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首页> 外文期刊>日本耳鼻咽喉科学会会報 >Investigation for cervical lymph node metastasis in unknown primary sites
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Investigation for cervical lymph node metastasis in unknown primary sites

机译：未知原主位点颈淋巴结转移的调查

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In patients with cervical adenopathy, especially, those of cervical lymph node metastasis with no detectable primary tumor, diagnosis and treatment planning can become confused. We evaluated 36 patients with cervical lymph node metastasis of unknown origin between 1985 and 2002. Primary sites were detected in 20 before treatment. The other 36 patients clearly had no primary lesions when treatment started. Primary sites were 5 cases of oropharynx, 2 of the parotid gland, and 1 each of larynx, nasopharynx, hypopharynx, and malignant lymphoma detected in 11 after treatment for cervical lymph nodes. No primary lesion was found in 28 patients. The neck LN stage was N1 in 11 patients, N2 in 29, N3 in 11, and unknown in 8. To detect the primary site, we conducted "random" biopsy, panendoscopy, and radiographic evaluation including FDG-PET. Biopsy sites were the nasopharynx, palatine and lingual tonsil, and piriform sinus. Some 35 patients (59.3%) underwent random biopsy, and primary sites were found this way in 5 patients (14.3%). The 36 who had no primary lesion were treated for cervical lymph nodes, of whom 24 underwent neck dissection. Chemotherapy and radiotherapy were the treatment of choice in many cases. We analyzed 31 patients for 5 year survival. Overall survival was 63.7%, disease-specific survival 69.2%, and disease-free survival 46.8%. In another analysis a statistically significant difference was seen in survival among patients who had neck surgery or not (85.7% vs. 38.9%, p = 0.029; log rank test). Analysis suggested that primary sites should be studied by CT, MRI, FDG-PET, and panendoscopy, including random biopsy. The primary site cannot be detected, treatment should initially involve cervical adenopathy with combined surgery, chemotherapy, and radiotherapy. After treatment, the patient should be followed up carefully to find the primary lesion.
机译：在宫颈腺肿的患者中，特别是没有可检测的原发性肿瘤，诊断和治疗计划的宫颈淋巴结转移的患者可能会混淆。我们在1985年和2002年间评估了36例宫颈淋巴结转移的宫颈淋巴结转移。治疗前20例检测原发性位点。当治疗开始时，其他36名患者显然没有初级病变。主要部位为肉癣的5例，腮腺2例，1例喉，鼻咽，鼻咽，下咽性肾病和治疗后11例检测到宫颈淋巴结后。在28名患者中发现了任何原发性病变。颈部LN阶段是N1，11例患者，N2在29，N3，8中，8例未知。要检测原遗址，我们进行了“随机”活组织检查，终镜，包括FDG-PET的射线照相评估。活组织检查位点是鼻咽，腭和舌扁桃体，吡虫窦。大约35名患者（59.3％）接受了随机活检，并在5名患者（14.3％）中发现了原发性位点。没有针对颈淋巴结治疗的36个没有初级病变，其中24个接受颈部解剖。化疗和放射疗法在许多情况下是选择的选择。我们分析了31例患者5年生存。总生存率为63.7％，疾病特异性存活率69.2％，无病生存率46.8％。在另一种分析中，在颈部手术或未出现颈部手术的患者中存在统计学上显着的差异（85.7％，P = 0.029;日志等级测试）。分析表明，CT，MRI，FDG-PET和终结性，包括随机活组织检查，应研究主要部位。不能检测到原发性部位，治疗应最初涉及宫颈癌患者与联合手术，化疗和放疗。治疗后，应仔细跟进患者以找到主要病变。

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