- 期刊
比較超音波導引下細針及粗針穿刺切片於頸部淋巴瘤之診斷
Comparison between Fine and Core-needle Biopsy under Real-time Ultrasound-guidance in the Diagnosis of Neck Lymphoma
摘要
背景：高解析度超音波可用來幫助我們鑑別診斷頸部腫塊之病因，配合即時超音波導引之下進行穿刺檢查可能避免不必要的外科手術切片，過去對於以頸部淋巴結腫表現的淋巴層，究竟要以超音波導引之下細針或粗針穿刺切片來當作診斷的第一線工具並沒有定論，因此我們進行此一研究。方法：本研究獲得亞東醫院倫理委員會同意進行，回溯收集從2007年11月到2010年12月，約3年期間，因頸部淋巴結腫為初始表現，於亞東醫院耳鼻喉科以超音波導引之下細針或粗針切片檢查，追蹤確定診斷為淋巴瘤的病人。收集病人的年齡、性別、淋巴結腫側別、淋巴結腫超奇波檢查結果，以及超音波導引細針穿刺細胞學檢查、與粗針穿刺切片病理學檢查之結果而納入分析。結果：共有22名淋巴瘤病患納入分析，病人之最終診斷為非何杰金氏淋巴瘤有18例，其中16例為B細胞淋巴瘤，2例為T細胞淋巴瘤；有4名病患為何杰金氏淋巴瘤。年齡分布為13到81歲，平均為52 ± 20歲；女性12例，男性10例，頸部主要淋巴結的分佈方面，兩側有6例，左側有8例，右側有8例，主要淋巴結大小平均為短軸1.9 ± 0.6 cm，長軸3.0 ± 0.9 cm 。22名病人共進行15次的超音波導引之下細針穿刺細胞學檢查，與10次超音波導引之下粗針穿刺切片病理學撿查。細針穿刺細胞學撿查7例為偽陰性、6例為懷疑、1例為陽性；粗針穿刺切片病理學檢查6例為陽性、4例為懷疑，沒有病例是偽陰性，結果達到統計顯著差異（Fisher Exact test，p值＝0.003）；從超音波導引之下細針或粗針穿刺切片到病理報告診斷為淋巴瘤平均時間分別為67.3 ± 25.8天與28.2 ±17.1天，也達統計顯著差異（Log-Rank test，P值＝0.03）。結論：針對超過2cm之頸部腫塊，於超音波下或臨床上有懷疑是淋巴瘤的病人建議直接以超音波導引下粗針穿刺切片取代細針穿刺切片以提高正確診斷率與縮短檢查到治療開始的時間。
並列摘要
BACKGROUND: High resolution ultrasound is helpful in the differential diagnosis of neck lumps. With real-time ultrasound-guidance needle biopsy, we can avoid unnecessary open biopsy. However, there was no report about which one is the best choice between fine-needle aspiration cytology and core-needle biopsy in diagnosis of neck malignant lymphoma.METHODS: This study was approved by ethical review board in Far Eastern Memorial Hospital (FEMH). From Nov 2007 to Dec 2010, we retrospectively review patients who presented with neck lymphadenopathies and received ultrasound guided fine-needle aspiration or core-needle biopsy in the department of otorhinolaryngology, FEMH. If the final diagnosis is malignant lymphoma, these patients were enrolled. We collect patients' age, gender, side of neck lumps, ultrasound characteristics and the results of needle biopsy.RESULTS: Total 22 patients with malignant lymphoma are included. The final diagnosis is non-Hodgkin's lymphoma in 18 cases (B-cell lymphoma in 16 cases and T-cell lymphoma in 2 cases), and Hodgkin's lymphoma in 4 cases. Their mean age ranges from 13 to 81 years old (mean ± SD, 52 ± 20). There are 12 female and 10 male patients. The laterality is both side in 6 cases and left or right side in 8 cases. The size is 1.9 ± 0.6 cm in short-axis and 3.0 ± 0.9 cm in long-axis. Fifteen ultrasound-guided fine-needle aspiration and ten core-needle biopsy were performed. The results of fine needle cytology showed 7 false negative, 6 suspicious and 1 positive finding, compared to 6 positive, 4 suspicious and no false negative result in core-needle biopsy (Fisher Exact test, p = 0.003). The mean time from the procedure to final diagnosis is 67.3 ± 25.8 days and 28.2 ± 17.1 days for fine-needle and core-needle biopsy (Log-Rank test, p = 0.03), representatively.CONCLUSION: For the neck lumps with suspicion of lymphoma clinically or sonographically, ultrasound-guided core-needle biopsy is superior to fine-needle biopsy due to better diagnostic rate and shorter diagnostic time. (J Taiwan Otolaryngol Head Neck Surg 2011; 46:260-267)