高频超声引导下粗针穿刺活检诊断颈部及锁骨上窝淋巴结病变的应用价值

Diagnostic value of high-frequency ultrasound-guided core needle biopsy in cervical and supraclavicular lymphadenopathy

摘要:

目的 探讨高频超声引导下粗针穿刺活检（CNB）诊断颈部及锁骨上窝淋巴结病变的应用价值。方法 选取2020年2月—2021年8月青海省人民医院收治的145例颈部及锁骨上窝淋巴结病变患者（145枚淋巴结）作为研究对象。统计临床淋巴结病变诊断结果。对比不同颈部及锁骨上窝淋巴结病变患者病理诊断结果。对比高频超声引导下CNB与病理诊断结果。并以病理诊断结果作为金标准，分析高频超声引导CNB对颈部及锁骨上窝淋巴结病变的诊断效能。结果 ≥ 45岁患者淋巴结恶性率高于< 45岁患者（P <0.05）。不同性别、淋巴结纵横比患者淋巴结恶性率比较，差异无统计学意义（P >0.05）。高频超声引导下CNB诊断结果为恶性病变100例（肿瘤淋巴结转移71例，淋巴瘤24例，淋巴结反应性增生1例，淋巴结结核4例），良性病变45例（肿瘤淋巴结转移1例，淋巴瘤1例，淋巴结反应性增生32例，淋巴结结核11例），病理诊断结果为恶性病变97例（肿瘤淋巴结转移72例，淋巴瘤25例），良性病变48例（淋巴结反应性增生33例，淋巴结结核15例）。高频超声引导下CNB对颈部及锁骨上窝淋巴结病变诊断的敏感性、特异性和准确率分别为97.94%（95% CI：0.477，0.878）、89.58%（95% CI：0.650，0.834）和95.17%（95% CI：0.610，0.785）。结论 高频超声引导下CNB诊断颈部及锁骨上窝淋巴结病变的效能较高，可作为临床诊断颈部及锁骨上窝淋巴结病变的首选方法。

Abstract:

Objective To investigate the diagnostic value of high-frequency ultrasound-guided core needle biopsy (CNB) in cervical and supraclavicular lymphadenopathy.Methods A total of 145 patients with lymph node lesions in the neck and supraclavicular fossa (145 lymph nodes) admitted to Qinghai Provincial People's Hospital from February 2020 to August 2021 were selected, and the clinical diagnosis of these lymph node lesions were determined. The pathological diagnosis of cervical and supraclavicular lymphadenopathy was compared in patients with different clinical features, and the diagnosis determined via high-frequency ultrasound-guided CNB was compared with that determined via pathology. The diagnostic performance of high-frequency ultrasound-guided CNB for cervical and supraclavicular lymphadenopathy was analyzed with pathological findings as the gold standard.Results The malignancy rate of the lymph node lesions in patients with an age of 45 years and older was higher than that of the lymph node lesions in those aged less than 45 years (P < 0.05). There was no difference in the malignancy rate between male and female patients or among patients with lymph node lesions with different short to long axis ratios (P > 0.05). Of the 145 cervical and supraclavicular lymph node lesions, 100 cases (71 cases of tumor metastasis, 24 cases of lymphoma, 1 case of reactive lymphoid hyperplasia, and 4 cases of tuberculous lymphadenitis) were diagnosed as malignant and 45 (1 case of tumor metastasis, 1 case of lymphoma, 32 cases of reactive lymphoid hyperplasia, and 11 cases of tuberculous lymphadenitis) were diagnosed as benign by the high-frequency ultrasound-guided CNB. The pathology determined that 97 cases (72 cases of tumor metastasis and 25 cases of lymphoma) were malignant and 48 (33 cases of reactive lymphoid hyperplasia and 15 cases of tuberculous lymphadenitis) were benign. The sensitivity, specificity and accuracy of high-frequency ultrasound-guided CNB in the diagnosis of cervical and supraclavicular lymph node lesions were 97.94% (95% CI: 92.03%, 99.64%), 89.58% (95% CI: 76.56%, 96.10%), and 95.17% (95% CI: 89.93%, 97.87%).Conclusions High-frequency ultrasound-guided CNB has high diagnostic efficacy in cervical and supraclavicular lymphadenopathy, and can be used as a preferred choice for clinical diagnosis of cervical and supraclavicular lymphadenopathy.