经超声内镜引导细针穿刺在淋巴瘤诊断及分型中的价值  

Value of endoscopic ultrasound guided fine needle aspiration(EUS-FNA)in the diagnosis and classification of lymphoma.

作　　者：张涵 程桂莲[2] 张晓慧[1] 陈萍[1] 胡端敏[2] 李炳宗[1] ZHANG Han;CHENG Gui-lian;ZHANG Xiao-hui;CHEN Ping;HU Duan-min;LI Bing-zong(Department of Hematology,the Second Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第二医院血液科,江苏苏州215000 [2]苏州大学附属第二医院消化科,江苏苏州215000

出　　处：《中国实用内科杂志》2023年第10期847-852,857,共7页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金面上项目(82270197)。

摘　　要：目的评估经超声内镜引导细针穿刺(EUS-FNA)在淋巴瘤诊断和分型中的作用。方法对苏州大学附属第二医院2015年2月至2023年2月期间疑诊为淋巴增殖性疾病(LPD)并接受EUS-FNA的患者进行回顾性分析。结果共纳入34例患者,其中男性21例(62%),中位年龄64岁,13例(38.2%)使用19G穿刺针,21例(62.8%)使用22G穿刺针,目标穿刺病灶包括胃(5例次)、肝脏(3例次)、胰腺(4例次)、肾上腺(3例次)、腹腔淋巴结(25例次),6例(17.6%)患者同时接受了前述2个类型目标病灶的穿刺。31例(91.2%)最终确诊为淋巴瘤,29例通过EUS-FNA诊断,其中20例(69.0%)可确定正确的病理学亚型,诊断低级别非霍奇金淋巴瘤(NHL)的灵敏度较高,所有患者均未发生EUS-FNA相关不良事件。EUS-FNA诊断淋巴瘤的灵敏度、特异度和准确率分别为93.5%、100.0%和94.1%,联合辅助技术可将准确率提高至97.1%。结论对于疑诊淋巴瘤患者,EUS-FNA是一种灵敏及安全的诊断技术,联合流式细胞术、二代测序等辅助技术可进一步提高诊断准确率。Objective To determine the role of EUS-FNA in the diagnosis and classification of lymphoma.Methods A retrospective analysis was conducted in patients with suspected lymphoproliferative disorders(LPD)who underwent EUSFNA at The Second Affiliated Hospital of Soochow University between February 2015 and February 2023.Results A total of 34 patients were included,including 21 males(62%)with a median age of 64 years.Thirteen cases(38.2%)used a 19G puncture needle,while 21 cases(62.8%)used a 22G puncture needle.Thirteen cases(38.2%)used a 19G puncture needle,while 21 cases(62.8%)used a 22G puncture needle.Target lesions for puncture included the stomach(5 cases),liver(3 cases),pancreas(4 cases),adrenal gland(3 cases),and abdominal lymph nodes(25 cases).About 17.6%of patients(6 cases)underwent punctures for lesions of both types mentioned above.Totally 31 cases(91.2%)were eventually diagnosed with lymphoma,with 29 cases diagnosed through EUS-FNA.Among them,20 cases(69.0%)could accurately determine the pathological subtype,with a high sensitivity for low-grade non-Hodgkin lymphomas(NHL).No adverse event related to EUS-FNA was observed.The sensitivity,specificity,and accuracy of EUS-FNA in diagnosing lymphoma were 93.5%,100.0%,and 94.1%,respectively.Combined with assistive techniques,the accuracy could be improved to 97.1%.Conclusion EUS-FNA is a sensitive and safe diagnostic technique for patients with suspected lymphoma,and auxiliary technologies such as flow cytometry and next-generation sequencing could further improve the diagnostic accuracy.

关 键 词：超声内镜 细针穿刺 淋巴瘤 诊断 

分 类 号：R557[医药卫生—血液循环系统疾病]