65例甲状腺癌的临床分析

目的分析术前检查对甲状腺癌的诊断意义及对制定手术方案的指导作用。方法回顾性分析术后病检确诊的65例甲状腺癌病例,探讨术前彩超、细针穿刺细胞学检查、彩超引导下穿刺病检以及术中快速冰冻切片病检对甲状腺癌的诊断意义及制定甲状腺癌手术方案的指导作用。结果 65例患者术前彩超检查发现可疑甲状腺癌42例,可疑淋巴结15例。27例行术前细针穿刺细胞学检查,18例确诊为甲状腺癌。15例行术前彩超引导穿刺病检,13例确诊为甲状腺癌。53例行术中快速冰冻切片检查,除1例漏诊外,均诊断为甲状腺癌。结论彩色超声检查可以对甲状腺癌进行初筛,细针穿刺细胞学检查和彩超引导下穿刺病检具有较高的确诊率,术中快速病检确诊率更高,有助于及时修订手术方案。     

超声下针吸活检术评价颈部肿瘤转移

评价头颈肿瘤颈淋巴转移较理想的指标是超声下细针穿刺活检术。为进一步了解它对颈淋巴结转移诊断的灵敏度、特异度、准确度 ,该作者对 1996年 4月 1日～ 1998年 7月 30日间的 5 6例头颈肿瘤的患者进行了研究。病人通过临床体格检查及影像学检查来筛选得到。这些体检包括检查颈部软组织及血管、唾液腺、甲状腺、肿大淋巴结的大小。如果患者有多个肿大淋巴结 ,则至少在每侧针吸两个淋巴结。所有针吸细胞经过处理制成涂片 ,然后将所有的病人进行选择性或挽救性颈部手术 ,取出标本进行甲醛固定 ,最后将涂片与标本的结论相比较。结果示 :5 6例患…     

头颈部肿瘤针吸细胞学检查与病理组织学检查比较（摘要）

头颈部肿瘤针吸细胞学检查与病理组织学检查比较（摘要）陆地红，张琨龄为了研究针吸细胞学检查（ＦＮＡ）与肿瘤组织病理诊断的差异，对１１７例患者（病理诊断头颈部恶性肿瘤５８例，良性肿瘤５４例，炎症５例）在做病理组织学检查的同时，进行ＦＮＡ检查，就其结果进行...     

喉癌局限性行选择性颈廓清的可行性

喉癌患者大部分死于本后肿瘤复发或转移。因此，喉癌预后的关键因素是颈部有无淋巴结转移。组织学证实有淋巴结转移及局部扩散者在选择性颈廓清术后可行放疗，多数领后不理想，使肿瘤局部或远处转移而未行颈廓清术者其复发率及死亡率则更高。几家医院专家采用并推荐选择性颈廓清治疗无颈部肿块的喉癌以降低复发率。选择性颈廓清主要基于n～IV期很容易发生淋巴结转移。尽管经过仔细检查（如现代影像技术及超声诱导的针吸细胞学技术的开展），本前对淋巴结有无转移的估计有失准确，对手术切除的淋巴结进行组织病理学分析则比较可靠。因此用于…     

原发性颈淋巴结结核的临床特征与治疗

目的：探讨原发性颈部淋巴结结核的临床特征和治疗方法。方法：回顾性分析32例原发性颈部淋巴结结核患者的临床资料。32例患者中29例活检前行CT检查,4例行细针穿刺针吸活检确诊,28例行手术病理检查确诊。27例行肿块全部切除或区域性颈部淋巴结清扫术,术后全身抗结核治疗6个月;5例确诊后行常规抗结核治疗1年。结果：CT显示肿块呈均匀或不均匀强化,部分肿块呈融合现象。全部病例治疗后均行随访,手术患者术后切口均Ⅰ期愈合,1例术后抗结核治疗3个月肿块增大,再次手术确诊为颈部淋巴结结核并发鼻咽癌颈部淋巴结转移,转肿瘤科治疗,其余31例患者均无颈部淋巴结结核复发和其他结核病表现。结论：原发性颈部淋巴结结核临床特征发生改变,颈部肿块为首发症状,多数位于颈后三角区。CT检查有助于本病的诊断和鉴别诊断。全身抗结核药物和手术切除淋巴结的联合应用能有效地治疗原发性颈部淋巴结结核。原发性颈部淋巴结结核的治疗应以手术为主,手术治疗能缩短治疗时间、减少药物用量及不良反应,防止冷脓肿及窦道形成。     

