Wong R, Rappaport W, Gorman S, Darragh M, Hunter G, Witzke D
University of Arizona, Department of Surgery, Tucson 85724.
Am J Surg. 1991 Dec;162(6):590-2; discussion 592-3. doi: 10.1016/0002-9610(91)90115-t.
The indications and value of lymph node biopsy in patients infected with the human immunodeficiency virus (HIV) are not clearly defined. We reviewed 29 consecutive lymph node biopsies performed on 24 patients with the HIV over a 4-year period. Indications for biopsy included: (1) new or worsening medical symptoms with no detectable etiology in patients with lymphadenopathy, (2) disproportionately larger or enlarging lymph node in patients with generalized adenopathy, and (3) exclusion of concomitant disease in patients with previously defined infectious or neoplastic processes. The biopsy samples exhibited a diversity of histologic appearances including atypical and reactive hyperplasia, malignancy, and infection. Nineteen biopsies (64%) resulted in the institution or alteration of treatment. The absolute number of T-helper cells prior to biopsy was significantly lower in patients with a diagnosis of malignancy or infection (p < 0.05), as well as in those who eventually died (p < 0.05). Four (14%) minor complications resulted from lymph node biopsy. Based on our results, we conclude that lymph node biopsy is indicated in the above three subsets of HIV-infected patients. Biopsy can be performed with minimal morbidity and significantly alters therapy in the majority of patients.
人类免疫缺陷病毒（HIV）感染患者淋巴结活检的指征和价值尚未明确界定。我们回顾了在4年期间对24例HIV患者连续进行的29次淋巴结活检。活检指征包括：（1）淋巴结病患者出现新的或恶化的医学症状且无可检测到的病因，（2）全身淋巴结病患者中不成比例地增大或正在增大的淋巴结，以及（3）在先前已确定的感染或肿瘤性疾病患者中排除合并疾病。活检样本呈现出多种组织学表现，包括非典型和反应性增生、恶性肿瘤和感染。19次活检（64%）导致了治疗方案的制定或改变。诊断为恶性肿瘤或感染的患者活检前T辅助细胞的绝对数量显著低于其他患者（p<0.05），最终死亡的患者也是如此（p<0.05）。淋巴结活检导致了4例（14%）轻微并发症。根据我们的结果，我们得出结论，上述三类HIV感染患者适合进行淋巴结活检。活检的发病率极低，且能在大多数患者中显著改变治疗方案。
