Value analysis of ultrasound-guided fine needle and core needle biopsy of cervical lymph nodes in diagnosis

Liang Fengping; Huang Rong; Wang Yibin; Ji Qiao; Liang Xuankun; Wang Xianxiang; Huang Yujun; Lu Xiaofang; Xu Zuofeng

doi:10.3760/cma.j.issn.1008-1372.2019.02.006

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超声引导下细针与粗针穿刺颈部淋巴结对诊断的价值分析

中国医师杂志, 2019,21(2) : 180-183. DOI: 10.3760/cma.j.issn.1008-1372.2019.02.006

摘要

目的

比较超声引导下细针穿刺(FNA)与粗针穿刺(CNB)在诊断颈部良恶性淋巴结的价值。

方法

回顾性分析2015年1月至2017年5月因颈部淋巴结肿大行穿刺活检的88例患者，进行FNA(n＝39例)或CNB(n＝49例)，比较两种方法诊断颈部良恶性肿大淋巴结的灵敏度、特异度及准确性。

结果

39例FNA中33例取材成功，6例取材失败，其中5例最后诊断为反应性增生，1例为菊池病。49例CNB中48例取材成功，1例最后诊断为淋巴瘤的病例CNB取材失败。FNA和CNB取材成功率分别为84.6%(33/39)、98%(48/49)，两者比较差异有统计学意义(P＝0.000)。FNA和CNB诊断颈部淋巴结恶性病变的灵敏度、特异度、准确性分别为90.9%、94.1%、92.3%，97.2%、100%、98%，差异均有统计学意义(P<0.01)。FNA和CNB诊断颈部淋巴结转移癌的灵敏度、特异度分别为100%、95.2%，100%、100%。CNB与FNA诊断颈部淋巴结转移癌的灵敏度差异无统计学意义(P＝0.102)，特异度差异有统计学意义(P＝0.000)。

结论

CNB诊断颈部淋巴结恶性的灵敏度、特异度及准确性优于FNA。但在诊断淋巴结转移癌时，FNA与CNB灵敏度比较无明显区别，推荐FNA为首选。

引用本文: 梁凤平, 黄容, 王译斌, 等. 超声引导下细针与粗针穿刺颈部淋巴结对诊断的价值分析 [J] . 中国医师杂志,2019,21 (2): 180-183. DOI: 10.3760/cma.j.issn.1008-1372.2019.02.006

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未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

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颈部淋巴结肿大是许多疾病淋巴结受累的常见表现，其良恶性诊断及鉴别诊断较困难。术前确诊的常用手段为影像学引导下细针穿刺活检(fine needle aspiration，FNA)及粗针穿刺活检(core needle biopsy，CNB)。FNA因为具有快速、廉价、微创、可靠、方便和良好的患者依从性等优点，常用于淋巴结肿大的初步评估，但FNA的诊断准确性高度依赖于操作者^[1,2]。FNA在淋巴瘤诊断中的应用价值仍然存在争议。CNB可以从淋巴结中获取足够的组织来诊断颈部肿大淋巴结，被认为是一种更有效的工具^[3,4,5]。因此本研究旨在比较两种方法对颈部淋巴结良恶性诊断及鉴别诊断能力，从而探索其临床应用价值。

贡献者信息

梁凤平

中山大学附属第七医院超声科，深圳　518000

黄容

中山大学附属第七医院妇产科；深圳　518000

王译斌

中南大学湘雅医院超声影像科，长沙　410000

纪巧

中山大学附属第七医院超声科，深圳　518000

梁璇坤

中山大学附属第七医院超声科，深圳　518000

王显翔

中山大学附属第七医院超声科，深圳　518000

黄羽君

中山大学附属第七医院超声科，深圳　518000

卢晓芳

中山大学附属第七医院病理科，深圳　518000

徐作峰

中山大学附属第七医院超声科，深圳　518000

通信作者

徐作峰

中山大学附属第七医院超声科，深圳　518000

Email：xuzuofeng77@aliyun.com

关键词

淋巴结; 活组织检查，针吸; 超声检查; 诊断，鉴别;

基金项目

国家自然科学基金青年基金项目（81201104）

利益冲突

利益冲突　所有作者均声明不存在利益冲突

历史

出版日期：2019-02-20

收稿日期：2018-11-12

本文编辑

谢意桃

Original Article

Value analysis of ultrasound-guided fine needle and core needle biopsy of cervical lymph nodes in diagnosis

Liang Fengping, Huang Rong, Wang Yibin, Ji Qiao, Liang Xuankun, Wang Xianxiang, Huang Yujun, Lu Xiaofang, Xu Zuofeng

Published 2019-02-20

Cite as J Chin Physician, 2019,21(2): 180-183. DOI: 10.3760/cma.j.issn.1008-1372.2019.02.006

Abstract

Objective

To compare the value of ultrasound-guided fine-needle aspiration (FNA) and core needle biopsy (CNB) in diagnosing benign and malignant cervical lymph nodes.

Methods

A retrospective analysis was performed on 88 patients who received biopsy for cervical lymph node enlargement from January 2015 to May 2017. FNA (n=39) or CNB (n=49) were performed respectively to compare the sensitivity, specificity and accuracy of the two methods in diagnosing benign and malignant cervical lymph node enlargement.

Results

84.6% (33/39) of FNA cases were successfully collected, and 98% (48/49) of FNA cases were successfully collected for definite pathological diagnosis (P=0.000). The sensitivity, specificity and accuracy of FNA and CNB in diagnosing malignant cervical lymph nodes were 90.9% and 97.2%, 94.1% and 100%, 92.3% and 98%, respectively. Compared with FNA, there were statistically significant differences in sensitivity, specificity and accuracy in differentiating benign and malignant lymphatic lesions in cervical enlargement (P<0.01). The sensitivity and specificity of FNA and CNB in diagnosing cervical lymph node metastatic carcinoma were 100% and 100%, 95.2% and 100%. Compared with FNA, there was no statistically significant difference in the sensitivity to the diagnosis of cervical lymph node metastatic carcinoma (P=0.102).

Conclusions

CNB is superior to FNA in sensitivity, specificity and accuracy in diagnosing cervical lymphadenopathy. However, when metastatic cancer was diagnosed, FNA was not significantly different from CNB in sensitivity (P=0.102), and FNA was recommended as the first choice.

Key words:

Lymph nodes; Biopsy, needle; Ultrasonography; Diagnosis, differential

Contributor Information

Liang Fengping