초록
술전 경부 임파절 평가의 정확성은 신체검사와 방사선학적 소견 모두에서 정확성의 한계를 보였으며, 정확성을 보다 높이기 위해서는 임상의사와 방사선의사간에 의견 교환이 중요하다고 사료된다. 그리고 필요에 따라서는 초음파 촬영, 세침 흡인세포검사(FNAC) 등의 보조적인 임파절 평가 방법을 이용하는 것도 전체 정진율을 높일 수 있을 것이다. 또한 구강암의 원발 부위가 고위험군인 경우에는 가음성도 비율이 높고, 방사선학적 검사에서 전체 정진율이 낮은 결과를 보이는 것으로 볼때, 지금까지 알려진대로 예방적 경부 곽청술을 보다 적극적으로 고려하는 것이 필요하다고 사료된다.
Purpose : The aim of this study was to determine the accuracy of clinical and radiologic assessments in detecting positive cervical lymph nodes in oral cancer. Materials and Methods : We had reviewed the preoperative clinical, radiologic and postoperative histopathologic reports of 46 patients who had been diagnosed as oral cancer and underwent surgical excision combined with neck dissection (52 sides of neck) in the Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University from the July 1, 1992 to the April 30, 1999. Results : The results were as follows 1. The male to female ratio was 4.38 : 1 and the mean age was 57. 2. Sensitivity values for the preoperative assessment of cervical lymph node metastasis in oral cancer were 62.5 % in clinical examination and 50.0 % in radiologic assessments. Specificity values were 77.8 % in clinical examination and 94.4 % in radiologic assessments. 3. False positive values were 44.4 % in clinical examination and 20.0 % in radiologic assessments. False negative values were 17.6 % in clinical and 19.0% in radiologic assessments. 4. Overall efficiency values were 73.1 % in clinical examination and 80.8 % in radiologic assessments. Summary : There were some limits on the accuracy of clinical and radiologic assessments in the preoperative detection of the cervical lymph nodes in oral cancer. To improve the accuracy, it is important to communicate between clinician and radiologist, and adjunctive diagnostic measures, ultrasound and fine needle aspiration cytology, were helpful increasing the overall efficiency. In the high risk sites (oral tongue and floor of the mouth) the false negative value is higher and the overall efficiency in radiologic evaluation is lower than those of the low risk sites (gingiva and alveolar ridge, retromolar trigone and buccal mucosa ). The elective neck dissection should be considered in the high risk sites.