大型队列研究中内镜超声引导下细针穿刺对淋巴结病患者的诊断充分性及安全性

Diagnostic adequacy and safety of endoscopic ultrasound-guided fine-needle aspiration in patients with lymphadenopathy in a large cohort.

作者信息

Bansal Rinkesh K, Choudhary Narendra S, Patle Saurabh K, Gupta Mahesh K, Vashishtha Chitranshu, Kaur Gagandeep, Sarin Haimanti, Puri Rajesh

机构信息

Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurugram, India.

Department of Cytopathology, Medanta The Medicity, Gurugram, India.

出版信息

Endosc Int Open. 2018 Apr;6(4):E421-E424. doi: 10.1055/s-0043-121986. Epub 2018 Mar 29.

DOI:10.1055/s-0043-121986

PMID:29607394

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5876022/

Abstract

BACKGROUND AND STUDY AIMS

The role of endoscopic-ultrasound (EUS) guided fine-needle aspiration (FNA) in patients with lymphadenopathy in terms of diagnostic adequacy and safety in large population is not well defined. The aim of this study was to evaluate diagnostic adequacy and safety of EUS-FNA in patients with lymphadenopathy.

PATIENTS AND METHODS

Retrospective study from October 2010 to September 2015 at tertiary care center in Delhi-NCR. We analyzed data from 1005 EUS- FNAs of lymph nodes.

RESULTS

The study cohort comprised 1005 lymph nodes in 865 patients; 68 % were males, mean age was 50 ± 14 years. Indications of FNA were to look for etiology of pyrexia of unknown origin or staging of malignancy mainly. FNA was taken from mediastinal nodes (n = 528, 52.5 %) and intra-abdominal nodes (n = 477, 47.5 %). Median size of nodes at long axis and short axis was 17 (12 - 25.7) and 10 (8 - 15) mm respectively. Adequate material by FNA was obtained in 92.8 % cases. The cytopathologic diagnosis were malignancy in 153 (15.2 %), granulomatous change in 452 (42 %), and reactive lymphadenopathy in 328 (35.6 %). There was statistically significant difference seen between groups with pathological and reactive lymph nodes regarding size at long and short axis, hypoechoic nature, well defined borders and presence of necrosis and calcification. Procedure-related adverse effects were encountered in 6 patients (0.8 %). Four patients had mild mucosal bleeding in chronic liver disease patients and two had mild hepatic encephalopathy related to sedation.

CONCLUSION

EUS-FNA of lymph nodes has good diagnostic adequacy and safety.

摘要

背景与研究目的

在大量人群中，内镜超声（EUS）引导下细针穿刺抽吸活检（FNA）在淋巴结病患者中的诊断充分性和安全性尚未明确界定。本研究旨在评估EUS-FNA在淋巴结病患者中的诊断充分性和安全性。

患者与方法

对2010年10月至2015年9月在德里-国家首都辖区三级医疗中心进行的回顾性研究。我们分析了1005例淋巴结EUS-FNA的数据。

结果

研究队列包括865例患者的1005个淋巴结；68%为男性，平均年龄为50±14岁。FNA的指征主要是寻找不明原因发热的病因或恶性肿瘤的分期。FNA取材于纵隔淋巴结（n = 528，52.5%）和腹腔内淋巴结（n = 477，47.5%）。淋巴结长轴和短轴的中位大小分别为17（12 - 25.7）mm和10（8 - 15）mm。92.8%的病例通过FNA获得了足够的材料。细胞病理学诊断为恶性肿瘤153例（15.2%），肉芽肿性改变452例（42%），反应性淋巴结病328例（35.6%）。在病理淋巴结组和反应性淋巴结组之间，长轴和短轴大小、低回声性质、边界清晰以及坏死和钙化的存在方面存在统计学显著差异。6例患者（0.8%）出现了与操作相关的不良反应。4例慢性肝病患者出现轻度黏膜出血，2例出现与镇静相关的轻度肝性脑病。