| Lymphadenectasis of neck is common in clinic. Etiopathogenisis is also fairly multiplicity. It appears as lymphadenectasis, such as general and regional infection,tuberculosis,lymphadenoma,metastatic,et. Qualitation diagnosis of lymphadenectasis is in clinical significance for ascertainment management,therapeutic effect evaluation,monitoring tumor advancement. Ultrasonic inspection can supply versatile aggregate analysis, such as size,morphous,internal echo,blood supply feature of node. It can supply abundant diagnostic evidence to qualitation diagnosis.Two-dimensional ultrasonic imag(e2DUS)&color doppler flow imaging ( CDFI ) conduces to discrimination of innate and malignant node.At present, there are three methods frequently in clinic to identify patho-property of Lymph node of neck, Namely Operation biopsy on Lymph node of neck, fine needle aspiration cytological examination and automatic biopsy gun dissection biopsy under ultrasonic guidance。ACNB is simple in manipulation and easy to handle, with little time, and high accuratissime rate. So it is easy to receive for most patients and increasingly extensive in clinic application. It contents clinical diagnosis demand to most extent. This text contrasts control with puncture patho-results by high frequency probe observation of lymphadenectasis of neck. It approaches ultrasonic feature and clinical application value of 2DUS & CDFI in superficial Lymph node intumescence.Material and method:1 Clinical data138 patients with lymphadenectasis of neck by palpation or ultrasound, firstly accept ACNB under ultrasonic guidance, secondly assess whether or not operate on the basis of pathological diagnosis consequence.2 Equipment and methodInstrument is siemens SEQUOIA 512 color Doppler diasonography; detecting head frequency is 7.5～12MHz. The third-generation biopsy gun in BAD corporation equipped with 18G architecture cutting needle of cisterna. ①measurement: The patient exposes cervical part thoroughly in prostration or appropriate lateral position lightly put detecting head and directly contact investigation. Firstly, investigate shape\size\internal echo of Lymph node by 2D(2-DIMENSIONAL) ultrasound, check lymphadenectasis maximum length wise and transversal, and then measure macro-diameter & brevi-diameter; secondly, observe its interior & peri-blood current condition, survey arteries flow rate and calculate resistant index by color Doppler flow imaging (CDFI) and color Doppler power imaging (CDPI).②Punctuation: The patient puts a bolster under raise his head and shoulder superior position with post-extend cervical part 20～30o . We try to get out of the way to great vessels and select optimal puncture location. After routine skin degerming by color ultrasound we spread out scarf to locate on focus of infection in the center of topography and local anesthesia at latero-detecting head tip 0.5～2.0 cm with 5 ml of lidocaine.We needle with 18G tissue cutting needle following detecting head scan plane. We make needle stick parallel with detecting head surface and drive slowly the borderline of focus of infection under real-time ultrasonic surveillance, and then withdrawal of needlesafter provocating biopsy gun. We Observe the location of pin hole in focus of infection with detecting head intersect to make pinhole high-level reecho in intralymph node. We unload tissue elder pith out of dissection socket and soak it in 10% formalin, and then transport it to patho-examination.3 Protocol the information of patients, the measurements, puncture procedure and the patho-results in full and then deposit these in compact disc. We do T analysis in use of Statistics SPSS11.0 package .If P<0.05, there is significant difference.ResultsThe materials of 138 cases is gratificated. These are divided 3 groups in evidence of Pathological diagnosis, namely 19 cases of innocence, 42 cases of tuberculosis (cheese sample), 72 cases of malignancy which consist of 12 cases of malignant lymphoma and 60 cases of metastatic carcinoma. The diagnosis of 5cases is in nubibus.1 Lymph node L/ S value: The L/ S of 94.7% innocence> 2;The L/ S of 83.3% tuberculosis > 2, while the L/S of 16.7%<2; The L/S of 98.7% malignancy<2. There is significance difference between innocence group and others(P<0.01), no significance difference between tuberculosis group and malignancy group(P>0.05).2 the feature of 2D(2-DIMENSIONAL):①innocence group: We can see interior uniformity micro-punctiform low to secondary echo, substantia corticalis and substantia medullaris homogeneity growth, and that sharpness of border smooth and glossy in Lymph node, no amixis phenomenon of Lymph node.