应用彩色多普勒超声内镜鉴别纵隔良、恶性淋巴结

Colour Doppler endoscopic ultrasonography in differential diagnosis of benign and malignant mediastinal lymph nodes

目的 评价彩色多普勒超声内镜在纵隔良、恶性淋巴结鉴别诊断中的价值。方法 应用彩色多普勒超声内镜(CDEUS)扫查CT检查已发现有纵隔淋巴结肿大并将进行手术治疗或超声内镜引导下活检 (EUS FNA)的患者 3 6例 (手术2 1例 ,EUS FNA 15例 ) ,记录CDEUS检查所见淋巴结的大小、部位、回声、边界及淋巴结内部有无彩色血流信号 ,术中或EUS FNA时将对应部位的淋巴结逐一标记后送病理检查 ,以病理检查结果为金标准判别CDEUS在纵隔良、恶性淋巴结鉴别诊断中的作用。结果 CDEUS共发现纵隔肿大的淋巴结 118枚 ,其中有彩色血流信号的淋巴结 2 8枚 ,无血流信号的淋巴结 90枚。术后病理检查证实有彩色血流信号的 2 8枚淋巴结均为恶性淋巴结 ,良性淋巴结中无一探及彩色血流信号 ,但仍有 3 1枚恶性淋巴结内 ,未检出彩色血流信号。CDEUS对纵隔良、恶性淋巴结诊断的特异度为 10 0 % ,阳性预测值 10 0 % ,阴性预测值 65 .5 % ,灵敏度 47.4%。结论 彩色多普勒超声内镜在纵隔良、恶性淋巴结鉴别诊断中具有一定意义。

Objective To evaluate the clinical value of colour Doppler endoscopic ultrasonography (CDEUS) in the differential diagnosis of benign and malignant mediastinal lymph nodes. Methods CDEUS was performed in 36 patients with detected mediastinal lymph nodes by CT before operation (21 cases) or EUS guided fine needle ampilution (15 cases). Size, region, echo signal, boundary and presence/absence of colour blood flow signal within the lymph node were recorded. Corresponding lymph node was marked individually and processed for pathological examination. Pathological results were regarded as golden standard to assess the role of CDEUS in the differential diagnosis of benign and malignant lymph nodes. Results A total of 118 enlarged lymph nodes were detected in 36 patients, of which 28 lymph nodes with colour blood flow signal and 90 without. Postoperative pathological examination confirmed that 28 nodes with color blood flow signal were all malignant, and no colour blood flow signal was detected in any benign lymph node. However, there were 31 malignant lymph nodes in which detection of color blood signal was failed. The specificity, sensitivity, positive prediction value and negative prediction value of CDEUS in the differential diagnosis of benign and malignant mediastinal lymph nodes was 100%, 47.4%, 100% and 65.5% separately. Conclusion CDEUS has certain value in differential diagnosis of benign and malignant mediastinal lymph nodes.