不能扪及的颈部淋巴结:超声检查及超声引导下细针穿刺活检

准确区分颈部淋巴结病变性质和预测其组织病理学结果需在影像学检查引导下进行活俭。超声检查对浅表淋巴结病变敏感，超声引导下外吸活检较CT和MRI等其他影像检查经济实用，操作简便。该文通过回顾性调查评估超声引导下对不能们及的颈部淋巴结进行细针穿刺活俭的价值。70例患者通过超声检查发现引处不能们及的颈部淋巴结病变，其中93％已知原发灶为恶性病变，并有71处病变（78％）接受过颈部放疗和／或手术。当发现淋巴结钙化、囊性变、中心回声区消失、最小轴径≥10mm、最小直径与最大直径之比＞O．4者均在5mHz超声探头引导F用22号细针…     

头颈部恶性肿瘤转移淋巴结用超声引导穿刺活检的临床应用评价

利用自动弹射活检装置在超声引导下对２３例头颈恶性肿瘤颈部淋巴结穿刺活检。以颈淋巴结清扫术或颈淋巴结探查术事对淋巴结检查的病理结果为标准,比较超声引导穿刺活检与临床触诊对淋巴结转移的诊断准确性,超声引导导穿刺活检诊断符合率８６．９６％,较临床触诊６９．５７％高,假阴性率低,无假阳性,两种方法对诊断淋巴结转移的准确指数具有显著性差异。     

咽旁间隙肿瘤(附89例临床分析)

目的总结诊治咽旁间隙肿瘤的经验.方法回顾分析咽旁间隙肿瘤89例.术前为32例患者行针吸活检术,50例行CT检查;全部患者均行手术治疗,经腮腺入路29例,经颈入路45例,经颈-下颌骨外旋入路15例,术后全部标本作病理检查.结果针吸活检32例中27例诊断正确,CT检查50例中46例可准确判断肿瘤的位置;组织学检查良性肿瘤72例(81%),以恶性肿瘤、混合瘤多见37(42%).良性肿瘤术后10例复发(14%),恶性肿瘤12例复发或转移(74%).结论术前针吸活检和CT检查对诊断咽旁肿瘤有意义,经腮腺和经颈部入路是最常用手术进路.     

颈部N_0的正电子发射断层分析

正电子发射断层（ＰＥＴ）是近年被应用于头颈肿瘤分析的功能性影像检查手段。该文报告１４例头颈肿瘤、临床检查未发现淋巴结转移（Ｎ０）的患者的ＰＥＴ分析。皆为男性,年龄４３～７．２岁,８例为口腔肿瘤,３例为口咽部肿瘤,２例为下咽部肿瘤,１例为喉癌。所有患者均先经详细的头颈部检查,确定为颈部Ｎ０期,临床分期为＿Ｉ期１例（行双侧颈廓清术）,Ⅱ期８例（行１３侧颈廓清术）,Ⅱ期２捌（行３侧颈廓清术）,Ⅳ期３例（行６侧颈廓清术）。均行ＰＥＴ检查,９例患者行ＣＴ检查。结果７例患者（１３侧颈廓清术）病理证实有颈淋巴…     

