超声引导下锁骨上区淋巴结穿刺活检在非小细胞肺癌患者中的应用

Utility of ultrasound-guided supraclavicular lymph node biopsy in patients with non-small cell lung cancer

目的探讨超声引导下锁骨上区淋巴结穿刺活检在非小细胞肺癌(NSCLC)患者临床分期中的应用价值。方法回顾性分析2005年1月至2014年2月在中山大学肿瘤防治中心超声科行超声引导下锁骨上区淋巴结穿刺活检的NSCLC患者临床病例资料,将穿刺活检结果与临床最终诊断结果进行对比,分析淋巴结的大小,超声引导下锁骨上区淋巴结穿刺活检的敏感度、特异度、阳性预测值和阴性预测值、准确性及对患者治疗方式的影响。结果 586例非小细胞肺癌伴锁骨上淋巴结肿大患者穿刺后病理证实阳性转移病例543例(92.66%);阴性转移病例30例(5.12%);未能诊断病例13例(2.22%)。阴性病例中有11例临床或影像学怀疑恶变者再次行超声引导下穿刺活检或切取活检,其中2例阳性。在573例病例中穿刺后取得有效病理诊断的敏感度为99.63%(543/545),特异度100.00%(28/28),阴性预测值93.33%(28/30),阳性预测值100.00%(543/543)。586例病例的总准确性97.44%(571/586)。有34例(5.80%)患者因超声引导下锁骨上淋巴结穿刺活检改变了分期及治疗方式。所有超声引导下锁骨上区淋巴结穿刺活检病例均未出现并发症。结论超声引导下锁骨上淋巴结穿刺活检是一种安全、高效的检查方法,可以作为NSCLC临床分期的可靠手段。

Objective To investigate the value of ultrasound-guided supraclavicular lymph nodes biopsy in the staging of non-small cell lung cancer（NSCLC） patients. Methods The present study was a retrospective review of patients with NSCLC who underwent ultrasound-guided supraclavicular lymph node biopsy from 2005 January to 2014 February. The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasound–guided supraclavicular lymph node biopsy are reported. The sizes of the lymph nodes which were biopsied and the number of instances in which treatment was changed were also reported. Results A total of 586 patients underwent ultrasound-guided supraclavicular lymph node biopsy. Of the 586 patients, 543（92.66%） had malignant findings, 30（5.12%） had benign findings; 11 of whom were suspected to be malignant and underwent another ultrasound-guided biopsy or incisional biopsy and 2 of them had malignant findings. Thirteen of 586 had nondiagnostic biopsy findings. As a result, ultrasound-guided supraclavicular lymph node biopsy changed the tumor stage and treatment planning in 34（5.8%） of the 586 patients. Overall, ultrasound-guided supraclavicular lymph node biopsy had a sensitivity of 99.63%, a specificity of 100%, a negative predictive value of 93.33%, a positive predictive value of 100% and an accuracy of 97.44%. No complications were found in the patients who underwent ultrasound-guided supraclavicular lymph nodes biopsy. Conclusions Ultrasound-guided supraclavicular lymph nodes biopsy was a safe and efficient option for patients with NSCLC which had suspicious supraclavicular lymph node, and also could be used as a reliable method for clinical staging of patients with NSCLC.