彩超指引下细针穿刺细胞学检测对颈部淋巴结结核的诊断意义

UNTRASONOGRAPHICALLY GUIDED FINE NEEDLE PUNCTURE ABSORBING CYTOLOGY EXAMINATION IN THE DIAGNOSIS OF CERVICAL LYMPH NODE TUBERCULOSIS

目的探讨彩超指引下细针穿刺细胞学（US-FNAC）对颈部淋巴结结核的临床诊断价值。方法选择2013年3月~2015年6月期间疑似颈部淋巴结结核病例454例,根据自愿原则将454例疑似病例分为两组：US-FNAC组326例,采用US-FNAC检测;FNAC组128例,采用FNAC进行检测。统计两组检测的灵敏度、特异度、阳性预测值、阴性预测值及准确性,随访两组并发症情况。结果 US-FNAC组326例病例,经US-FNAC检测308例阳性,后经病理证实真阳性304例,假阳性4例,经US-FNAC检测18例阴性,后经病理证实真阴性15例,假阴性3例;FNAC组128例病例,经FNAC检测107例阳性,后经病理证实真阳性102例,假阳性5例,经FNAC检测21例阴性,后经病理证实真阴性12例,假阴性9例。US-FNAC检测颈部淋巴结结核的敏感度（99.02%）高于FNAC（91.89%）,差异有统计学意义（p〈0.05）;US-FNAC和FNAC检测颈部淋巴结结核的特异性、阳性预测值、阴性预测值差异无统计学意义（p〉0.05）;US-FNAC检测颈部淋巴结结核的准确性（95.30%）高于FNAC（89.47%）,差异有统计学意义（p〈0.05）;US-FNAC组并发症发生率（1.23%）低于FNAC组（4.69%）,差异有统计学意义（X2=5.1095,p=0.0238,p〈0.05）。结论 US-FNAC用于颈部淋巴结结核的诊断,具有高灵敏度、高准确性等优点。因此将US-FNAC用于颈部淋巴结结核疑似病例的诊断,具有重要临床价值。

Objective To explore the clinical value of untrasonographically guided fine needle puncture absorbing cytology examination in the diagnosis of cervical lymph node tuberculosis. Methods In March 2013 to June2015 454 cases of suspected cervical lymph node tuberculosis cases were selected,and 454 suspected cases according to the voluntary principle were divided into two groups： US- FNAC groups： 326 cases with US- FNAC detection;FNAC groups： 128 cases,using FNAC. Statistical degree of two groups of detection sensitivity,specific,positive predictive value,negative predictive value and accuracy,and follow- up of two groups of complications. Results In US- FNAC group 326 cases,after the US- FNAC tested positie 308 cases,304 cases confirmed by pathology after true positive and false positive 4 cases,through US- FNAC tested negatie 18 cases,were confirmed by pathology after true negative,15 cases of false negative in 3 cases; FNAC in the group of 128 cases of FNAC tested positie 107 cases,102 cases confirmed by pathology after true positive and false positive in 5 cases,by FNAC tested negatie 21 cases,12 cases confirmed by pathology after really negative,9 cases of false negative. US- FNAC,the sensitivity of the detection of cervical lymph node tuberculosis（ 99. 02%） than FNAC（ 91. 89%）,the difference was statistically significant（ p〈0. 05）; US- FNAC and FNAC cervical lymph node tuberculosis detection specificity,positive predictive value,negative predictive value differences had no statistical significance（ p〈0. 05）; US- FNAC,the accuracy of the detection of cervical lymph node tuberculosis（ 95. 30%） than FNAC（ 89. 47%）,the difference was statistically significant（ p〈0. 05）; US- FNAC,incidence of complications（ 1. 23%） is lower than the FNAC group（ 4. 69%）,and the difference was statistically significant（ chi- square = 5. 1095,p = 5. 1095,p〈0. 05）.Conclusion US- FNAC is used for the diagnosis of cervical lymph node tuberculosis,and has the advantages of high sensitivity,high accuracy. So US- FNAC diagnosis in cervical lymph node tuberculosis suspected cases has the important clinical value.