触诊和非触诊淋巴结的细针抽吸细胞学检查，以检测转移性黑色素瘤。

Fine needle aspiration cytology of palpable and nonpalpable lymph nodes to detect metastatic melanoma.

机构信息

Department of Dermatology, Charité University Medicine, Charitéplatz 1, Berlin 10117, Germany.

出版信息

J Natl Cancer Inst. 2011 Dec 7;103(23):1771-7. doi: 10.1093/jnci/djr381. Epub 2011 Sep 21.

DOI:10.1093/jnci/djr381

PMID:21940673

Abstract

BACKGROUND

Fine needle aspiration cytology (FNAC) is usually used to evaluate palpable nodes in patients with melanoma. The goal of our study is to review the sensitivity and specificity of this technique when applied to palpable but also to nonpalpable nodes.

METHODS

FNAC was performed during 1984-2007 in 1279 patients with suspicious lesions and/or lymph nodes. Indications for biopsy included increased size and/or palpability of nodes or abnormal ultrasound findings such as increased perfusion or focal lesions within the lymph nodes. The sensitivity, specificity, and positive and negative predictive values of FNACs guided by palpation or ultrasound were calculated for all patients and for subgroups of patients with palpable nodes or nonpalpable but sonomorphologically suspicious nodes.

RESULTS

A total of 2446 FNACs were performed in 1279 melanoma patients, of which 2011 (82.2%) FNACs had clinically or histologically confirmed results. Increased size and/or palpability of nodes was observed in 376 (29.4%) of 1279 patients, and abnormal ultrasound findings occurred for 903 (70.6%), indicating that a biopsy was needed. FNACs guided by palpation had sensitivity, specificity, and positive and negative predictive values similar to that of FNACs guided by ultrasound (sensitivity = 98.4% vs 97.2%, specificity = 100% vs 99.8%, positive predictive value = 100% vs 99.9%, and negative predictive value = 95.2% vs 96.4%, for palpation-guided FNACs vs ultrasound-guided FNACs, respectively). Results did not differ between patients with the palpable nodes and patients with nonpalpable but sonomorphologically suspicious nodes.

CONCLUSIONS

Ultrasound-guided FNAC of suspicious lymph nodes and lesions in melanoma patients has a high sensitivity and specificity, and FNAC should not be limited to palpable nodes. FNAC of normal-sized nodes and/or lymph nodes with abnormal ultrasound findings can be used to identify early metastatic disease.

摘要

背景

细针抽吸细胞学检查（FNAC）通常用于评估患有黑色素瘤的可触及淋巴结患者。我们的研究目的是回顾该技术的敏感性和特异性，不仅适用于可触及的淋巴结，也适用于不可触及的淋巴结。

方法

1984 年至 2007 年期间，对 1279 例可疑病变和/或淋巴结患者进行了 FNAC。活检的适应证包括淋巴结大小增加和/或可触及，或超声异常，如淋巴结内灌注增加或局灶性病变。计算了所有患者以及可触及淋巴结或不可触及但超声形态可疑淋巴结患者亚组的 FNAC 触诊或超声引导的敏感性、特异性、阳性和阴性预测值。

结果

在 1279 例黑色素瘤患者中进行了总共 2446 次 FNAC，其中 2011 次（82.2%）FNAC 具有临床或组织学确认结果。在 1279 例患者中，有 376 例（29.4%）出现淋巴结大小增加和/或可触及，903 例（70.6%）出现超声异常，表明需要进行活检。触诊引导的 FNAC 的敏感性、特异性、阳性和阴性预测值与超声引导的 FNAC 相似（触诊引导的 FNAC 的敏感性=98.4%比 97.2%，特异性=100%比 99.8%，阳性预测值=100%比 99.9%，阴性预测值=95.2%比 96.4%）。可触及淋巴结患者与不可触及但超声形态可疑淋巴结患者的结果无差异。