超声引导下细针与粗针穿刺颈部淋巴结对诊断的价值分析  

Value analysis of ultrasound-guided fine needle and core needle biopsy of cervical lymph nodes in diagnosis

作　　者：梁凤平 黄容[2] 王译斌 纪巧 梁璇坤 王显翔 黄羽君 卢晓芳[4] 徐作峰[1] Liang Fengping;Huang Rong;Wang Yibin;Ji Qiao;Liang Xuankun;Wang Xianxiang;Huang Yujun;Lu Xiaofang;Xu Zuofeng(Department of Ultrasonic,the Seventh Hospital Affiliated to Sun Yat-sen University,Shenzhen 518000,China;Department of Gynecology and Obstetrics,the Seventh Hospital Affiliated to Sun Yat-sen University,Shenzhen 518000,China;Department of Ultrasonic Imaging,Xiangya Hospital,Central South University,Changsha 410000,China;Department,of Pathology,the Seventh Hospital Affiliated to Sun Yat-sen University ,Shenzhen 518000,China)

机构地区：[1]中山大学附属第七医院超声科,深圳518000 [2]中山大学附属第七医院妇产科,深圳518000 [3]中南大学湘雅医院超声影像科,长沙410000 [4]中山大学附属第七医院病理科,深圳518000

出　　处：《中国医师杂志》2019年第2期180-183,共4页Journal of Chinese Physician

基　　金：国家自然科学基金青年基金项目(81201104)~~

摘　　要：目的比较超声引导下细针穿刺(FNA)与粗针穿刺(CNB)在诊断颈部良恶性淋巴结的价值。方法回顾性分析2015年1月至2017年5月因颈部淋巴结肿大行穿刺活检的88例患者,进行FNA(n=39例)或CNB(n=49例),比较两种方法诊断颈部良恶性肿大淋巴结的灵敏度、特异度及准确性。结果 39例FNA中33例取材成功,6例取材失败,其中5例最后诊断为反应性增生,1例为菊池病。49例CNB中48例取材成功,1例最后诊断为淋巴瘤的病例CNB取材失败。FNA和CNB取材成功率分别为84. 6%(33/39)、98%(48/49),两者比较差异有统计学意义(P=0. 000)。FNA和CNB诊断颈部淋巴结恶性病变的灵敏度、特异度、准确性分别为90. 9%、94. 1%、92. 3%,97. 2%、100%、98%,差异均有统计学意义(P <0. 01)。FNA和CNB诊断颈部淋巴结转移癌的灵敏度、特异度分别为100%、95. 2%,100%、100%。CNB与FNA诊断颈部淋巴结转移癌的灵敏度差异无统计学意义(P=0. 102),特异度差异有统计学意义(P=0. 000)。结论 CNB诊断颈部淋巴结恶性的灵敏度、特异度及准确性优于FNA。但在诊断淋巴结转移癌时,FNA与CNB灵敏度比较无明显区别,推荐FNA为首选。Objective To compare the value of ultrasound-guided fine-needle aspiration (FNA) and core needle biopsy (CNB) in diagnosing benign and malignant cervical lymph nodes. Methods A retrospective analysis was performed on 88 patients who received biopsy for cervical lymph node enlargement from January 2015 to May 2017. FNA (n=39) or CNB (n=49) were performed respectively to compare the sensitivity, specificity and accuracy of the two methods in diagnosing benign and malignant cervical lymph node enlargement. Results 84.6%(33/39) of FNA cases were successfully collected, and 98%(48/49) of FNA cases were successfully collected for definite pathological diagnosis (P=0.000). The sensitivity, specificity and accuracy of FNA and CNB in diagnosing malignant cervical lymph nodes were 90.9% and 97.2%, 94.1% and 100%, 92.3% and 98%, respectively. Compared with FNA, there were statistically significant differences in sensitivity, specificity and accuracy in differentiating benign and malignant lymphatic lesions in cervical enlargement (P<0.01). The sensitivity and specificity of FNA and CNB in diagnosing cervical lymph node metastatic carcinoma were 100% and 100%, 95.2% and 100%. Compared with FNA, there was no statistically significant difference in the sensitivity to the diagnosis of cervical lymph node metastatic carcinoma (P=0.102). Conclusions CNB is superior to FNA in sensitivity, specificity and accuracy in diagnosing cervical lymphadenopathy. However, when metastatic cancer was diagnosed, FNA was not significantly different from CNB in sensitivity (P=0.102), and FNA was recommended as the first choice.

关 键 词：淋巴结 活组织检查 针吸 超声检查 诊断 鉴别 

分 类 号：R445.1[医药卫生—影像医学与核医学] R551.2[医药卫生—诊断学]