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中华医学超声杂志(电子版) ›› 2016, Vol. 13 ›› Issue (01) : 61 -65. doi: 10.3877/cma.j.issn.1672-6448.2016.01.015

所属专题: 文献

介入超声影像学

超声引导下锁骨上区淋巴结穿刺活检在非小细胞肺癌患者中的应用
韩峰1, 杨嵘2, 王建伟1, 郭智兴1, 郑玮1, 林庆光1, 庄淑莲1, 李安华1,()   
  1. 1. 510060 广州,华南肿瘤学国家重点实验室 中山大学肿瘤防治中心超声科
    2. 830001 乌鲁木齐,新疆维吾尔自治区人民医院超声科
  • 收稿日期:2015-08-17 出版日期:2016-01-01
  • 通信作者: 李安华

Utility of ultrasound-guided supraclavicular lymph node biopsy in patients with non-small cell lung cancer

Feng Han1, Rong Yang2, Jianwei Wang1, Zhixing Guo1, Wei Zheng1, Qingguang Lin1, Shulian Zhuang1, Anhua Li1,()   

  1. 1. Department of Ultrasound, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
    2. Department of Ultrasound, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
  • Received:2015-08-17 Published:2016-01-01
  • Corresponding author: Anhua Li
  • About author:
    Corresponding author: Li Anhua, Email:
引用本文:

韩峰, 杨嵘, 王建伟, 郭智兴, 郑玮, 林庆光, 庄淑莲, 李安华. 超声引导下锁骨上区淋巴结穿刺活检在非小细胞肺癌患者中的应用[J/OL]. 中华医学超声杂志(电子版), 2016, 13(01): 61-65.

Feng Han, Rong Yang, Jianwei Wang, Zhixing Guo, Wei Zheng, Qingguang Lin, Shulian Zhuang, Anhua Li. Utility of ultrasound-guided supraclavicular lymph node biopsy in patients with non-small cell lung cancer[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(01): 61-65.

目的

探讨超声引导下锁骨上区淋巴结穿刺活检在非小细胞肺癌(NSCLC)患者临床分期中的应用价值。

方法

回顾性分析2005年1月至2014年2月在中山大学肿瘤防治中心超声科行超声引导下锁骨上区淋巴结穿刺活检的NSCLC患者临床病例资料,将穿刺活检结果与临床最终诊断结果进行对比,分析淋巴结的大小,超声引导下锁骨上区淋巴结穿刺活检的敏感度、特异度、阳性预测值和阴性预测值、准确性及对患者治疗方式的影响。

结果

586例非小细胞肺癌伴锁骨上淋巴结肿大患者穿刺后病理证实阳性转移病例543例(92.66%);阴性转移病例30例(5.12%);未能诊断病例13例(2.22%)。阴性病例中有11例临床或影像学怀疑恶变者再次行超声引导下穿刺活检或切取活检,其中2例阳性。在573例病例中穿刺后取得有效病理诊断的敏感度为99.63%(543/545),特异度100.00%(28/28),阴性预测值93.33%(28/30),阳性预测值100.00%(543/543)。586例病例的总准确性97.44%(571/586)。有34例(5.80%)患者因超声引导下锁骨上淋巴结穿刺活检改变了分期及治疗方式。所有超声引导下锁骨上区淋巴结穿刺活检病例均未出现并发症。

结论

超声引导下锁骨上淋巴结穿刺活检是一种安全、高效的检查方法,可以作为NSCLC临床分期的可靠手段。

Objective

To investigate the value of ultrasound-guided supraclavicular lymph nodes biopsy in the staging of non-small cell lung cancer (NSCLC) patients.

Methods

The present study was a retrospective review of patients with NSCLC who underwent ultrasound-guided supraclavicular lymph node biopsy from 2005 January to 2014 February. The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasound–guided supraclavicular lymph node biopsy are reported. The sizes of the lymph nodes which were biopsied and the number of instances in which treatment was changed were also reported.

Results

A total of 586 patients underwent ultrasound-guided supraclavicular lymph node biopsy. Of the 586 patients, 543 (92.66%) had malignant findings, 30 (5.12%) had benign findings; 11 of whom were suspected to be malignant and underwent another ultrasound-guided biopsy or incisional biopsy and 2 of them had malignant findings. Thirteen of 586 had nondiagnostic biopsy findings. As a result, ultrasound-guided supraclavicular lymph node biopsy changed the tumor stage and treatment planning in 34 (5.8%) of the 586 patients. Overall, ultrasound-guided supraclavicular lymph node biopsy had a sensitivity of 99.63%, a specificity of 100%, a negative predictive value of 93.33%, a positive predictive value of 100% and an accuracy of 97.44%. No complications were found in the patients who underwent ultrasound-guided supraclavicular lymph nodes biopsy.

Conclusions

Ultrasound-guided supraclavicular lymph nodes biopsy was a safe and efficient option for patients with NSCLC which had suspicious supraclavicular lymph node, and also could be used as a reliable method for clinical staging of patients with NSCLC.

图3 超声引导下穿刺入淋巴结,病理为低分化腺癌转移
图6 超声引导下穿刺入淋巴结,病理示大量干酪样坏死,上皮样细胞及郎罕氏多核巨细胞,散在分布慢性炎细胞,病变符合结核病。术后左肺病灶病理为腺癌
图9 超声引导下穿刺入"淋巴结",术后病理仅见横纹肌及少量皮肤组织,未见淋巴组织,未见肿瘤。复习穿刺图像,可见以血管为参考穿刺部位并非淋巴结。1周后行淋巴结切取活检,病理示低分化腺癌转移
表1 573例非小细胞肺癌首次行超声引导下锁骨上淋巴结穿刺活检成功的病理诊断结果(例)
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