J. et al. Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography. AJR Am J Roentgenol 2008;191(2):604–10.
18. Bhatia K.S., Cho C.C., Yuen Y.H. et al. Real-time qualitative ultrasound elastography of cervical lymph nodes in routine clinical practice: interobserver agreement and correlation with malignancy. Ultrasound Med Biol 2010;36(12):1990–7.
19. Lyshchik A., Higashi T., Asato R. et al. Cervical lymph node metastases: diagnosis at sonoelastography – initial experience. Radiology 2007;243(1):258–67.
20. Tan R., Xiao Y., He Q. Ultrasound elastography: Its potential role in assessment of cervical lymphadenopathy. Acad Radiol 2010;17(7):849–55.
21. Berdnikov S.N., Sholokhov V.N., Patyutko Yu.I. i dr. Elastometriya i elastografiya v differentsial'noĭ diagnostike gepatotsellyulyarnogo raka. Annaly khirurgicheskoĭ gepatologii 2013;(1):63–9. [Berdnikov S.N., Sholokhov V.N., Patyutko Yu.I. et al. Elastometry and elastography in the differential diagnostics of the hepatocellular carcinoma. Annaly khirurgicheskoy gepatologii = Annals of Surgical Hepatology 2013;(1):63–9. (In Russ.)].
22. Berdnikov S.N., Sholokhov V.N., Patyutko Yu.I. i dr. Sravnitel'nyĭ analiz dannykh elastografii i elastometrii ob\"emnykh obrazovaniĭ pecheni s dannymi, poluchennymi pri issledovanii udalennogo makropreparata. Annaly khirurgicheskoĭ gepatologii 2013;(3):54–61. [Berdnikov S.N., Sholokhov V.N., Patyutko Yu.I. et al. Somparative analysis of the elastography and elastometry data of mass liver lesions with data, obtained at the examination of the extracted gross specimen. Annaly khirurgicheskoy gepatologii = Annals of Surgical Hepatology 2013;(3):54–61. (In Russ.)].
23. Berdnikov S.N., Sholokhov V.N., Patyutko Yu.I. i dr. Elastometriya i elastografiya v differentsial'noĭ diagnostike giperekhogennykh obrazovaniĭ pecheni. Annaly khirurgicheskoĭ gepatologii 2014;(3):40–6. [Berdnikov S.N., Sholokhov V.N., Patyutko Yu.I. et al. Elastometry and elastography in the differential diagnostics of liver hyperechoic formations. Annaly khirurgicheskoy gepatologii = Annals of Surgical Hepatology 2014;(3):40–6. (In Russ.)].
24. Teng D.K., Wang H., Lin Y.Q. et al. Value of ultrasound elastography in assessment of enlarged cervical lymph nodes. Asian Pac J Cancer Prev 2012;13(5):2081–5.
25. Choi Y.J., Lee J.H., Lim H.K. et al. Quantitative shear wave elastography in the evaluation of metastatic cervical lymph nodes. Ultrasound Med Biol 2013;39(6): 935–40.
