超声造影后细针穿刺活检术在颈部淋巴结结核诊断中的应用

摘要

目的：探讨超声造影后细针穿刺活检术在颈部淋巴结结核诊断中的应用价值。方法选取2012年1月—2014年3月在杭州市红十字会医院住院因颈部淋巴结肿大、临床疑似淋巴结结核的患者105例，采用掷硬币法将患者分为 A 组（47例）和 B 组（58例）。A 组进行超声引导下细针穿刺活检术；B 组先行超声造影后再行超声引导下细针穿刺活检术。结果 A 组患者47枚淋巴结超声表现：18枚（38.3%）为低回声，29枚（61.7%）为低回声伴液化。病理诊断结果：33枚为颈部淋巴结结核，2枚为反应性增生，1枚为转移癌，病理诊断阳性率为76.6%（36/47）。B组患者65枚淋巴结行超声造影：全淋巴结增强型和淋巴结部分增强型58枚（89.2%），7枚（10.8%）为淋巴结边缘增强型和淋巴结无增强型。58枚适合穿刺的淋巴结行超声引导下细针穿刺活检术，病理诊断结果：47枚为颈部淋巴结结核，5枚为反应性增生，3枚为转移癌，病理诊断阳性率为94.8%（55/58）。B 组细针穿刺活检术病理诊断阳性率高于 A 组（χ2=7.47，P <0.05）。结论超声造影后细针穿刺活检术应用于颈部淋巴结结核，可明显提高病理诊断阳性率。%Objectjve To study the application value of the contrast - enhanced ultrasonography before the fine aspiration needle biopsy(FNAB)in the diagnosis of cervical tuberculous lymphadenitis. Methods 105 patients with neck lymph node enlargement and clinical suspected tuberculous lymphadenitis who were admitted to Red Cross Hospital of Hangzhou during January 2012 to March 2014,were divided into group A(47 cases)and group B(58 cases)by coin tossing method. Cases in group A received FNAB under the guidance of ultrasonography;cases in group B received contrast - enhanced ultrasonography firstly,then received FNAB under the guidance of ultrasonography. Results The ultrasonography findings of 47 lymph nodes in group A:18 lymph nodes(38. 3% )displayed the character of low echo,29 lymph nodes(61. 7% )displayed the character of low echo and liquidation. The pathological diagnosis of 47 lymph nodes in group A:33 lymph nodes were cervical tuberculous lymphadenitis,2 were reactive hyperplasia,1 was metastatic carcinoma,the positive rate of pathological diagnosis was 76. 6%(36 / 47). The contrast - enhanced ultrasonography findings of 65 lymph nodes in group B:58 lymph nodes(89. 2% )showed intensified in whole node or in partial node,7(10. 8% )showed not intensified or showed intensified in edge of node. The pathological diagnosis of 58 lymph nodes in group B:47 lymph nodes were cervical tuberculous lymphadenitis,5 were reactive hyperplasia,3 were metastatic carcinoma of 58 patients,the positive rate of pathological diagnosis was 94. 8%(55 / 58). The positive rate of pathological diagnosis in group B was significantly higher than that in group A( χ2 = 7. 47,P < 0. 05 ). Conclusjon The application of the contrast - enhanced ultrasound before FNAB in the diagnosis of cervical tuberculous lymphadenitis can obviously improve the positive rate of pathological diagnosis.