口腔癌頸部リンパ節転移に対する画像診断法のアプローチ

抄録

Palpation and imaging procedures such as computed tomography (CT), ultrasonography (US), magnetic resonance imaging (MR), radioisotope imaging (RI) and lymphography are examined for predicting cervical lymph node metastasis in head and neck cancer patients. We reviewed the criteria for metastasis and diagnostic accuracy (sensitivity, specificity and accuracy) of these diagnostic procedures in previous reports. We then discussed the efficiency of these diagnostic procedures for predicting cervical metastasis. Furthermore, our criteria and its positive predictive value (PPV) and negative predictive value (NPV) with CT, B-mode US and power Doppler US, and the methods of CT and US examinations in our department were reported. In previous reports, it was reported that sensitivity was 47%-97%, specificity was 38-92%, accuracy was 69-88% with palpation. The diagnostic efficiency of lympography was considered to be low. Now this procedure is not used in diagnosing cervical metastasis. ¹⁸FDG-PET was preformed mainly. Its sensitivity and specificity were 50-93% and 77-100%, respectively. With CT, sensitivity and specificity were 49%-100%, 38%-100%, respectively. With MR, sensitivity and specificity were 47%-100%, 48%-100%, respectively. With B-mode US, sensitivity and specificity were 58%-95%, 37%-96%, respectively. With Doppler US, sensitivity and specificity were 55%-98%, 77%-100%, respectively. In the results of our study, PPV for predicting metastasis with CT was 91%. PPV for predicting metastasis with B-mode US were 97%. PPV for predicting metastasis with power Doppler US were 87%.