Ultrasonographic findings of neck masses and efficacy of fine needle aspiration biopsy cytology
Authors
조희경
Issue Date
1991
Description
의학과/석사
Abstract
[한글]
경부 초음파술은 경부 종괴의 물리적인 성상, 위치 결정 및 잠재성 병변의 확인을 위해 현재 가장 보편적으로 이용되는 영상 진단술이다. 그러나 다른 영상 진단술과 마찬가지로 경부 초음파술은 병변의 조직학적 확진에 대한 정보를 주지 못하므로 감별 진단을 위
해서는 보다 관혈적인 진단술을 필요로 하게 된다. 이들 중 세침흡인생검에 의한 세포학적 진단(Fine needle aspiration biopsy cytology, FNABC)은 합병증이 없고 간편하며, 비교적 정확한 확진이 가능하여 이미 널리 임상에 응용되고 있다.
저자는 1985년 3월 부터 1991년 5월까지 경부의 종괴를 주소로 내원하여 초음파 유도하에 FNABC를 시행 하였던 252예를 대상으로 첫째, 경부 초음파의 소견으로 조직학적 분류를 예측할 수 있는가, 둘째, FNABC에 초음파 유도를 병행함으로써 영상 진단으로서의 초
음파술과 조직학적 진단으로서의 FNABC가 서로의 한계점을 보완할 수 있는가, 세째, FNABC의 진단이 최종 진단을 위해 외과적 생검술을 대치할 수 있는가에 대하여 검토하였으며 그 결과는 다음과 같다.
1. 최종 진단의 조직학적 분류상 악성 병변이 85예, 양성 병변이 167예였으며 악성 병변 중에는 림프선의 전이암이, 양성 병변 중에는 결핵성 림프선염이 가장 많았다.
과 hypoechoic하면서 후방 echo 증강을 가지거나 혼합형의 소견을 보이는 경우는 양성 병변을, hyperechoic한 소견을 보인 경우 악성 병변의 가능성이 많았으며 특히 hypoechoic하면서 후방 echo 증강을 가지는 경우 결핵을, 혼합형인 경우는 농양을 의심할 수 있었다.
necrotizing lymphadenitis(n= 1) mucocele of parotid(n=1), lymphangioma(n=1), and
metastatic ductal cell carcinoma(n=1) had no false diagnosis. Comparing the FNABC
diagnosis with final ones, the positivity of diagnosis was highest in the
unclassified malignancy(n=1,100%) and was lowest in the malignant lymphoma(n=15,
60.0%). In benign lesion, abscess was highest one(n=20, 95.2%) and congenital
anomaly was lowest(n=2, 22, 2%). Ultrasound guided FNABC seems to be simple,
accurate and safe diagnostic modality fur neck masses, so that experienced
technique with improve the diagnostic accuracy of FNABC in diagnosing neck mass.
[영문]
Although ultrasonography(US) is the most popular method for detecting the physical quality of neck masses and occult lesions, as with other imaging modalities, it cannot reveal any histologic finding. For the histologic confirmation of neck masses, variable invasive methods are also necessary. Among them, the fine needle aspiration biopsy cytoplogic diagnosis(FNABC) has been proved
to be a safe, rapid, and accurate diagnostic modality for the differentiation of neck masses. In this prospective study of 252 consecutive ultrasono guided FNABC findings, it was analysed that whether the US findings could predict the histologic classification, whether ultrasonography and FNABC could be supplimented each other and whether the FNABC could be substituted fur any surgical biopsy for the final diagnosis. There were 113 male and 142 female patients and their mean age was 41.9 years. After the detailed US examination of architecture and the presence of satellite nodules of masses, a 22gauge or 24gauge Chiba needle was percutaneously introduced into the mass and was aspirated with 20cc syringe attached wish specially designed aspirator. Specimens were smeared and prepared for cytologic diagnosis : an air-dry specimen stained with Giemsa method, a formalin-fixed specimen stained with Papanicolaou's method. When the tuberculosis is suspicious, the Ziehl-Neelsen stain were added. A preliminary microscopic examination for
adequacy of specimen was performed immediately after the aspiration.
Masses could be divided into five US categories: 1) hypoechoic lesion with posterior enhancement(n=68, 27.0%) 2) hypoechoic lesion without posterior enhancement(n= 130, 51.6%) 3) hyperechoic lesion(n=16, 6.4%) 4) mixed lesion(n=38, 15.1%). A statistical significance was observed in the prediction of benign(hypoechoic with posterior enhancement or mixed lesions) and malignant(hyperechoic lesions) masses (p<0.05, p<0.01) and it was possible for hypoechoic lesion with posterior enhancement as a tuberculous one and for mixed one as an abscess (p<0.01), respectively.
The final diagnosis revealed that there were 85 malignant and 165 benign lesions.
The metastaic lymphadenopathies(76.5%) and tuberculous lymphadenitis(60.5%) were predominant masses in each group. The sensitivity, specificity, accuracy, false negativity, and false positivity of FNABC were 83.5%, 98.8%, 93.7%, 16.5% and 1.2%
respectively. Parathyroid adenova(n=4), hemangioma(n=3), lipoma(n=2), subacute necrotizing lymphadenitis(n= 1) mucocele of parotid(n=1), lymphangioma(n=1), and metastatic ductal cell carcinoma(n=1) had no false diagnosis. Comparing the FNABC
diagnosis with final ones, the positivity of diagnosis was highest in the unclassified malignancy(n=1,100%) and was lowest in the malignant lymphoma(n=15, 60.0%). In benign lesion, abscess was highest one(n=20, 95.2%) and congenital anomaly was lowest(n=2, 22, 2%). Ultrasound guided FNABC seems to be simple,
accurate and safe diagnostic modality fur neck masses, so that experienced technique with improve the diagnostic accuracy of FNABC in diagnosing neck mass.