Dorfman Tatiana, Neymark Mariya, Begal Julia, Kluger Yoram
Division of General Surgery, Rambam Health Care Campus, affiliated with Rappaport Faculty of Medicine, Technion-lsrael Institute of Technology, Haifa, Israel.
Ambulatory and Breast Surgery Service, Rambam Health Care Campus, affiliated with Rappaport Faculty of Medicine, Technion-lsrael Institute of Technology, Haifa, Israel.
Isr Med Assoc J. 2018 Nov;20(11):674-678.
Enlarged lymph nodes (ELN) pose a great diagnostic challenge. They may represent the first clinical finding of a hematologic disease or other malignancy and may be an indication of a wide range of infectious and non-infectious diseases. Because many patients undergo percutaneous biopsy, surgical excisional biopsy is not often considered.
To analyze indications for a patient's referral for surgical biopsy of ELN and diagnostic steps to follow until referral, and to determine the number of ELN.
A retrospective study was conducted of prospectively collected data of patients who underwent surgical biopsy of ELN from January 2004 to December 2013.
Of 118 patients who underwent surgical biopsy of ELN, only 52 (44%) had needle biopsy (NB) before referral. Lymphoma was diagnosed by NB in 24 (46%) of the referred patients. In patients with a previous diagnosis of lymphoma, NB of ELN yielded a sensitivity of 67% and specificity of 79%. In patients with lymphadenopathy but with no previous history of malignancy, sensitivity for lymphoma was 68% and specificity was 71%. The investigative time period until final diagnosis was 3 months in patients who had NB but only 1.25 months in patients who were referred directly for surgery (P < 0.0001).
Surgical biopsy of ELN still has a place in the clinical evaluation of patients with ELN. Surgery may significantly reduce the length of investigation and prevent unnecessary diagnostics, especially in patients with suspected lymphoma recurrence.
肿大淋巴结（ELN）带来了巨大的诊断挑战。它们可能是血液系统疾病或其他恶性肿瘤的首个临床发现，也可能提示多种感染性和非感染性疾病。由于许多患者接受经皮活检，手术切除活检并不常被考虑。
分析患者转诊进行ELN手术活检的指征以及转诊前应遵循的诊断步骤，并确定ELN的数量。
对2004年1月至2013年12月接受ELN手术活检患者的前瞻性收集数据进行回顾性研究。
在118例接受ELN手术活检的患者中，只有52例（44%）在转诊前进行了针吸活检（NB）。在转诊患者中，24例（46%）通过NB诊断为淋巴瘤。在既往诊断为淋巴瘤的患者中，ELN的NB敏感性为67%，特异性为79%。在有淋巴结病但无恶性肿瘤病史的患者中，淋巴瘤的敏感性为68%，特异性为71%。进行NB的患者直到最终诊断的调查时间为3个月，而直接转诊进行手术的患者仅为1.25个月（P<0.0001）。
ELN手术活检在ELN患者的临床评估中仍有一席之地。手术可显著缩短调查时间并避免不必要的诊断，尤其是在疑似淋巴瘤复发的患者中。
