Sharma S D, Stimpson P
B-ENT. 2016;12(4):291-296.
Assessment and management of presumed branchial cleft cysts: our experience.
The aim was to assess the accuracy of diagnosis and management of presumed branchial cleft cysts in our centre.
Retrospective review of patients with a clinical diagnosis of branchial cleft cyst at B arts Health NHS Trust from 2009 to 2015.
67 patients underwent surgical excision for presumed branchial cysts. Ninety per cent were histologically confirmed, 7% demonstrated cystic metastatic squamous cell carcinoma, and 3% lymph node metastases from papillary thyroid cancer. No patient had pre-operative Multi-Disciplinary Team (MDT) discussion. Pre-operative FNA had a positive predictive value of 90% (95% Cl 0.82-0.95). Age >40 years (p=0.02) and presence of lymph nodes (p=0.02) carried a higher risk of malignancy.
Patients >40 years with or without multiple lymph nod 'es on imaging should be treated as presumed meta- static cancer. Consideration should be given to concurrent panendoscopy and intra-operative frozen section +/- selective neck dissection after discussion at the Head & Neck MDT.
疑似鳃裂囊肿的评估与管理：我们的经验
旨在评估我们中心对疑似鳃裂囊肿的诊断及管理的准确性。
对2009年至2015年在巴茨健康国民保健服务信托基金临床诊断为鳃裂囊肿的患者进行回顾性研究。
67例患者因疑似鳃裂囊肿接受了手术切除。90%经组织学确诊，7%显示为囊性转移性鳞状细胞癌，3%为甲状腺乳头状癌的淋巴结转移。无患者进行术前多学科团队（MDT）讨论。术前细针穿刺抽吸活检（FNA）的阳性预测值为90%（95%置信区间0.82 - 0.95）。年龄>40岁（p = 0.02）及存在淋巴结（p = 0.02）提示恶性风险更高。
年龄>40岁且影像学检查有或无多发淋巴结的患者应被视为疑似转移性癌。头颈MDT讨论后，应考虑同时进行全内镜检查及术中冰冻切片检查+/-选择性颈清扫术。