细针抽吸活检对头颈肿瘤的诊断作用

头颈部肿物在诊断上常遇到困难,临床检查、放射线和血液化验等常难作出结论,最后要靠组织学检查,但手术切除活检诸多不便,近年来针吸细胞学检查日益受到重视。作者对头颈部肿块病人52例行细针抽吸细胞学检查,并以手术活检组织学检查对照。检查部位主要是颈部淋巴结,另外尚有涎腺、口咽部、上颌窦、颊部及颈部。细针抽吸系用20ml注射器,装有特制把柄而可单手操作,采用21～23G针头。操作时用一手固定肿块、针头插入肿块后     

Screening for lymph nodes in the neck with ultrasound

In a study of the value of ultrasound in staging patients with head and neck malignancies, we performed ultrasound of the neck. The results of this investigation were compared with palpation. A fine needle aspiration biopsy and/or histologic examination was carried out on lymph nodes which were found. One hundred and six patients were included in this study. In 44 of the patients no lymph nodes could be detected, either on palpation or by ultrasound examination. In the other 62 patients all palpable lymph nodes were also demonstrated by ultrasound. However, in 20 patients with negative palpatory findings, ultrasound revealed lymph nodes: 11 metastases and 9 benign nodes. In 40 patients an ultrasound guided fine needle aspiration biopsy (UGFNAB) was performed. In 85% of these patients a cytological diagnosis could be made. From these results we conclude that ultrasound and UGFNAB are of considerable value in staging head and neck malignancies.     

A 5-year study of patients with neck lymphadenopathy

The purpose of this study was to investigate neck lymphadenopathy patients in our hospital, and to investigate items requiring attention on the occasion of examination of these patients. In this study, 134 patients with neck lymphadenopathy in the five years from April 2005 to March 2010 were included. The kind of diseases, the period of suffering (the period from onset to consultation), relationship with pain, radiological examination, fine needle aspiration cytology and lymph node biopsy findings were examined. Of 134 patients, the disease was inflammatory in 109 patients (81.3%) and malignant in 25 patients (18.7%). The suffering period was longer in the malignant group than in the inflammatory group. Furthermore, the inflammatory group had more patients with neck lymph node pain than the malignant group, and the group with the short suffering period had more patients with neck lymph node pain than that with the long suffering period. Fine needle aspiration cytology was performed in 36 patients (26.9%), and finally, all of the seven patients with class III were diagnosed as having malignant disease. A neck lymph node biopsy was performed in 38 patients (28.4%), and four of 38 patients were diagnosed as having metastatic carcinoma. Two patients in the inflammatory group and two patients in the malignant group took more than 90 days to reach a definite diagnosis. Many kind of diseases cause neck lymphadenopathy, and, therefore, it is important to perform a neck lymph node biopsy immediately, if it is difficult to establish a diagnosis.     

A case of bilateral cervical lymph node metastasis of thyroglossal duct cancer

We reported a case of thyroglossal duct cancer, which metastasized to the bilateral cervical lymph nodes. The cervical lymph node metastases were detected in the upper portion of the neck. According to the results obtained in the preoperative fine needle aspiration cytology, the lymph node metastases were classified as group V and a diagnosis of papillary carcinoma was made. The preoperative studies with 123I revealed no concentration in the submittal tumor. In our surgical procedure, bilateral supraomohyoid neck dissection was added to excision of the tumor. CONCLUSION: In view of the fact that thyroglossal duct cancer metastasized bilaterally to cervical lymph nodes in the present case, we experienced an extremely rare case.     

Ultrasonography guided fine needle aspiration cytology in patients with laryngo-hypopharyngeal lesions

