超音波導引下細針穿刺切片檢查在小兒族群頸部腫塊的應用

Applicability of Ultrasound-guided Fine Needle Aspiration Biopsy in Pediatric Neck Masses

李彥儀(Yen-Yi Li) ； 廖立人(Li-Jen Liao) ； 鄭博文(Po-Wen Cheng) ； 周煦文(Hsu-Wen Chou) ； 張淳翔(Chun-Hsiang Chang) ； 羅武嘉(Wu-Chia Lo)

《台灣耳鼻喉頭頸外科雜誌》 48卷1期 (2013/03) Pp. 64-72

https://doi.org/10.6286/2013.48.1.64

摘要

背景：此篇是在未經麻醉鎮靜的小兒族群患者上，針對頸部腫塊進行超音波導引下細針穿刺切片檢查之研究。方法：回顧從2007年7月至2011年10月，年齡小於或等於18歲之病患，期間因為頸部腫塊接受超音波導引下細針穿刺切片檢查的所有病患納入此研究中。結果：共有100名患者納入此研究，平均年齡為13.9±3.5歲，包含46名男性及54名女性。其超音波導引下細針穿刺切片檢查執行之成功率為100%，而其穿刺切片結果顯示良性病灶有87例，惡性病灶有5例，另外檢體不足者有8例；而所有患者之最終診斷則是有95例良性病灶及5例的惡性病灶。最終此檢查在鑑別頸部腫塊是否為惡性病灶的應用上，其敏感度為80%，特異度為95.7%，準確性為92.9 %，陽性預測值為80%，以及陰性預測值為95.7%。在此研究中，兒童及青少年最常見之頸部腫塊可分為三大類，分別為發炎性腫塊（73%）、腫瘤性腫塊（19%），及先天性腫塊（6%）三類。結論：超音波導引下細針穿刺切片檢查在未使用麻醉鎮靜藥物之小兒頸部腫塊的評估上，可以得到良好的檢體採樣率及有效地篩檢出良、惡性病變，減少不必要之手術切片。

關鍵字

超音波 ； 細針穿刺切片 ； 小兒 ； 頸部腫塊

並列摘要

BACKGROUND: Pediatric neck masses are a common concern in clinical practice. However, the literature has paid less attention to the utility of ultrasound-guided fine needle aspiration biopsy (US-FNAB) in pediatric patients. It usually relates to the evaluation of thyroid nodules rather than non-thyroid masses, and the discussions about whether local anesthesia or sedation is used are still lacking. Hence, the aim of this study is to evaluate the applicability of US-FNAB in non-sedative children or adolescents having neck masses.METHODS: From July 2007 to October 2011, patients (≤ 18-year-old) who had received US-FNAB for their neck masses were enrolled.RESULTS: There were 100 cases enrolled in this study. They all received US-FNAB without local anesthesia or sedation. No complications (except mild pain) were found during or after US-FNAB. The cases included 46 men and 54 women, and the mean age was 13.9 ± 3.5 years old (range, 2-18 years). The outcome of US-FNAB revealed 87 negative findings, 5 positive results, and 8 unsatisfactory specimens. The final diagnoses showed 95 benign lesions and 5 malignancies. Accordingly, the application of US-FNAB in differentiating malignant neck masses had sensitivity of 80%, specificity of 95.7%, accuracy of 92.9%, positive predictive value of 80%, and negative predictive value of 95.7%. In this study, the etiologies of pediatric neck masses could be classified into 3 categories, including inflammatory lesions (73%, n = 73), neoplastic lesions (19%, n = 19), and congenital lesions (6%, n = 6). The most common inflammatory lesion was reactive lymphadenopathy (n = 49). As to neoplastic lesions, thyroid masses (n = 9) were the most common. There were 3 cases of papillary thyroid carcinomas within them. Then the following was salivary pleomorphic adenoma (n = 6). There were also 2 cases of lymphoma in this group. Congenital anomaly as the third common etiology included thyroglossal duct cyst (n = 3) and branchial cleft cyst (n = 3).CONCLUSIONS: US-FNAB of neck masses could be performed on children and adolescents without use of anesthesia and sedation. High adequacy rate of sampling can be obtained and malignant lesions can be detected effectively in this patient group. Accordingly, US-FNAB is a useful modality to direct the clinicians' treatment plan and reduce unnecessary surgical biopsy and the associated cost.

並列關鍵字

ultrasound ； fine-needle aspiration biopsy ； pediatric ； neck mass