| Objective: To explore the diagnostic value of this technique in the etiological analysis of abnormal cervical enlarged lymph nodes and summarize the ultrasound images characteristics of different types of lymph nodes,through the study of ultrasound-guided percutaneous core-needle biopsy in cervical enlarged lymph node,so as to provide valuable experience and reference for further clinical promotion of ultrasound-guided percutaneous core-needle biopsy(US-PCNB).Methods: We collected 493 abnormal cervical enlarged lymph nodes cases in affiliated hospital of North Sichuan Medical college from June 2015 to September 2017.All patients underwent US-PCNB.We analyzed the clinical data,biopsy and postoperative pathology of patients,calculated the material satisfaction and diagnostic accuracy,compared the coincidence rate between biopsy and operation,and summarized the operational skills.Results:(1)98.38%(485/493)of the puncture samples were qualified by US-PCNB,diagnostic rate was 85.40%(421/493).The diagnostic rates of16 G and 18 G were 86.76% and 78.82%,respectively.And the difference showed no statistically significance(P > 0.05).(2)421 identified cases showed that 261(62.00%)cases were malignant,224 were metastatic carcinomas,36 were lymphomas,and 1 case was follicular dendritic cell sarcoma.160(38.00%)cases were benign,92 weretuberculosis,44 were lymphadenitis,15 were reactive hyperplasia,6 were schwannoma,1 case was ligament fibromatosis,1was cat scratch disease and1 case was hemangioma.No positive pathological results were obtained in 77 cases which had only little meaningful tissue or even nonsense materials.(3)118 people performed the operation,the coincidence rate between US-PCNB and operation was 94.07%(111/118),and the difference was statistically significant(P < 0.05).There was no significant difference in the diagnosis rate of benign and malignant diseases by US-PCNB(P > 0.05).(4)The benign lymph nodes were mostly oval,L/S>2,echo homogenous.Most of them showed clear corticomedullary demarcations and either portal or central blood supply.Some of tuberculous lymph nodes could occur liquefaction and multiple fusion.Most malignant lymph nodes were round,L/S?2.Fusion and not clear corticomedullary demarcations were often seen.The echo was heterogeneity.Calcification and liquid-echo free area were closely related to primary carcinoma.The blood supply modes were diverse.Peripheral and mixed types formed the majority.Portal blood supply was common in lymphoma.(5)The metastatic area of tumor was closely related to lymphatic drainage.Metastatic lymph nodes of esophageal carcinoma were mostly found in the medial supraclavicular group(IVb).59.76% lung cancer metastases lymph nodes appeared on IV.Nasopharyngeal carcinoma was most frequently involved in the internal jugular vein lymph node chain.Metastatic lymph nodes of breast cancer were largely found in the lateral supraclavicular group(Vc).Thyroid cancer metastasis was most commonly found in the cervical and central regions.All areas of the lymphoma could be involved.Conclusion:(1)US-PCNB has high sampling and diagnosis rates.The coincidence rate between US-PCNB and operation was 94.07%,and the difference was statistically significant.There is no significant difference between 16 G and18G in the diagnostic rate.(2)Cervical malignant lymph nodes mostly are metastatic carcinoma and lymphoma.And the areas where are discovered are closely related to lymphatic drainage.The main components of benign lymph nodes are tuberculosis and lymphadenitis.(3)A small amount of benign and malignant lymph node ultrasonic images are overlapped,which mostly appears in tuberculous lymph nodes.Some pelvic malignancy can also be transferred to the neck.Low-risk areas should not be ignore in clinical practice.(4)Standardized puncture can help to reduce complications and improve the surgical safety. |
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