超声引导下穿刺活检对儿童浅表淋巴结的诊断价值

Application value of superficial lymph node biopsy guided byultrasound in children

目的探讨超声引导下穿刺活检对儿童浅表淋巴结的诊断价值。方法选取195例浅表淋巴结肿大患儿,均行超声引导下浅表淋巴结穿刺活检,以术后病理结果为标准,计算超声引导下穿刺活检的取材满意度,以及其诊断颈部淋巴结病变的敏感性、特异性;分析免疫组化对诊断准确率的影响和颈部淋巴结病变与分区的情况。结果①195例患儿中,经穿刺活检病理诊断为良性166例,误诊1例淋巴结结核;恶性21例;未做出诊断8例,漏诊1例霍奇金淋巴瘤,以术后病理诊断结果为标准,超声引导下穿刺活检诊断儿童浅表淋巴结的准确率为95.4%,敏感性为95.5%,特异性为100%,阳性预测值为100%,阴性预测值为99.4%。195例患儿均未见大出血或其他严重并发症。②取材满意者穿刺活检的诊断准确率为99.4%,取材不满意者穿刺活检的准确率为75.8%,两者比较差异有统计学意义(χ^(2)=29.5988,P<0.05)。加做免疫组化者诊断准确率为99.0%,未加做免疫组化者诊断准确率为91.6%,两者比较差异有统计学意义(χ^(2)=4.5253,P<0.05)。③颈部淋巴结病变中恶性、良性病例累及Ⅱ区者最多,分别为72.7%、81.6%。结论超声引导下穿刺活检对儿童浅表淋巴结有较高的诊断价值,且操作简单、价廉、安全、患者耐受良好,具有广阔的应用前景。

Objective To investigate the clinical value of ultrasound-guided superficial lymph node biopsy in children.Methods A total of 195 children with superficial lymphadenectasis were selected and underwent ultrasound-guided superficial lymph node biopsy.Taking the postoperative pathological results as standard,the accurate diagnostic rate of ultrasound-guided biopsy,the sensitivity and specificity of the diagnosis of cervical lymph node malignant lesions,and the sample quality were calculated.According to the immunohistochemistry results,the influence factors of diagnostic accuracy,and the relationship between cervical lymph node lesion and cervical lymph node region were analyzed.Results①Among 195 children,166 cases were benign diagnosed by biopsy,of which 1 case of lymph node tuberculosis was misdiagnosed,21 cases were malignant,8 cases were not diagnosed,and 1 case of Hodgkin’s lymphoma was missed.Taking postoperative pathological diagnosis as the standard,the sensitivity,specificity,positive predictive value and negative predictive value of ultrasound-guided biopsy in the diagnosis of malignant lesions were 95.5%,100%,100%and 99.4%respectively.None of the 195 children had massive bleeding or other serious complications.②The diagnostic accuracy of biopsy was 99.4%for qualified sample,and 75.8%for unqualified sample.The difference was statistically significant(χ^(2)=29.5988,P<0.05).The diagnostic accuracy was 99.0%for those with immunohistochemistry and 91.6%for those without immunohistochemistry,and the difference was statistically significant(χ^(2)=4.5253,P<0.05).③The incidence of cervical lymph node was highest in regionⅡ,malignant was 72.7%and benign was 81.6%.Conclusion Ultrasound-guided superficial lymph node biopsy has high diagnostic value,with advantages of simple operation,low price,safety,good tolerance,and so on,which has a promising application.