IntroductionLaryngeal lesions are usually evaluated by microlaryngoscopy/direct laryngoscopy under anaesthesia for disease mapping and tissue diagnosis. However patients with anticipated airway compromise due to laryngeal mass may require either a protective tracheotomy or emergency tracheotomy to secure the airway. To minimise risk of unplanned tracheotomy and expedite the diagnosis we performed ultrasound-guided transcutaneous fine needle aspiration cytology.ObjectiveTo evaluate the feasibility and performance of ultrasound-guided transcutaneous fine needle aspiration cytology of suspicious/recurrent laryngo-hypopharyngeal masses.MethodsFine needle aspiration cytology was performed under ultrasound guidance. Twenty- four patients were recruited, of which 17 had a pure laryngeal lesion; 6 patients had laryngo-pharyngeal, and one patient had a base tongue lesion with supra-glottis extension.ResultsOut of 24 patients, 21 had positive cytology for squamous cell carcinoma, 2 patients had non-diagnostic cytology (atypical cells) and the other had inadequate tissue for definitive diagnosis. Patients with negative and inconclusive cytology underwent direct laryngoscopy biopsy, which was positive for squamous malignancy. All patients tolerated the procedure well and no adverse events were noted.ConclusionAlthough direct laryngoscopy remains the standard of care in evaluation of laryngo-hypopharyngeal lesions, this pilot study has shown that ultrasound-guided transcutaneous fine needle aspiration cytology was feasible as an out-patient procedure, employing safe and sensitive technique enabling rapid diagnosis and avoiding the need for direct laryngoscopy under GA for tissue diagnosis.     

Diagnostic procedures for detection of lymph node metastases in cancer of the larynx

Squamous cell carcinoma is the most common malignant neoplasm of the larynx. One of the most important influences on prognosis is the presence of metastases to the cervical lymph nodes. Accurate determination of lymph node involvement is therefore a prerequisite for individualized therapy in patients with squamous cell carcinoma of the larynx. Clinical palpation of the neck is not very accurate and the role of imaging techniques such as ultrasound, ultrasound-guided fine needle aspiration cytology, color Doppler ultrasound, computed tomography, magnetic resonance imaging and positron emission tomography is being applied in order to improve upon the results of clinical investigation alone. According to our investigations and review of the literature, the accuracy of computed tomography scanning (84.9%) and magnetic resonance imaging (85%) was superior to palpation (69.7%) and ultrasound (72.7%). Ultrasound-guided fine needle aspiration cytology showed an accuracy of 89% and was in the same range with positron emission tomography (90.5%).     

What is important for ultrasound evaluation of occult metastatic lymph nodes in laryngeal cancer: size, shape, vascularity or cytological findings?

The assessment of the status of the cervical lymph nodes in patients with a squamous cell carcinoma of the head and neck is still one of the most challenging diagnostic problems. We evaluated ultrasonography criteria with respect to their value for comparative determination of occult metastatic lymph nodes in laryngeal carcinoma. A prospective study was performed in 60 patients with laryngeal squamous cell carcinoma without enlarged neck nodes on CT scan. We used recommended sonography criteria for size, shape and vascularity for distinguishing metastatic and nonmetastatic nodes preoperatively and compared them with cytological and histopathological investigations. Fifty-two of 144 lymph nodes were involved with metastasis on histopathological examination. Respective values for ultrasound-guided fine needle aspiration cytology (USg FNAC) showed high sensitivity, specificity, positive and negative predictive values and accuracy (92, 100, 100, 96, and 97%, respectively). The size, shape and vascularity showed significantly lower values of these statistic parameters. USg FNAC is useful for preoperative evaluation of the neck, as the most reliable, inexpensive and easily available method. It is essential for diagnosis, staging and therapy choices.     

The management of neck metastases in nasopharyngeal cancer

PURPOSE OF REVIEW: The management of cervical lymph node metastases in nasopharyngeal carcinoma is important for a favourable outcome. The strategy of diagnosis and treatment for the lymph nodes on presentation and those that have recurred after initial therapy are different. This review presents the current concept. RECENT FINDINGS: The detection of the cervical lymph node metastases on presentation has improved with magnetic resonance imaging and positron emission tomography. The confirmation of the presence of malignancy is through fine needle aspiration cytology. For those lymph nodes that have recurred after concurrent radiotherapy and chemotherapy, the progression of the nodes detected through clinical examination and imaging studies indicates that salvage therapy is necessary. The surgical procedure of salvage is radical neck dissection, as pathological studies have shown that these lymph nodes exhibit extensive involvement of the neck tissue. Postoperative brachytherapy should be applied when the deep resection margins are close. SUMMARY: Identification of lymph node metastasis provides accurate staging of the disease and radical surgery should be performed for salvage.     

