颈部淋巴结细针穿刺误诊原因分析  

Misdiagnosis of cervical lymph node lesions by fine-needle aspiration cytology

作　　者：刘蕾蕾[1] 陈辉[1] 李万春[1] 涂频[1] 季洪爱[1] 石群立[1] 

机构地区：[1]南京军区南京总医院病理科

出　　处：《医学研究生学报》2015年第1期58-60,共3页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81101856)

摘　　要：目的：颈部淋巴结肿大的成因可分为炎症性肿大及肿瘤性肿大。文中分析颈部淋巴结细针穿刺病理诊断中的难点及避免误诊及漏诊措施。方法回顾性分析南京军区南京总医院病理科2010至2013年颈部淋巴结细针穿刺病例435例，并与对应淋巴结组织学活检结果比较。结果7例患者淋巴结细针穿刺与组织活检诊断结果不相符合，均因颈部淋巴结肿大而就诊。其中男性5例、女性2例；年龄41～71岁，平均年龄（58．4±8．9）岁；临床局部淋巴结肿大6例，全身淋巴结肿大1例；7例均可触及肿大淋巴结，直径1～4 cm。细针穿刺细胞学检查（ fine-needle aspiration cytology ， FNAC）将淋巴瘤误诊为差分化转移癌1例、低分化腺癌误诊为恶性淋巴瘤1例、淋巴瘤诊断为淋巴组织增生建议活检2例、提示恶性肿瘤未进一步分类1例、描述镜下特点建议淋巴结活检2例。与活检结果对比，FNAC的定性诊断符合率为99．3％（432／435）、误诊率1．6％（7／435）。结论 FNAC对初筛淋巴结疾患的良恶性及肿瘤类型有重要意义，而对于淋巴造血系统疾病的形态特征、诊断鉴别以及穿刺技术的熟悉与掌握，是降低FNAC诊断漏诊及误诊率的关键。Objective Cervical lymph node enlargement may be attributed to inflammation or tumors .This study was to analyze the pitfalls in fine-needle aspiration cytology （ FNAC） of cervical lymph nodes and the measures for avoiding misdiagnosis of cervical lymph node lesions . Methods We retrospectively analyzed the data about 435 cases of FNAC in comparison with the results of corre-sponding tissue biopsies in cervical lymph nodes . Results Among the 435 cases, 7 showed disagreement between the results of cytolog-ic and histologic diagnoses, which included 5 males and 2 females, at the age of 41 to 71 （58.4 ±8.9） years.Six of the cases presented with local lymph node enlargement and 1 with generalized lymphadenopathy, all with enlarged lymph nodes palpable 1-4 cm in diameter . Based on the results of FNAC, 1 case of malignant lymphoma was misdiagnosed as lowly differentiated adenocarcinoma, 1 case of lympho-ma misdiagnosed as poorly differentiated metastatic carcinoma, 2 cases of lymphoma diagnosed as lymphoproliferation and recommended for biopsy, 1 case suggestive of malignant tumor without further classification, and 2 cases microscopically characterized and recommended for lymph node biopsy.Compared with the results of the biopsy, FNAC achieved a 99.3%coincidence rate of qualitative diagnosis （432/425）, with a misdiagnosis rate of 1.6%（7/435）. Conclusion FNAC plays a very important role in the initial identification of the nature of lymph node lesions and the type of tumors.Practiced puncture skills and intimate knowledge about the histopathological features, diagnostic criteria, and differential diagnosis of the lymphatic system disorders are essential for improving the diagnostic accuracy of FNAC .

关 键 词：淋巴结 细针抽吸细胞学检查 误诊 

分 类 号：R441[医药卫生—诊断学]