Bazemore Andrew W, Smucker Douglas R
Department of Family Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Am Fam Physician. 2002 Dec 1;66(11):2103-10.
The majority of patients presenting with peripheral lymphadenopathy have easily identifiable causes that are benign or self-limited. Among primary care patients presenting with lymphadenopathy, the prevalence of malignancy has been estimated to be as low as 1.1 percent. The critical challenge for the primary care physician is to identify which cases are secondary to malignancies or other serious conditions. Key risk factors for malignancy include older age, firm, fixed nodal character, duration of greater than two weeks, and supraclavicular location. Knowledge of these risk factors is critical to determining the management of unexplained lymphadenopathy. In addition, a complete exposure history, review of associated symptoms, and a thorough regional examination help determine whether lymphadenopathy is of benign or malignant origin. Unexplained lymphadenopathy without signs or symptoms of serious disease or malignancy can be observed for one month, after which specific testing or biopsy should be performed. While modern hematopathologic technologies have improved the diagnostic yields of fine-needle aspiration, excisional biopsy remains the initial diagnostic procedure of choice. The overall evaluation of lymphadenopathy, with a focus on findings suggestive of malignancy, as well as an approach to the patient with unexplained lymphadenopathy, will be reviewed.
大多数出现外周淋巴结病的患者都有易于识别的良性或自限性病因。在出现淋巴结病的初级保健患者中，恶性肿瘤的患病率估计低至1.1%。初级保健医生面临的关键挑战是识别哪些病例继发于恶性肿瘤或其他严重疾病。恶性肿瘤的关键风险因素包括年龄较大、淋巴结质地硬、固定、持续时间超过两周以及位于锁骨上。了解这些风险因素对于确定不明原因淋巴结病的管理至关重要。此外，完整的暴露史、相关症状的回顾以及全面的局部检查有助于确定淋巴结病是良性还是恶性起源。对于无严重疾病或恶性肿瘤体征或症状的不明原因淋巴结病，可观察一个月，之后应进行特定检测或活检。虽然现代血液病理学技术提高了细针穿刺的诊断率，但切除活检仍然是首选的初始诊断方法。本文将综述淋巴结病的总体评估，重点关注提示恶性肿瘤的发现，以及对不明原因淋巴结病患者的处理方法。
