常规超声评估浅表恶性淋巴结的图像特征

Image Characteristics of Superficial Malignant Lymph Nodes Evaluated by Routine Ultrasound

摘要: 目的：回顾扬州大学附属医院浅表恶性淋巴结患者的常规超声图像特征，从而总结浅表恶性淋巴结具有诊断价值的超声图像特征。方法：收集经术后或超声引导下穿刺活检病理确诊为浅表恶性淋巴结患者的常规超声检查结果，对照病理结果分为真阳性组及假阴性组，分析其图像特征：边界(清晰、不清晰)，形状(规则、不规则)，最大橫径大小，最大纵径大小，纵横比(最大短轴与最大长轴比值)，皮髓质分界(清晰、不清)，内部回声(均匀、不均匀)。结果：真阳性组96例中，边界清96例(100%)，边界不清0例(0%)；边缘规则光滑94例(98%)，边缘不规则2例(2%)；大小：最大橫径 ≤ 10 mm，7例(7%)，10 mm < 最大橫径 ≤ 20 mm，30例(31%)，最大橫径 > 20 mm，59例(61%)；最大纵径 ≤ 10 mm，31例(32%)，最大纵径 > 10mm，65例(68%)；纵横比 ≤ 0.5，16例(17%)，0.5 < 纵横比 ≤ 1，78例(81%)，纵横比 > 1，2例(2%)；回声相对均质61例(63%)，回声不均质35例(36%)；皮髓质分界不清96例(100%)，皮髓质分界清0例(0%)。结论：我们发现淋巴结超声图像提示皮髓质分界不清，则恶性淋巴结的诊断率非常高，对于恶性淋巴结有直接诊断价值；纵横比 ≥ 1时，发病率很低，但一旦超声图像提示，则恶性淋巴结的诊断率可达百分之百，且不管是纵横比、橫径，还是纵径大小，均与恶性淋巴结的诊断呈正相关；超声图像提示淋巴结的内部回声与恶性淋巴结的诊断关系不确定，不能仅以淋巴结内部回声特点判断淋巴结的性质；常规超声对浅表恶性淋巴结诊断的准确率很高，但是会存在漏诊的发生，在日常检查过程中需仔细探查，必要时应加大扫查范围。

Abstract: Objective: To review the characteristics of routine ultrasound images of patients with superficial malignant lymph nodes in Affiliated Hospital of Yangzhou University, so as to summarize the diag-nostic characteristics of superficial malignant lymph nodes. Methods: Routine ultrasonic examina-tion results of patients with superficial malignant lymph nodes confirmed by postoperative or ul-trasound-guided puncture biopsy were collected, and compared with pathological results, they were divided into true positive group and false negative group, and image characteristics were an-alyzed: Boundary (clear, unclear), shape (regular, irregular), maximum transverse diameter, max-imum longitudinal diameter, aspect ratio (ratio of maximum short axis to maximum long axis), cu-ticular medullary boundary (clear, unclear), and internal echo (uniform, uneven). Results: In 96 cases of true positive group, the boundary was clear in 96 cases (100%) and the boundary was un-clear in 0 cases (0%). There were 94 cases (98%) with regular smooth edges and 2 cases (2%) with irregular edges. Size: Maximum transverse diameter ≤ 10 mm, 7 cases (7%), 10 mm < maximum transverse diameter ≤ 20 mm, 30 cases (31%), maximum transverse diameter > 20 mm, 59 cases (61%); maximum longitudinal diameter ≤ 10 mm, 31 cases (32%), maximum longitudinal diame-ter > 10 mm, 65 cases (68%); aspect ratio ≤ 0.5, 16 cases (17%), 0.5 < aspect ratio ≤ 1, 78 cases (81%), aspect ratio > 1, 2 cases (2%). The echoes were relatively homogeneous in 61 cases (63%) and heterogeneous in 35 cases (36%). There were 96 cases (100%) with unclear skin and medul-lary boundary and 0 cases (0%) with clear skin and medullary boundary. Conclusion: We found that the ultrasonography of lymph nodes showed that the boundary between the skin and medulla was not clear, so the diagnosis rate of malignant lymph nodes was very high, and it had direct diagnostic value for malignant lymph nodes; when the aspect ratio was ≥ 1, the incidence was very low, but once the ultrasound image indicated, the diagnosis rate of malignant lymph nodes could reach 100%, and both the aspect ratio, transverse diameter and longitudinal diameter were positively correlated with the diagnosis of malignant lymph nodes; ultrasound images suggest that the rela-tionship between the internal echo of lymph nodes and the diagnosis of malignant lymph nodes is uncertain, and the nature of lymph nodes cannot be determined only by the characteristics of in-ternal echo of lymph nodes; the accuracy of routine ultrasound in the diagnosis of superficial ma-lignant lymph nodes is very high, but there will be missed diagnosis. Careful exploration should be conducted in daily examination, and the scope of scan should be increased if necessary.