超声引导下细针穿刺细胞学检查诊断不同大小颈部淋巴结

Ultrasound-guided fine-needle aspiration cytology in diagnosing different size neck lymph nodes

目的探讨超声引导下细针穿刺抽吸细胞学检查(US-FNAC)对不同大小颈部淋巴结的定性诊断价值。方法回顾性分析130例患者共142个颈部淋巴结的US-FNAC资料,并与术后病理检查或临床随访最终确诊结果对照。将142个淋巴结按其短径分为A组(<5mm)、B组(5~10mm)及C组(>10mm),进行统计学分析。结果 US-FNAC诊断阳性淋巴结65个(恶性58个,可疑恶性7个),阴性淋巴结77个(良性59个,不确定及不满意18个);经术后病理检查或临床随访最终确诊为恶性淋巴结70个,良性淋巴结72个。颈部淋巴结US-FNAC定性诊断敏感度、特异度、准确率、阳性预测值及阴性预测值分别为:A组,82.35%(14/17)、95.00%(19/20)、89.19%(33/37)、93.33%(14/15)、86.36%(19/22);B组,91.17%(31/34)、97.56%(40/41)、94.67%(71/75)、96.88%(31/32)、93.02%(40/43);C组,94.73%(18/19)、100%(11/11)、96.67%(29/30)、100%(18/18)、91.67%(11/12)。3组间敏感度、特异度、准确率、阳性预测值及阴性预测值差异均无统计学意义(P均>0.05)。结论 US-FNAC为鉴别颈部淋巴结良恶性的有效手段,对不同大小的淋巴结均具有较高诊断效能。

Objective To investigate the value of ultrasound-guided fine-needle aspiration cytology（US-FNAC）in qualitative diagnosis of cervical lymph nodes with different sizes.Methods Data of 130 patients with 142 lymph nodes in neck treated with US-FNAC were retrospectively analyzed.The results of US-FNAC were compared with the final diagnosis confirmed by pathology and clinical follow-up.According to the short diameter,142 lymph nodes were divided into group A（〈5 mm）,B（5—10 mm）and C（〉10 mm）for statistical analysis.Results Sixty-five lymph nodes were diagnosed as positive metastasis by US-FNAC,including 58 malignant and 7 suspected malignant lymph nodes.The other77 lymph nodes were diagnosed as negative metastasis by US-FNAC,including 59 benign and 18 unsatisfactory or undetermined lymph nodes.Actually,there were 70 malignant and 72 benign lymph nodes confirmed by pathology and clinical follow-up.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of USFNAC in diagnosing malignant lymph nodes in neck was 82.35%（14/17）,95.00%（19/20）,89.19%（33/37）,93.33%（14/15）and 86.36%（19/22）in group A,91.17%（31/34）,97.56%（40/41）,94.67%（71/75）,96.88%（31/32）and93.02%（40/43）in group B,94.73%（18/19）,100%（11/11）,96.67%（29/30）,100%（18/18）and 91.67%（11/12）in group C.There was no statistical difference of the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of US-FNAC among the three groups（all P〉0.05）.Conclusion US-FNAC is an effective method for differential diagnosis of benign and malignant lymph nodes in neck,therefore having high diagnostic efficacy to lymph nodes with different sizes.