高分辨率超声/内镜检查和弹性成像在预测淋巴结恶性肿瘤中的作用。
Role of high resolution ultrasound/endosonography and elastography in predicting lymph node malignancy.
机构信息
Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt.
Department of Pathology, Cairo University, Cairo, Egypt.
出版信息
Endosc Ultrasound. 2014 Jan;3(1):58-62. doi: 10.4103/2303-9027.121252.
OBJECTIVE
The objective of this study is to evaluate the role of high resolution ultrasonography (US) and endoscopic ultrasound (EUS)-elastography in predicting malignant lymphadenopathy.
PATIENTS AND METHODS
This prospective study included 88 patients who underwent EUS or US examination of different groups of lymph nodes (LNs). The classification as benign or malignant based on the real time elastography pattern and the B-mode US/EUS images was compared with the final diagnosis obtained by EUS or US guided fine-needle aspiration cytology (FNAC), tru-cut biopsy or excisional biopsy and follow-up in benign lesions not indicated for biopsy for at least 12 months.
RESULTS
Regarding the echogenicity, 98.3% of the benign LNs were hyperechoic, 1.7% was hypoechoic while 89.7% of the malignant LNs were hypoechoic, 3.4% were heterogenous and 6.9% were hyperechoic. With cut-off value of 1.93, the sensitivity of longitudinal to transverse ratio was 73% and the specificity was 100%. Score 1 elastography had specificity of 100% in diagnosis of benign LNs, sensitivity was 76.3%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 84.7% while score 2 had a sensitivity of 60%, specificity of 31.5%, PPV of 15.3%, NPV of 79.3%. Score 3 had a sensitivity of 70.2%, specificity of 100%, PPV of 13.8%, NPV of 100% in detecting malignancy while score 4 had a sensitivity of 85.5%, specificity of 100%, PPV of 100%, NPV of 65.5%.
CONCLUSION
Elastography is a promising diagnostic modality that may complement standard ultrasound and EUS and help guide FNAC during staging of LNs.
目的
本研究旨在评估高分辨率超声（US）和内镜超声（EUS）-弹性成像在预测恶性淋巴结病变中的作用。
患者和方法
本前瞻性研究纳入了 88 例接受不同组淋巴结（LNs）EUS 或 US 检查的患者。基于实时弹性成像模式和 B 型 US/EUS 图像，将基于良恶性分类与 EUS 或 US 引导下细针穿刺细胞学（FNAC）、 tru-cut 活检或切除术活检的最终诊断进行比较，并对良性病变进行随访，对于无活检指征的良性病变，随访时间至少 12 个月。
结果
就回声强度而言，98.3%的良性 LNs 呈高回声，1.7%呈低回声，而 89.7%的恶性 LNs 呈低回声，3.4%呈不均匀回声，6.9%呈高回声。当纵向与横向比值的截断值为 1.93 时，其灵敏度为 73%，特异性为 100%。弹性成像评分 1 对良性 LNs 的诊断具有 100%的特异性，灵敏度为 76.3%，阳性预测值（PPV）为 100%，阴性预测值（NPV）为 84.7%，而评分 2 的灵敏度为 60%，特异性为 31.5%，PPV 为 15.3%，NPV 为 79.3%。评分 3 对恶性病变的检测灵敏度为 70.2%，特异性为 100%，PPV 为 13.8%，NPV 为 100%，评分 4 的灵敏度为 85.5%，特异性为 100%，PPV 为 100%，NPV 为 65.5%。
结论
弹性成像作为一种很有前途的诊断方式，可能会补充标准超声和 EUS，并有助于在 LNs 分期时指导 FNAC。
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