协和医学杂志

2014, (1)

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超声引导穿刺活检对原发性甲状腺淋巴瘤的诊断价值
Role of Ultrasound-Guided Fine Needle Aspiration and Core Biopsy in Primary Thyroid Lymphoma

朱庆莉;姜玉新;李文波;王铭;夏宇

摘要(Abstract):

目的  探讨原发性甲状腺淋巴瘤(primary thyroid lymphoma, PTL)的超声特征及超声引导甲状腺活检的诊断价值。方法  回顾性分析2003年至2013年北京协和医院22例经病理证实的PTL患者的临床资料(年龄32~81岁,中位年龄61岁)、超声声像图表现及活检方式,将PTL超声表现分为3型,即弥漫型、结节型和混合型。结果  22例PTL患者的主要病理类型为黏膜相关淋巴组织B细胞淋巴瘤(45.5%,10/22)和弥漫性大B细胞淋巴瘤(36.4%,8/22)。16例PTL患者(72.7%)首发症状为颈部肿物近期明显增大。22例PTL患者中16例(72.7%)超声诊断为恶性或可疑恶性,6例(27.3%)超声诊断为良性。10例行超声引导细针抽吸活检,其中仅2例诊断可疑PTL;9例行超声引导组织活检,其中8例获得明确病理诊断。15例PTL患者接受外科手术活检,获得病理诊断。PTL超声声像图特征分为弥漫型(45.5%,10/22)、结节型(40.9%,9/22)和混合型(13.6%, 3/22)。结论  超声声像图特征有助于PTL诊断,尤其是对有近期颈部肿物迅速增大病史的患者。超声引导组织活检安全、准确,是诊断PTL的首选方法。
Objective  To explore the sonographic findings of primary thyroid lymphoma (PTL) and evaluate the role of ultrasound-guided core-needle biopsy in diagnosing this disease. Methods  The clinical data, sonographic, and biopsy modes of 22 patients (age range, 32 - 81 years; median, 61 years) with pathologically confirmed PTL were retrospectively analyzed. The sonographic findings of PTL were divided into three types: diffuse type, nodular type, and mixed type. Results  The main pathologic types of PLT in these 22 patients included mucosa-associated lymphoid tissue lymphoma (n=10, 45.5%) and diffuse large B-cell lymphoma (n=8, 36.4%). In 16 patients (72.7%), the initial symptom was enlarged neck mass. Among the 22 patients with a diagnosis of PTL, 16 (72.7%) were sonographically diagnosed as malignancies or suspected malignancies and 6 (27.3%) as benign lesions. In 10 patients who had received ultrasound-guided fine-needle aspiration biopsy, only 2 were diagnosed as suspected malignancies. In 9 patients who had received ultrasound-guided core-needle biopsy, 8 (88.9%) achieved definitive pathological diagnoses. In 15 patients who had undergone surgical biopsy, pathological diagnoses were obtained in all of them. The distribution of the sonographic findings of PTL was asfollows: diffuse type, n=10 (45.5%); nodular type, n=9 (40.9%); and mixed types, n=3(13.6%). Conclusions  Ultrasonography is helpful for PTL diagnosis, especially in patients with rapid thyroid enlargement. Ultrasound-guided core-needle biopsy is safe and accurate, and therefore remains a preferred method for diagnosing thyroid lymphoma.

关键词(KeyWords): |淋巴瘤|甲状腺肿瘤|甲状腺活检|超声引导|
|lymphoma| thyroid neoplasm| thyroid biopsy| ultrasound guidance|

Abstract:

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基金项目(Foundation): 甲状腺结节超声诊断及遗传学标记研究

作者(Author): 朱庆莉;姜玉新;李文波;王铭;夏宇

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