The Correlational Research Of Preoperative B-mode Ultrasonography And Pathological Examination Of Cervical Lymph Nodes In Maxillofacial Squamous Cell Carcinoma

ObjectivesThe cervical lymph nodes of patients with oral and maxillofacial squamous cell carcinoma were examined by B-mode ultrasonography before operation,and the results were compared with those of pathological examination after operation to explore the accuracy of B-mode ultrasonography in detecting cervical lymph node metastasis of patients with oral and maxillofacial squamous cell carcinoma.To summarize the ultrasonographic characteristics of cervical lymph node metastasis in patients with maxillofacial squamous cell carcinoma,and to provide clinical guidance for the examination and treatment of patients with squamous cell carcinoma.Materials and MethodsAccording to the inclusion criteria of the experiment,20 cases of oral and maxillofacial squamous cell carcinoma(14 males and 6 females)were selected from the Department of Oral and Maxillofacial Surgery of Dalian Stomatological Hospital from September 2016 to July 2018.Their ages ranged from 31 to 76 years,with an average age of 56.7 + 10.4 years.All the subjects were diagnosed as newly diagnosed patients with oral and maxillofacial squamous cell carcinoma by biopsy.The same B-mode ultrasound doctor used the same B-mode ultrasound machine to examine the cervical lymph nodes before the operation.During the examination,the cervical lymph node metastasis was recorded in detail in each patient.At the same time,the ultrasonographic features such as the zoning,adjacent structures,longitudinal,transverse,hilar echoes and boundary of the metastasis lymph nodes were recorded.A total of 55 lymph nodes were suspected of metastasis by B-mode ultrasound.Surgical treatment was performed within one week after B-mode ultrasonography examination,including primary enlarged resection combined with neck lymph node dissection.According to the results of B-mode ultrasonography,lymph nodes suspected of malignant metastasis were carefully identified and separated,and recorded.Pathological examination was carried out with cervical specimens and all dissected lymph nodes,but only lymph nodes suspected of malignant metastasis by preoperative B-mode ultrasonography were studied.Postoperative and pathological results were compared,the lymph nodes were divided into metastasis group(46)and non-metastasis group(9)according to the pathological diagnosis results.The parameters were compared.Finally,SPSS 20.0statistical software was used for statistical analysis of data.Independent sample t test and Fisher exact probability method were used for the analysis method.p< 0.05 represented statistical difference.Results1)The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 93.75%,50%,85%,88.23% and 66.67% respectively.2)55 lymph nodes were suspected of metastasis by B-mode ultrasonography before operation,of which 46(84%)were confirmed by pathology after operation,and 9(16%)were not.3)The lymph nodes of metastatic and non-metastatic groups had statistical differences in longitudinal,transverse,L/S and echo parameters of lymphatic hilum(p<0.05),which could be used to judge whether lymph nodes metastasized or not,while there was no significant difference in boundary parameters between the two groups(p>0.05),so it could not be used as an index to judge whether lymph nodes metastasized or not,and should be diagnosed together with other indicators.4)The effective B-mode ultrasound parameters of 55 lymph nodes were counted.It can be seen that all the lymph nodes with three or four effective parameters were in the metastatic group,while in the non-metastatic group,the number of lymph nodes was 0;The effective B-ultrasonographic parameters of 46 metastatic lymph nodes were counted.The increase of transverse diameter accounted for 82.60% of the single parameter results.Conclusions1)Preoperative examination of cervical lymph nodes in patients with maxillofacial squamous cell carcinoma by B-mode ultrasonography is of high accuracy.B-mode ultrasonography can be used as the main imaging method for preoperative examination of lymph node metastasis;2)Increased longitudinal and transverse diameter of lymph nodes,L/S < 2,eccentricity or disappearance of lymphatic hilum echoes are important indicators for judging whether lymph node metastasis occurs or not,and whether the boundary is clear or not has no special indicative effect on lymph node metastasis,and should be diagnosed together with other indicators;3)When B-mode ultrasonography finds that lymph nodes have three or four effective parameters at the same time,it is more likely to be judged as malignant metastatic lymph nodes.;4)Increasing the transverse diameter of lymph nodes can clearly indicate the metastatic lymph nodes.Preoperative examination of lymph nodes should pay attention to the transverse diameter of lymph nodes,and neck lymphadenectomy should be performed to remove the enlarged lymph nodes;5)The most common location of squamous cell carcinoma of the maxillofacial region and the most prone primary site of cervical lymph node metastasis are the tongue.When symptoms occur in the tongue,it is necessary to pay close attention to and perform B-mode ultrasonography of the cervical lymph nodes in time;The most common area of cervical lymph node metastasis is area I~III.Preoperative B-mode ultrasonography should focus on area I~III.