超声引导下细针联合粗针穿刺活检在锁骨上淋巴结疾病诊断中的应用价值

The value of ultrasound-guided fine needle aspiration combined with coarse needle biopsy in the diagnosis of supraclavicular lymph node disease

目的探讨对锁骨上肿大淋巴结行细针及粗针联合穿刺活检的临床应用价值。方法本文回顾性选取2016年1月至2022年5月同时接受粗针及细针活检的锁骨上淋巴结穿刺标本共计147份,分析其临床病理资料。结果结果显示147份资料中锁骨上淋巴结取材满意率约为99%,总诊断率约82.3%。其中2例患者因取材不足无法诊断,另外24例因免疫组化原因无法做出具体分型。113例明确为肺癌锁骨上淋巴结转移,并且能进一步区分是小细胞癌还是非小细胞癌,非小细胞癌中又能区分腺癌及鳞癌。一些少见肺癌类型如神经内分泌肿瘤、典型类癌、淋巴上皮瘤样癌等也在锁骨上淋巴结中得到了明确诊断。同时还发现了8例肺外来源的标本,分别是消化道、妇科、泌尿系、乳腺、血液系统等。结论本研究显示细针联合粗针穿刺活检在锁骨上淋巴结疾病病理诊断及分型方面有较高的临床推广价值,它一定程度上避免了非必要的手术切除活检。

Objective To explore the clinical application value of ultrasound-guided fine needle aspiration combined with coarse needle biopsy in the diagnosis of supraclavicular lymph node lesions.Methods A total of 147 supraclavicular lymph node puncture specimens that underwent both ultrasoundguided fine needle aspiration combined with coarse needle biopsy in our department from January 2016 to May 2022 were retrospectively selected for analysis of their clinicopathological data.Results The results showed that the sampling satisfactory rate of supraclavicular lymph node was approximately 99%in 147cases,and the overall diagnosis rate was approximately 82.3%.Two of the patients could not be diagnosed due to inadequate sampling and 24 could not be specifically staged due to immunohistochemistry.113cases were clearly identified as supraclavicular lymph node metastases from lung cancer and could be further differentiated between small cell carcinoma and non-small cell carcinoma.Non-small cell carcinoma can be subdivided into adenocarcinoma and squamous carcinoma.Some rare types of lung cancer such as neuroendocrine tumours,typical carcinoid tumours and lymphoepithelioma-like carcinomas were also diagnosed in the supraclavicular lymph nodes.We also identified eight specimens of extra-pulmonary origin from the gastrointestinal tract,gynaecological,urological,breast and haematological systems.Conclusion This study shows that fine needle aspiration combined with coarse needle biopsy has a high clinical value in the pathological diagnosis and staging of supraclavicular lymph node disease,and it avoids unnecessary surgical excisional biopsies to a certain extent.