高分辨率超声/内镜超声及弹性成像在预测淋巴结恶性肿瘤中的作用。
Role of high resolution ultrasonography/endoscopic ultrasonography and elastography in predicting lymph node malignancy.
机构信息
Cairo University, Cairo, Egypt.
Assiut University, Cairo, Egypt.
出版信息
Endosc Ultrasound. 2014 Apr;3(Suppl 1):S6.
OBJECTIVE
To evaluate the role of high resolution ultrasonography (US) and endoscopic ultrasonography (EUS)-elastography in predicting malignant lymphadenopathy.
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 to 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% were 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
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。
方法
本前瞻性研究纳入了 88 例接受不同组淋巴结（LN）EUS 或 US 检查的患者。基于实时弹性成像模式和 B 型 US/EUS 图像的分类，将良性或恶性与 EUS 或 US 引导下细针抽吸细胞学（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，在无活检指征的情况下至少随访 12 个月。
结果
在回声方面，98.3%的良性 LN 呈高回声，1.7%呈低回声，而 89.7%的恶性 LN 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，其敏感性为 73%，特异性为 100%。1 分弹性成像在诊断良性 LN 时具有 100%的特异性，敏感性为 76.3%，阳性预测值（PPV）为 100%，阴性预测值（NPV）为 84.7%，而 2 分的敏感性为 60%，特异性为 31.5%，PPV 为 15.3%，NPV 为 79.3%。3 分在检测恶性病变时的敏感性为 70.2%，特异性为 100%，PPV 为 13.8%，NPV 为 100%，而 4 分的敏感性为 85.5%，特异性为 100%，PPV 为 100%，NPV 为 65.5%。
结论
弹性成像是一种很有前途的诊断方法，它可以补充标准的超声和 EUS，并有助于指导 LN 分期时的 FNAC。
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