颈部淋巴结穿刺活检的误诊原因分析  

Misdiagnosis Analysis of Neck Lymph Node Biopsy

作　　者：袁轶群[1] 郭一川[1] 田振刚[2] 

机构地区：[1]新疆生产建设兵团第一师医院病理科,新疆阿克苏843000 [2]新疆生产建设兵团第一师医院超声科,新疆阿克苏843000

出　　处：《新疆医学》2016年第7期859-860,865,共3页Xinjiang Medical Journal

摘　　要：目的探讨超声引导下颈部淋巴结穿刺活检术在病理学诊断中的难点和避免误诊、漏诊的措施。方法回顾性分析新疆生产建设兵团第一师医院病理科2012年10月-2015年10月超声引导下颈部淋巴结穿刺活检病例215例,对其淋巴结活检的病理学检查结果进行分析。结果在215例病例中,病理学未能明确诊断者或与临床疑似诊断不相符合者23例,占10.70%,对这23例均进行了完整的淋巴结手术切除活检,4例为早期结核病变,占结核病变的7.27%;8例为反应性增生,占淋巴结反应性增生的11.27%,6例为淋巴瘤,占淋巴瘤的46.15%,2例为淋巴结转移癌,占转移癌的2.74%,3例诊断不明确。结论超声引导下颈部淋巴结穿刺活检对明确淋巴结的良恶性有重要意义,因此,提高淋巴结穿刺活检技术及熟练掌握淋巴结相关疾病的形态特征、诊断鉴别要点,是降低颈部淋巴结穿刺活检诊断漏诊及误诊率的关键。但对于高度怀疑淋巴瘤的患者,仍建议完整的淋巴结手术活检。Objective To explore the pitfalls of ultrasound-guided superifcial neck lymph node biopsy in the diagnosis of pathology and to take measures to avoid misdiagnosis and missed diagnosis.Methods 215 cases who underwent ultrasound-guided superifcial neck lymph node biopsy in the first division hospital of Xinjiang Production and Construction Corps from October 2012 to October 2015 were analyzed.Results There were 23 cases showing improper diagnosis or misdiagnosis among 215 cases,accounting for 10.70%（23/215）.Among the 23 cases,which there were 4 cases for early tuberculous,accounted for 7.27%（4/55）.8 cases was reactive hyperplasia,accounting for 11.27%（8/71）.6 cases belonging to lymphoma,accounted for 46.15%（6/13）.2 cases being lymph node metastasis carcinoma,accounted for 2.74%（2/73）.3 cases was not clearly diagnosed.Conclusion Ultrasound-guided superifcial neck lymph node biopsy plays a very important role in the initial diagnosis to lymph node lesions.Practiced puncture skills and knowledge about the histopathological features,diagnostic criteria,and knowing about the main points of this disease are essential to reduce missed diagnosis and misdiagnosis.But for highly suspected cases,complete surgical removal of the lymph node biopsy was still suggested.

关 键 词：淋巴结 穿刺活检 误诊 

分 类 号：R441[医药卫生—诊断学]