Ultrasonography-guided fine-needle aspiration for the assessment of cervical metastases

OBJECTIVE: To assess the value of ultrasonography (US) combined with fine-needle aspiration (FNA) cytology for the investigation of lymph node metastases in patients with head and neck cancer. DESIGN: Comparison of clinical examination (palpation) and preoperative US-FNA examination results of cervical nodes in a sample of patients with head and neck cancer. The histological features of the neck dissection specimens are used to validate these 2 variables. SETTING: A head and neck oncology service in a tertiary referral hospital. PATIENTS: A consecutive sample of 56 patients with head and neck squamous cell carcinoma, first seen between April 1, 1996, and July 30, 1998, who had neck dissections performed after the US-FNA examination. INTERVENTION: Cervical US-FNA preoperatively, followed by elective or therapeutic radical modified or selective neck dissection. MAIN OUTCOME MEASURES: The histological examination results of subsequent neck dissection specimens are used to determine the sensitivity, specificity, and accuracy of US-FNA for individual nodes. Second, the results of node staging by clinical examination and US-FNA examination are compared. RESULTS: The sensitivity was 89.2%; specificity, 98.1%; and accuracy, 94.5%. Correct node stages were obtained in 52 (93%) of the patients using US-FNA compared with 34 (61%) using palpation. CONCLUSIONS: Ultrasonography combined with FNA is a highly accurate technique for the investigation of cervical lymph node metastases. A more accurate diagnosis may result in more appropriate treatment, particularly in a setting with limited resources. Retropharyngeal nodes, micrometastases, and lymph nodes smaller than 4 mm are limitations of US-FNA. Ultrasonography combined with FNA is a useful technique for the staging of head and neck cancer.     

细胞学检查在≥4cm甲状腺结节中的假阴性率研究

目的 通过比较甲状腺结节(≥4 cm)穿刺后细胞学检查与术后组织病理学检查结果,探讨细针穿刺细胞学(fine-needle aspiration cytology,FNAC)方法检查甲状腺结节(≥4 cm)中的假阴性率,进而指导临床诊断、治疗.方法 选择符合条件甲状腺结节(≥4 cm)患者,先后予FNAC检查及手术切除...     

Strategy of neck dissection in parotid cancer

We conducted definitive surgery on 45 patients with untreated primary parotid cancer from 1975 to 1995, and evaluated methods of neck dissection and results of treatment. All 14 with clinical neck lymph node metastasis underwent ipsilateral radical neck dissection and only 1 developed neck lymph node recurrence at the peripheral dissected site. Of 31 patients without clinical neck lymph node metastasis, 27 of 19 of 36 with high-grade malignancy and 12 of 24 with T3 or T4 did not undergo prophylactic neck dissection and developed latent neck lymph node metastasis in 2 cases (7.4%). Whereas in most cases we achieved good control of the primary site but neck lymph node recurrences occurred, recurrent sites were observed all around the ipsilateral neck and prognosis were very poor if neck dissection was conducted as secondary treatment. Although histopathological diagnosis was considered feasible for predicting occult neck lymph node metastasis, correct diagnostic with fine needle aspiration cytology revealed only 21.8%. Pathological positive lymph nodes in 15 patients who underwent neck dissection were detected all over (level I to V) the ipsilateral neck and the recurrent positive rate at level II was 100%. Based on the above results, we conclude that (1) in cases with neck lymph node metastasis in preoperative evaluation, ipsilateral radical neck dissection is mandated, and (2) in cases without neck lymph node metastasis, prophylactic neck dissection is not usually needed. When pathological results of frozen section from intraoperative jugulodigastric nodal sampling are positive, ipsilateral radical neck dissection is mandated.