Nakahara Osamu, Yamao Kenji, Bhatia Vikram, Sawaki Akira, Mizuno Nobumasa, Takagi Tadayuki, Shimizu Yasuhiro, Koshikawa Takashi, Yatabe Yasushi, Baba Hideo
Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
J Gastroenterol. 2009;44(6):562-7. doi: 10.1007/s00535-009-0048-4. Epub 2009 Apr 10.
The differentiation between benign and malignant abdominal lymph nodes is difficult, especially if no primary site is evident or if cancer resection was remote in time. The aim of this study was to evaluate the yield of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in patients with undiagnosed intra-abdominal lymphadenopathy.
Fifty-seven consecutive patients with undiagnosed abdominal lymphadenopathy who were registered in our EUS-FNA database from January 1997 to December 2007 were reviewed. EUS-FNA was carried out using a 22-G needle. The final pathological diagnosis was based on the cytopathological, histological, and immunohistochemical (IHC) findings.
Adequate specimens were obtained in 93% cases. The final diagnoses included local recurrence of malignancy after resection (n = 16), lymphoma (n = 12), and benign/reactive changes (n = 17). The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of EUS-FNA were 94, 100, 100, 90 and 96%, respectively. In addition, it was also possible to classify lymphoma subtypes in 83% of cases. No complications occurred during the procedures.
EUS-FNA is clinically very useful for establishing the diagnosis of abdominal lymphadenopathy of unknown cause and can provide sufficient tissue for IHC and subtyping of lymphomas.
良性和恶性腹部淋巴结的鉴别诊断存在困难，尤其是在未发现原发部位或癌症切除时间已久的情况下。本研究旨在评估内镜超声引导下细针穿刺抽吸术（EUS-FNA）在不明原因的腹腔内淋巴结肿大患者中的诊断价值。
回顾性分析1997年1月至2007年12月在我们的EUS-FNA数据库中登记的57例连续的不明原因腹部淋巴结肿大患者。使用22G针进行EUS-FNA。最终病理诊断基于细胞病理学、组织学和免疫组织化学（IHC）结果。
93%的病例获得了足够的标本。最终诊断包括切除术后恶性肿瘤局部复发（n = 16）、淋巴瘤（n = 12）和良性/反应性改变（n = 17）。EUS-FNA的敏感性、特异性、阳性预测值、阴性预测值和总体准确率分别为94%、100%、100%、90%和96%。此外，83%的病例还能够对淋巴瘤亚型进行分类。操作过程中未发生并发症。
EUS-FNA在临床上对于不明原因的腹部淋巴结肿大的诊断非常有用，并且可以为免疫组织化学和淋巴瘤亚型分类提供足够的组织。
