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淋巴结是人体重要的外周免疫器官, 是T细胞、B细胞定居的场所, 也是识别外来抗原后发生免疫应答的部位。近年来, 临床上以颈部淋巴结肿大为主诉而首诊的患者越来越多, 其病因也相当复杂, 其中, 良性病变包括结核、淋巴结反应性增生、组织坏死性淋巴结炎等, 恶性病变包括淋巴瘤、转移瘤等。颈部淋巴结是头颈部肿瘤最常转移的部位之一, 也是呼吸、消化系统肿瘤的终末转移站。有文献报道, 颈部淋巴结转移者5年生存率会下降50%[1], 因此, 明确肿大淋巴结的良、恶性对临床选择正确的治疗方案有重要的作用。
通过触诊来判断淋巴结性质的敏感性较低, 其检出淋巴结肿大的灵敏度仅为45%~78%[2], 且位置较深的淋巴结无法触及, 单凭触诊很难鉴别淋巴结性质。目前, 评估颈部淋巴结性质的影像学方法包括超声检查、CT、MRI及PET等, 它们能较为直观的观察淋巴结的位置、大小、结构以及血流动力学等信息, 为颈部淋巴结病变性质的鉴别提供了丰富的诊断信息, 其中, 超声检查以其实时性、操作简便、价格低廉、无创伤、可重复性强等优点, 成为诊断浅表淋巴结病变的首选影像学方法[3]。但是, 即使使用了这些方法, 对部分淋巴结的病变性质仍难以作出定性诊断。随着超声介入技术的发展, 应用超声引导下穿刺活检来获取病理诊断, 对淋巴结定性诊断起着重要作用。本文就超声及超声引导下穿刺活检对颈部淋巴结病变诊断的现状及进展作一综述。
超声引导下穿刺活检术对颈部淋巴结诊断的现状及进展
Status and advances of cervical lymph nodes diagnosis by ultrasound-guided core-needle biopsy
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摘要: 颈部淋巴结占全身淋巴结约1/3,全身各个部位的恶性肿瘤均有可能转移到颈部淋巴结致其肿大,因此明确其性质对恶性肿瘤分期、治疗计划制定和疗效分析等具有重要意义。目前,超声引导下穿刺活检被认为是非手术条件下获取明确病理组织学诊断的最佳方法之一。该文探讨了超声引导下穿刺活检术在颈部淋巴结病变病理学诊断中的临床应用价值及研究进展。Abstract: Cervical lymph nodes account for approximately 1/3 of the lymph nodes all over the body. The malignant tumor all over the body can metastasize to head and cervical lymph nodes.So it is significant tomake clear its property to determine the malignant tumor staging, establish treatment plan and analyze curative effect.Now ultrasound-guided core-needle biopsy is generally accepted as the optimal diagnose way to made correct histopathological diagnosis in non-surgical condition.The aim of this study was to survey and evaluate the accuracy of pathological diagnosis using the ultrasound-guided core-needle biopsy in the cervical lymph nodes.
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Key words:
- Ultrasonography /
- Neck /
- Lymph nodes /
- Lymphoma /
- Lymphatic metastasis /
- Biopsy, needle
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