②tuberculosis group : peri-echo is a little strong, center-echo fairly low. We can see some echoless fluidity echofree, calcification high-level echo and coalesce to irregularity lump.③malignancy group : We can see irregular bouncary with star pustute or notch. Internal echo is low, uneven,high-level echo like flock or cluster. There is mostly no substantia medullaris high-level echo-strand or a few with deformity, offset or substantia corticalis thickening unsymmetrically.3 Color Doppler Flow Imaging(CDFI):①innocence group : There is no blood fluent signal or diffuse little dot blood fluent signals.②tuberculosis group: Sometimes there is small blood fluent signal in perimeter and some interior diffuse dot blood fluent signals.③malignancy group : blood fluent signal is affluence in node, like branches or bulky dot blood fluent signals.4 Blood fluent rate(Vmax):①innocence group: 16.0士8.0cm/s.②tuberculosis group: 18.7士6.3cm/s.③malignancy group: 30.7士4.4cm/s.There is significance difference between innocence group and malignancy group(P<0.05), no significance difference between tuberculosis group and others(P>0.05).5 resistant index(RI):①innocence group: 0.52～0.74.②tuberculosis group: 0.50～0.69.③malignancy group:0.66～0.72.There is significance difference between innocence group and malignancy group(P<0.05), no significance difference between tuberculosis group and others(P>0.05).DiscussionIn imageology examinations of lymph node, it is known that ultrasound diagnostic technique is simple in operation, with better results, no radioactive radiation or contrast agent, and more economical visualization method. High-frequency ultrasound is the leader select of routine examination,which can directly reflect the size,number,morphous,internal echo feature of lymph node and the relation of periph forthcoming blood vessel. Innocent Lymphadenovarix in cervical part seen in ultrasound, substantia corticalis and substantia medullaris of lymph node thicken, flat oval-shap. There is no pressurization phenomenon between lymphadenectasis and tissue & blood vessel periphery. Because the Inflammatory reaction of lymph node is diffuse and homogeneity, it remain original condition(L/S>2)。In color doppler flow imaging,short it is rod-shape blood signal.Courser following hilum of lymph gland, which focus on central part mostly, while few in terminal part. Blood flow rate & resistent index of peak amplitude in lymph node arterial systole phase become higher than those of normal lymph node.Malignant Lymphadenovarix in cervical part seen in ultrasound ,we can find that Lymphadenovarix is more in short diameter increasing L/S< 2. The whole lymph node tend to spherical in shape and confluens conglobation each other whose internal echo is uneven. Substantia medullaris strong-echo disappear or like leptonemaa, while substantia corticalis thickening uneven. So substantia medullaris and porch dysmorphosis to deflect to one side. Blood current is abundant intralymph node in color doppler flow imaging. The branches from stem vessels streches to substantia corticalis and substantia medullaris to distribute the whole lymph node, and then courser tortuosity. The structure of malignant node is broken down for tumor cells infiltrating. Therefore, blood vessel courser disorder, blood flow rate & resistent index of peak amplitude in lymph node arterial systole phase become higher than those of normal and innoate lymph node.So high-frequency color Doppler ultrasound is the leader select method of imageology examination,which can observe the morphous,size,echo-strongth and blood signal in many ways. According to case history, it is valuable in the diagnosis and antidiastole of Lymph node of neck disorders.Recently with spread use of puncture under ultrasonic guidance and Improvement of biopsy gun, puncture biopsy takes the place of operation biopsy gradually. In puncture under ultrasonic guidance we can see real-time needle hole and the process of neddling which increase accurationConclusion:1,High-frequency ultrasound is the first select method of routine examination, which can directly reflect the size,number,morphous,internal echo feature of lymph node and the relation of periph forthcoming blood vessel.2,Color Doppler with high frequency and high resolution can conduce to identify innate or malignant lymph node.3,ACNB is a new method with high quality & quantity materials which can satisfy tissue pathologic diagnosis. We should use it to draw the materials from skin-deep lymph node. It is convenient and simple with a little trauma. Patients like to accept it. |
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