内镜超声引导下细针抽吸术联合流式细胞术在深部淋巴瘤诊断中的应用初探

EUS-FNA combined with flow cytometry in diagnosis of deep-seated lymphoma

目的探讨内镜超声引导下细针抽吸术（EUS—FNA）联合流式细胞术（FCM）在诊断腹膜后及纵隔等深部位淋巴瘤诊断中的应用价值。方法回顾性分析24例经B超、CT或MRI检查发现腹膜后或纵隔肿大淋巴结疑似淋巴瘤患者的病例资料，总结EUS—FNA联合FCM以及EUS—FNA联合普通细胞学病理学的检测结果，结合最终诊断结果统计上述两种检测方法的诊断性并行对比分析。结果24例中最终8例确诊为淋巴瘤，14例确诊为非淋巴瘤病变，2例无法明确诊断。EUS．FNA联合FCM诊断淋巴瘤的敏感度为87．5％（7／8），特异度为100。0％（14／14），阳性预测值为100．0％（7／7），阴性预测值为93．3％（14／15），准确率为95．5％（21／22）；EUS—FNA联合普通细胞学及病理学诊断淋巴瘤的敏感度为25．0％（2／8），特异度为85．7％（12／14），阳性预测值为50．0％（2／4），阴性预测值为66．7％（12／18），准确率为63．6％（14／22）。两种检测方法比较差异有统计学意义（P〈0．05）。结论EUS—FNA联合FCM是一种可靠的诊断非霍奇金淋巴瘤的手段，尤其是对以深部淋巴结肿大为主要表现的疑似淋巴瘤更应优先考虑行EUA—FNA联合FCM检测。

Objective To evaluate the performance of EUS-FNA combined with flow cytometry （FCM） in diagnosis of mediastinal or retroperitoneal lymphoma. Methods This study was a retrospective analysis of a collection of data over one year period. Since 2011,24 patients with lesions suspicious for lym- phoma detected by uhrasonography, CT or MRI underwent EUS-FNA and FCM. Results Of the 24 patients, 8 were confirmed as lymphoma including 7 cases of non-Hodgkin＇s lymphoma and 1 case of Hodgkin＇s lymphoma, 14 patients were diagnosed as nonlymphoma lesions and the 2 other patients got indeterminate diagnosis because of insufficient material for FCM. The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV）, and accuracy of EUS-FNA combined with FCM for diagnosing lymphoma were 87.5%, 100. 0%, 100. 0% , 93.3%, and 95.5%, respectively. The sensitivity, speci- ficity, PPV, NPV and accuracy of EUS-FNA only for diagnosing lymphoma were 25.0%, 85.7%, 50. 0% , 66. 7% , and 63.6% , respectively. There was significant difference between these two methods. Conclusion EUS-FNA combined with FCM is a highly sensitive, specific and accurate method for the diagnosis of B-cell non-Hodgkin＇s lymphoma.