淋巴结空芯针穿刺活检对淋巴组织增生性疾病的诊断意义  

Diagnostic significance of lymph node core needle biopsy for lymphoproliferative disease： a clinicopathologic study of 1013 cases

作　　者：黄蓉飞[1,2] 张文燕[1] 刘卫平[1] 赵莎[1] 叶云霞[1] 孙虹 高立敏[1] 王健超[1] 杨群培[1] 

机构地区：[1]四川大学华西医院病理科,成都610041 [2]成都医学院第一附属医院病理科

出　　处：《中华病理学杂志》2018年第1期19-24,共6页Chinese Journal of Pathology

基　　金：四川省卫生和计划生育委员会科研课题重点项目（16ZD009）;四川省卫生和计划生育委员会科研课题普及应用项目（16PJ337）;四川省科学技术厅四川省应用基础研究项目（2017JY0266）

摘　　要：目的 探讨淋巴结空芯针穿刺活检（CNB）对淋巴组织增生性疾病的诊断意义.方法收集并分析2009年1月1日至2015年12月31日四川大学华西医院病理科1013例淋巴结CNB诊断淋巴组织增生性疾病病例的年度分布、疾病构成、患者的临床信息、样本大体检查、组织学特征、辅助检测应用情况、多次活检结果.结果 （1）淋巴结CNB样本占同期总活检样本病例的比例由0.2%（2009年）递增至0.8%（2015年）.（2）包括淋巴瘤471例、不典型淋巴增生（ALH）12例、疑似淋巴瘤136例、良性病变372例、描述性诊断22例.（3）淋巴造血组织肿瘤患者以〈20岁的青少年儿童和〉60岁的老人居多.53.1%（538/1013）样本组织条数≥4条,40.5%（410/1013）样本总长度〉2 cm.（4）104例既往手术切除活检后行淋巴结CNB,包括45例癌的引流区淋巴结 CNB均未见癌转移;32例淋巴瘤以CNB为疗效观察;4例疑似淋巴瘤、1例ALH、22例良性病变行CNB后分别有1例、1例和3例为淋巴瘤.（5）217例淋巴结CNB后再行CNB（70例）或手术切除活检（147例）诊断淋巴瘤,包括78.5%（73/93）疑似淋巴瘤、5/7 ALH和32.3%（20/62）良性病变.结论 淋巴结CNB有一定的临床应用指征.对淋巴增生性疾病诊断的应用价值相对局限.CNB诊断为疑似淋巴瘤和ALH需再次活检,良性病变者不排除再次活检.Objective To study the clinicopathologic features of lymphoproliferative disease by lymph node core needle biopsy（CNB）and to evaluate the diagnostic significance of CNB for lymphoproliferative disease. Methods The annual distribution, entity constitute, clinical finding, gross feature,morphologic change,affiliate study and repeat biopsy diagnosis of 1 013 cases of lymph node CNB diagnosed at West China Hospital of Sichuan University from January 2009 to December 2015 were investigated. Results （1）Proportion of lymph node CNB in total amount of biopsy specimens increased from 0.2% in 2009 to 0.8% in 2015.（2）The study cohort included 471 lymphomas,12 atypical lymphoid hyperplasia（ALH）,136 suspected lymphomas,372 benign lesions,and 22 cases of descriptive diagnoses. The most common types were diffuse large B cell lymphoma and T-lymphoblastic lymphoma.（3）Majority of patients were adolescents and children younger than 20 years or the elderly older than 60 years. 53.1% CNB tumor specimen consisted of =4 tissue cores and 40.5% were 〉2 cm in length.（4）104 CNB cases with previous history of excision biopsy was included 45 carcinomas（no metastatic carcinoma was found）, 32 lymphomas for treatment observation.1/14 suspicious lymphomas,1/1 ALH and 3/22 cases benign lesions were diagnosed as lymphoma by repeat biopsy respectively.（5）217 CNB cases were diagnosed as lymphoma by subsequent CNB（70）, or subsequent excision biopsy（147）including 78.5%（73/93）suspected lymphomas,5/7 ALH and 32.3%（20/62）benign lesions. Conclusions Lymph node CNB has certain clinical indications,although limited for the diagnosis of lymphoproliferative disorders. Suspected lymphomas and ALH diagnosed by CNB should be followed by repeat tissue biopsy. For the benign lesions by CNB it does not rule out additional biopsy to further investigate the lesion.

关 键 词：淋巴瘤 淋巴结 穿刺术 

分 类 号：R551.2[医药卫生—血液循环系统疾病]