超声造影引导下经皮穿刺取材在浅表淋巴结结核诊断中的价值

doi:10.3969/j.issn.1000-6621.2019.12.002

摘要/Abstract

摘要：

目的探讨超声造影(contrast-enhanced ultrasound,CEUS)引导下经皮穿刺取材在浅表淋巴结结核诊断中的价值。方法回顾性分析同济大学附属上海市肺科医院结核科2018年1月1日至2018年12月31日期间收治的接受CEUS引导下经皮穿刺取材、资料完整的疑似淋巴结结核患者249例,其中男96例,女153例,中位年龄32(16,82)岁,记录患者的临床特征、超声诊断结果、淋巴结穿刺取材进行检测的结果(包括病理学、细菌学及分子生物学),最终评估CEUS引导下穿刺取材并送检相关检测对浅表淋巴结结核的检出效能。结果 249例患者中,最终通过CEUS引导下经皮穿刺进行病理学、细菌学、分子生物学检测或者诊断性抗结核治疗确诊为淋巴结结核219例,非淋巴结结核30例。以临床最终诊断作为参考标准,超声引导取材送检病理学检测诊断淋巴结结核的敏感度为86.76% (190/219),特异度为100.00% (190/190)。取材组织行细菌学检测诊断淋巴结结核的敏感度为31.51% (69/219),特异度100.00% (69/69);其中100例行GeneXpert MTB/RIF检测,诊断淋巴结结核的敏感度为97.80% (89/91),特异度100.00% (9/9)。CEUS引导下取材诊断淋巴结结核的总体敏感度及特异度分别为97.72% (214/219)及100.00% (30/30),阳性预测值为100.00% (214/214),阴性预测值为85.71% (30/35),符合率为97.99%(244/249),Kappa值为 0.91。结论 CEUS引导下经皮淋巴结穿刺取材有助于浅表淋巴结结核的诊断。

关键词: 结核, 淋巴结, 超声检查, 介入性, 活组织检查, 评价研究, 超声造影

Abstract:

Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) guided percutaneous sampling in the early diagnosis of superficial lymph node tuberculosis. Methods A retrospective analysis was performed on patients with suspected superficial lymphatic tuberculosis admitted to the tuberculosis department of Shanghai Pulmonary Hospital from 2018.1.1-2018.12.31,who received lymph node puncture/biopsy guided by ultrasound. A total of 249 patients with complete record were enrolled, including 96 males and 153 females. The median age was 32 (16-82) years. Clinical data of patients were collected and a database was established to record the clinical characteristics of patients, the findings of interventional ultrasound and the result of pathological, bacteriological, and molecular biological examinations on the sampling tissues of lymph node. Then the diagnostic efficiency of interventional ultrasonography sampling was evaluated, data was analyzed with statistical methods. Results Two hundred and nineteen cases were diagnosed as lymphatic tuberculosis and 30 cases were diagnosed as non-TB. Using the final diagnostic results as reference standard, the sensitivity and specificity of pathology examination after interventional ultrasonography in the diagnosis of lymphatic tuberculosis were 86.76% (190/219) and 100.00% (190/190);that of bacteriological test were 31.51% (69/219) and 100.00% (69/69). The sensitivity and specificity of GeneXpert MTB/RIF in the diagnosis of lymphatic tuberculosis in 100 patients were 97.80% (89/91) and 100.00% (9/9). With the final diagnosis result as the gold standard, the overall sensitivity and specificity of interventional ultrasound guided sampling in the diagnosis of lymphatic tuberculosis were 97.72% (214/219) and 100.00% (30/30), respectively;The positive predictive value was 100.00% (214/214), and the negative predictive value was 85.71% (30/35),the coincidence rate was 97.99% (244/249) and the Kappa value was 0.91. Conclusion Interventional ultrasonography could be helpful for diagnosis of superficial lymphatic tuberculosis.

Key words: Tuberculosis, lymph nodes, Ultrasonography, interventional, Biopsy, Evaluation studies, Contrast-enhanced ultrasound

孙雯雯,张怡,沈梦君,朱惠铭,王茵,范琳. 超声造影引导下经皮穿刺取材在浅表淋巴结结核诊断中的价值[J]. 中国防痨杂志, 2019, 41(12): 1241-1245. doi: 10.3969/j.issn.1000-6621.2019.12.002

Wen-wen SUN,Yi ZHANG,Meng-jun SHEN,Hui-ming ZHU,Yin WNAG,Lin FAN. Evaluation of interventional ultrasonography sampling in early diagnosis of superficial lymphatic tuberculosis[J]. Chinese Journal of Antituberculosis, 2019, 41(12): 1241-1245. doi: 10.3969/j.issn.1000-6621.2019.12.002

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超声造影诊断	淋巴结结核		淋巴结恶性肿瘤		淋巴结反应性增生		淋巴结结节病
超声造影诊断	例数	检出率(%)	例数	检出率(%)	例数	检出率(%)	例数	检出率(%)
良性	217	87.15	2	0.80	8	3.21	2	0.80
恶性	2	0.80	18	0.00	0	0.00	0	0.00
合计	219	67.95	20	8.03	8	3.21	2	0.80

超声介入取材检测结果	临床最终诊断		敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	符合率 (%)	Kappa值
超声介入取材检测结果	结核例数	非结核例数	敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	符合率 (%)	Kappa值
阳性	214	0	97.72	100.00	100.00	85.71	98.00	0.91
阴性	5	30