超声引导细针穿刺细胞病理学对卵巢肿瘤及腹膜后转移性淋巴结的临床诊断价值

Value of ultrasound-guided fine needle aspiration cytology in the assessment of ovarian neoplasms and retroperitoneal metastatic lymph nodes

目的探讨超声引导细针穿刺细胞病理学(US-FNAC)检查在卵巢肿瘤及腹膜后转移性淋巴结的临床诊断价值。方法选取2012年1月至2016年6月在浙江省肿瘤医院行卵巢肿瘤与腹膜后转移性淋巴结US-FNAC患者126例,穿刺后的细胞学涂片行HE染色,以外科手术病理组织学与临床随访为"金标准",计算敏感度、特异度、准确度、阳性预测值及阴性预测值。结果穿刺获得的样本满意率为86.2%,获得病理学诊断的占85.7%。在腹膜后的淋巴结穿刺中,93.5%结节的最短径<20 mm。FNAC诊断卵巢肿瘤及腹膜后转移性淋巴结的敏感度为81.6%、86.2%、特异度为95.8%、100.0%、准确性为85.3%、87.1%、阳性预测值为98.3%、100.0%及阴性预测值为63.9%、33.3%。7例出现腹部轻微不适,未临床处理自行缓解。结论在卵巢肿瘤及腹膜后转移性淋巴结的诊断中,US-FNAC具有较高的阳性预测值,且安全准确有效,推荐应用于卵巢肿瘤患者的临床诊断。

Objective To evaluate the diagnostic value of ultrasound-guided fine needle aspiration cytology(US-FNAC)in the assessment of radiologically detected ovarian neoplasms and retroperitoneal metastatic lymph nodes.Methods FNAC was performed under ultrasound guidance on126patients suspected of ovarian neoplasms and retroperitoneal metastatic lymph nodes.Cytologic examination was performed after staining smears with the haematoxylin and eosin method.Clinical data were retrieved from the medical records and all cytological specimens were reviewed.In these cases,the cytologic findings were correlated with histology of the primary tumor and were compared with surgical pathology.Results Satisfactory sampling was obtained in86.2%of punctures,and cytological diagnosis was made in85.7%cases.The size of the lymph nodes punctured was less than20mm in93.5%cases,with the sensitivity of81.6%、86.2%,specificity of95.8%、100.0%,positive predictive value of98.3%、100.0%,negative predictive value of63.9%、33.3%,and accuracy of85.3%、87.1%.Seven patients presented slight abdominal discomfort,and relieved without clinical treatment.Conclusions The fine needle aspiration technique has excellent positive predictive value and low morbidity.US-FNAC,as the valuable investigation,is not only useful in the diagnosis of ovarian masses and lymph nodes but can also help in choosing appropriate management.From our experience,US-FNAC can be added in follow-up of selected patients in whom the cytological identification of such masses and nodes is significant for the patient′s treatment.