GIÁ TRỊ CỦA CHỤP CẮT LỚP VI TÍNH VÀ CỘNG HƯỞNG TỪ TRONG CHẨN ĐOÁN DI CĂN HẠCH CỔ TIỀM ẨN Ở BỆNH NHÂN UNG THƯ BIỂU MÔ TẾ BÀO GAI HẠ HỌNG VÀ THANH QUẢN

Abstract

Background: Accurate diagnosis of cervical lymph node status is a key factor in treating squamous cell carcinoma (SCC) of the hypopharynx and larynx. Although computed tomography (CT) and magnetic resonance imaging (MRI) are the main diagnostic tools, their potential to miss occult lymph node metastases (OLM) remains a major challenge, directly impacting treatment decisions. Objective: To evaluate the sensitivity, specificity, positive predictive value, and negative predictive value of CT and MRI in diagnosing diagnosing cervical lymph node metastasis in patients with hypopharyngeal and laryngeal SCC. Materials and Methods: A descriptive cross-sectional study was conducted by reviewing medical records of 78 patients with hypopharyngeal and laryngeal SCC who underwent primary tumor resection and bilateral neck dissection of levels II, III, and IV at the University Medical Center HCMC and Military Hospital 175 from January 2021 to June 2025. Preoperative imaging findings were compared with postoperative histopathological results. Results: On a per-patient basis, the diagnosis of nodal metastasis (cN) using CT or MRI showed a sensitivity of 85.2%, specificity of 86.3%, positive predictive value of 82.9%, and negative predictive value of 88.3%. On a per-nodal-level basis (n=468), the sensitivity decreased to 67.2% while the specificity was 96.3%. Conclusion: CT and MRI are highly valuable tools for determining the overall nodal status at the patient level. However, these modalities have limited sensitivity in detecting metastasis at individual nodal levels, indicating a potential to miss occult metastatic disease and affirming the role of staging neck dissection.