超声引导下触诊阴性且小于10mm颈部淋巴结细针穿刺细胞学检查的应用价值

Ultrasound-guided fine-needle aspiration cytology of cervical nonpalpable lymph nodes smaller than 10 mm in the maximum diameter

目的探讨临床触诊阴性且长径<10mm颈部淋巴结超声引导下细针穿刺细胞学检查(US-FNAC)的应用价值。方法回顾性分析我院行US-FNAC,临床触诊阴性且长径<10mm的超声疑似颈部淋巴结恶变的肺癌患者108例淋巴结110个,对其超声表现及细胞学检查结果进行分析,并与组织学病理或随访结果对照分析。结果 110个疑似恶变的颈部淋巴结中,细胞学明确诊断恶性的61个,其中考虑腺癌24个,低分化非小细胞癌37个。细胞学提示未见恶性细胞的41个,经活检组织学提示腺癌12个,结节病2个,反应性增生13个,另14个在随访过程中未见明显改变。细胞学提示核异型的8个,经组织学活检提示3个为小细胞癌,5个为腺癌。US-FNAC诊断颈部恶性淋巴结的准确率为88. 2%(97/110)、敏感性为84. 1%(69/82)、特异性100%(28/28)。结论常规超声有助于临床触诊阴性且长径<10mm的疑似恶性淋巴结的US-FNAC的选择,而US-FNAC对其具有较高的临床应用价值。

Objective To evaluate the value of Ultrasound-guided fine-needle aspiration cytology of cervical nonpalpable lymph nodes smaller than 10 mm in the maximum diameter. Methods A retrospective review of 108 patients with 110 suspected malignant by ultrousand cervical nonpalpable lymph nodes, which were smaller than 10 mm in the maximum diameter, was conducted, including cytopathological findings. These diagnostic data were compared with hyphological findings or clinical follow-up results. Results Of all 110 cervical nonpalpable lymph nodes, the cytology was classified as malignant for 61 lesions, including 24 cases of adenocarcinoma, 37 cases of poorly differentiated non-small-cell cancer. There were 41 benign lesions, among which 12 cases were adenocarcinoma, 2 cases were sarcoidosis,13 cases were reactive hyperplasia by the hyphological findings. Another 14 cases were unchanged by clinical follow-up. According to the cytopathological findings, another 8 lesions were nuclear atypia. Actually there were 3 lesions of small cell lung cancer and 5 of adenocarcinoma by hyphological results. The accuracy, sensitivity and specificity of US-FNAC were 88.2%(97/110), 84.1%(69/82), 100%(28/28). Conclusion Ultrasonography is helpful in deciding cervical lymph nodes for US-FNAC and US-FNAC of cervical nonpalpable lymph nodes smaller than 10 mm in the maximum diameter is an effective diagnostic procedure.