超声在评估颈部淋巴结病变中的应用。
Usefulness of ultrasonography for the evaluation of cervical lymphadenopathy.
机构信息
Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, India.
出版信息
World J Surg Oncol. 2011 Feb 28;9:29. doi: 10.1186/1477-7819-9-29.
AIM
To evaluate the role of ultrasonography for differentiating cervical lymphadenopathy due to tuberculosis, metastasis and lymphoma.
METHODS
Ultrasonography of the neck nodes was carried out prior to FNAC in 192 patients using a 10 mHz linear transducer. The sonographic findings were then correlated with the definitive tissue diagnosis obtained by FNAC or lymph node biopsy.
RESULTS
The most significant distinguishing feature was strong internal echoes seen in 84% of tubercular lymph nodes. This finding was found in only 11% of metastatic nodes and absent in lymphomatous nodes. The other findings such as L/S ratio, irregular margins, hypoechoic center, fusion tendency, peripheral halo and absent hilus were helpful in differentiating reactive from diseased nodes but showed considerable overlap in the 3 groups of tubercular, metastatic and lymphoma lymph nodes.
CONCLUSION
Ultrasonography is noninvasive and can give useful clues in the diagnosis of cervical lymphadenopathy. It should be interpreted in conjunction with FNAC result. Ideally ultra-sonographic guided FNAC should be obtained from the sonographically most representative node. In FNAC indeterminate cases, sonographic features may obviate the need for an invasive lymph node biopsy.
目的
评估超声在鉴别结核性、转移性和淋巴瘤性颈淋巴结病中的作用。
方法
对 192 例患者使用 10MHz 线性探头在 FNAC 前进行颈部淋巴结超声检查。然后将超声表现与 FNAC 或淋巴结活检获得的明确组织诊断进行相关性分析。
结果
最显著的鉴别特征是 84%的结核性淋巴结内有强回声。这种发现仅见于 11%的转移性淋巴结，而在淋巴瘤性淋巴结中则不存在。其他发现，如 L/S 比值、不规则边缘、低回声中心、融合趋势、周边晕环和无门部等，有助于鉴别反应性和疾病性淋巴结，但在结核性、转移性和淋巴瘤性淋巴结 3 组中存在相当大的重叠。
结论
超声是一种非侵入性的方法，可以为颈淋巴结病的诊断提供有用的线索。它应该与 FNAC 结果一起解读。理想情况下，应从超声最具代表性的淋巴结进行超声引导下 FNAC。在 FNAC 不确定的情况下，超声特征可能无需进行有创性的淋巴结活检。
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