Grønlund Søren, Mey Kristianna, Andersen Elo, Rasmussen Eva Rye
Department of Otorhinolaryngology Hillerød Hospital Hillerød Denmark.
Department of Otorhinolaryngology, Head and Neck Surgery and Audiology Rigshospitalet and Gentofte Hospital, University of Copenhagen Copenhagen Denmark.
Laryngoscope Investig Otolaryngol. 2016 Jun 21;1(4):78-82. doi: 10.1002/lio2.23. eCollection 2016 Aug.
In this study, the true malignancy rate in 135 patients with a preoperative tentative diagnosis of a lateral neck cyst (LNC) was assessed. Furthermore, the sensitivity and specificity of fine needle aspiration of suspected LNC were evaluated and the diagnostic delay was analyzed.
This study was retrospective in design and included all patients who had undergone surgery for a suspected LNC in four secondary hospitals in the eastern regions of Denmark during the period of 2009 to 2012.
One hundred thirty-five patients were identified and included by means of a search strategy for NOMECO surgical procedure codes KENB40A+B in the electronic surgical booking systems. Because the procedure codes also include median neck cysts and fistulas, the latter were excluded manually.
Of the 135 patients preoperatively diagnosed with LNC, a malignant postoperative histopathological diagnosis was revealed in 19 patients (14.4%). Of these, three individuals were between 35 to 40 years of age. In 17 cases, preoperative fine-needle aspiration biopsy showed benign cytology, whereas histopathology postoperatively proved to be malignant. This renders a sensitivity of 88.8% and a specificity of 60.0% for fine needle aspiration biopsy with regard to LNC diagnostics.
This study suggests that, for patients older than 35 years, a cystic lateral neck mass should be considered potentially malignant; by contrast, LNC is a diagnosis of exclusion. Any delay in treatment should be avoided until final histopathological diagnosis has been obtained. Arguably, all patients older than 35 years with a cystic lesion laterally on the neck should be included in the fast-track cancer referral program.
2b.
本研究评估了135例术前初步诊断为颈部外侧囊肿（LNC）患者的真正恶性率。此外，还评估了疑似LNC细针穿刺的敏感性和特异性，并分析了诊断延迟情况。
本研究为回顾性设计，纳入了2009年至2012年期间在丹麦东部地区四家二级医院接受疑似LNC手术的所有患者。
通过电子手术预约系统中NOMECO手术程序代码KENB40A+B的搜索策略，识别并纳入了135例患者。由于该程序代码还包括颈部正中囊肿和瘘管，后者通过人工排除。
在术前诊断为LNC的135例患者中，19例（14.4%）术后组织病理学诊断为恶性。其中，3例年龄在35至40岁之间。在17例中，术前细针穿刺活检显示细胞学良性，而术后组织病理学证明为恶性。这使得细针穿刺活检对LNC诊断的敏感性为88.8%，特异性为60.0%。
本研究表明，对于年龄大于35岁的患者，颈部外侧囊性肿块应被视为潜在恶性；相比之下，LNC是一种排除性诊断。在获得最终组织病理学诊断之前，应避免任何治疗延迟。可以说，所有年龄大于35岁的颈部外侧有囊性病变的患者都应纳入快速癌症转诊计划。
2b。
