红外热成像技术诊断口腔鳞状细胞癌颈淋巴结转移

doi:10.19723/j.issn.1671-167X.2019.05.028

摘要/Abstract

摘要：

目的:探索以无创、无电离辐射暴露、经济快捷的红外热成像技术诊断口腔鳞状细胞癌颈淋巴结转移的可行性,并通过联合诊断试验评价其诊断效能及应用价值。方法:选择2015年7月至2017年6月北京大学口腔医院口腔颌面外科主因口腔鳞状细胞癌住院治疗,拟行颈淋巴清扫术的患者共74例,收集受试者的基线资料及术前常规临床检查结果,如体格检查和增强CT,并在术前对受试者行红外热成像检查。根据诊断试验的基本原理,以术后病理检查报告为金标准,计算红外热成像检查的诊断效能指标。结果:红外热成像技术诊断口腔鳞状细胞癌颈淋巴结转移癌的灵敏度为75.0%,特异度为69.0%,符合率为71.6%, 阳性预测值为64.9%,阴性预测值为78.4%。红外热成像与其他常规术前检查并联试验的灵敏度为87.9%,串联试验的特异度为97.6%。结论:红外热成像技术可以纳入术前临床检查,可以同其他影像学检查手段联合作为口腔鳞状细胞癌颈淋巴结转移癌的诊断手段。

关键词: 红外热成像, 口腔鳞状细胞癌, 颈淋巴结转移癌, 诊断试验

Abstract:

Objective: To evaluate the diagnostic performance of a non-invasive, non-radiating, economical and convenient infrared thermal imaging in the detection of oral squamous cell carcinoma (OSCC) cervical lymph node metastasis, and evaluate its applicability via parallel test and series test. Methods: This study was a prospective clinical study which passed the ethical review by the Biomedical Ethics Committee, Hospital of Stomatology, Peking University, and had been submitted for clinical trial registration. Totally 74 OSCC patients who were to undergo a neck dissection were included in this study. The inclusion criteria were patients who: (1) were pathologically diagnosed as malignant tumors and planned to undergo surgical treatment including neck dissection; (2) agreed to participate in this study. The exclusion criteria were those who: (1) had undergone surgeries at head and neck previously; (2) with a history of systemic tumor adjuvant therapies such as radiotherapy or chemotherapy etc; (3) were unwilling or unable to cooperate. Basal information as well as clinical examination results were collected, such as physical examination and contradictive enhanced CT. Besides, infrared thermal imaging was done ahead of surgery. Analysis of the diagnostic power of infrared thermal imaging followed the principles of diagnostic test. The positive signs of infrared thermal imaging were: (1) asymmetric thermographic pattern including vascular pattern in ROI; (2) thickening image of unilateral facial artery/vein, submental artery/vein or external carotid artery; (3) surface temperature of ROI raised over 1 ℃ compared with the opposite side; (4) changes of neck profile with abnormal temperature pattern. The gold standard of this diagnostic test was pathology diagnosis of cervical lymph nodes. Results: The sensitivity of infrared thermal imaging was 75.0%, while the specificity was 69.0%, accuracy was 71.6%, positive predictive value was 64.9% and negative predictive value was 78.4%. The sensitivity of parallel test which stood for the combination of infrared thermal imaging and conventional clinical examinations was 87.9% while the specificity of series test was 97.6%. Conclusion: Infrared thermal imaging is a promising non-invasive, non-radiating and economical tool in the detection of cervical lymph node metastasis from OSCC when combined with conventional pre-operative examination.

Key words: Infrared thermal imaging, Oral squamous cell carcinoma, Cervical lymph node metastasis, Diagnostic test

中图分类号:

R739.8

陶船思博,董凡,王佃灿,郭传瑸. 红外热成像技术诊断口腔鳞状细胞癌颈淋巴结转移[J]. 北京大学学报（医学版）, 2019, 51(5): 959-963.

Chuan-si-bo TAO,Fan DONG,Dian-can WANG,Chuan-bin GUO. Diagnostic test for detection of cervical lymph node metastasis from oral squamous cell carcinoma via infrared thermal imaging[J]. Journal of Peking University(Health Sciences), 2019, 51(5): 959-963.

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Title	Subtitle	Number	Percentage
Number of patients		74
Average age/years		58.9±12.3
Gender	Male	50	67.6
	Female	24	32.4
Physical examinateion	cN0	41	55.4
	cN+	33	44.6
Site of the primary tumor
ICD10-C00	Lip	1	1.3
ICD10-C01	Base of Tongue	6	8.1
ICD10-C02	Tongue	29	39.2
ICD10-C03	Gum	13	17.6
ICD10-C04	Floor of mouth	6	8.1
ICD10-C05	Palate	2	2.7
ICD10-C06.0	Buccal mucosa	11	14.9
ICD10-C06.2	Retromolar area	4	5.4
ICD10-C10	Oropharynx	2	2.7
Primary tumor diameter
	d_max≤2.0 cm	33	44.6
	2.0 cm<d_max≤4.0 cm	35	47.3
	4.0 cm<d_max≤6.0 cm	5	6.8
	d_max>6.0 cm	1	1.3
Primary tumor pathology
	SCC level Ⅰ	28	37.8
	SCC level Ⅰ-Ⅱ	27	36.5
	SCC level Ⅱ	14	18.9
	SCC level Ⅱ-Ⅲ	4	5.4
	SCC level Ⅲ	1	1.4
Pathological N staging
	pN0	42	56.8
	pN1	12	16.1
	pN2a	2	2.7
	pN2b	13	17.6
	pN2c	5	6.8
	pN3	0	0