颈部淋巴结超声分析及活检对非小细胞肺癌患者手术决策的价值

Role of cervical lymph node ultrasound analysis and biopsy in deciding surgery for non-small cell lung cancer

目的分析非小细胞肺癌伴颈部淋巴结肿大患者术前超声引导下穿刺活检对手术决策的价值及声像特征。方法回顾性分析2011年5月-2013年12月在解放军总医院住院拟行肺癌根治术、术前超声检查提示颈部淋巴结肿大诊断为恶性并建议穿刺活检的非小细胞肺癌患者64例,分析超声引导下穿刺活检的病理结果与肺部原发灶比较的恶性率;同时比较超声检查显示的淋巴结大小、血流丰富程度、皮髓质间界限清晰程度、有无淋巴门结构和病理良恶性之间的关系。结果经淋巴结穿刺病理证实的颈部淋巴结恶性率为81.2%,其中转移性腺癌30例,鳞癌18例,淋巴瘤4例,炎性增生12例;癌性淋巴结平均直径(2.1±0.6)cm,血流信号丰富率为57%,皮髓质界限不清占43%,无淋巴门结构61%,癌性与炎性淋巴结在这4个方面差异均有明显统计学意义(P<0.01)。结论术前颈部及锁骨上超声检查对明确非小细胞肺癌患者有无淋巴结转移及对患者术前病情评估具有重要临床意义。

Objective To analyze the role of ultrasound-guided biopsy in diagnosis of non-small cell lung cancer （NSCLC） patients with cervical lymph node enlargement. Methods Clinical data about 64 NSCLC patients with cervical or supraclavicular lymph node enlargement admitted to Chinese PLA General Hospital from May 2011 to December 2013 were retrospectively analyzed. Biopsy findings and malignancy of primary foci were compared. The relation between lymph node size, blood flow, boundaries between cortex and medulla, lymph door structure, benign or malignant lesion was analyzed. Results The incidence of malignant cervical lymph nodes was 81.2%. Of the 64 patients, 30 were diagnosed with adenocarcinoma, 18 were diagnosed with squamous cell carcinoma, 4 were diagnosed with lymphoma, and 12 were diagnosed with inflammatory hyperplasia. The average diameter of cancerous lymph nodes was 2.1 ± 0.6 cm. The positive blood flow signals accounted for 57%, unclear boundaries between cortex and medulla accounted for 43%, and lymph door-free structure accounted for 61% （P 〈 0.01）. Conclusion Cervical and supraclavicular ultrasonography plays an important role in diagnosis of preoperative lymph node metastasis and assessment of the postoperative condition in NSCLC patients.