Fine needle aspiration biopsy: Role in diagnosis of pediatric head and neck masses
Fine needle aspiration biopsy: Role in diagnosis of pediatric head and neck masses
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DOI：
10.1016/j.ijporl.2008.07.009
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发表时间：
2008-10-01
影响因子：
1.5
通讯作者：
Mandell, David L.
中科院分区：
文献类型：
--
作者：
Anne, Samantha;Teot, Lisa A.;Mandell, David L.
目的：评估细针抽吸活检（FNAB）作为儿童颈部肿块诊断工具的可行性和方法。设计：回顾性图表审查。地点：三级保健儿童医院。患者：连续 71 名患有头颈部肿块的儿童接受 FNAB 作为主要诊断方式。干预：FNAB 由儿科细胞病理学家进行和解释。进行快速现场分析，以便立即评估样本充足性并获得初步诊断，然后进行常规细胞学染色。当怀疑恶性肿瘤时，对细胞学标本进行流式细胞术，当细胞学诊断有疑问时，进行开放活检。主要结果指标：技术、儿童 FNAB 的可行性、并发症、细胞病理学诊断、快速现场分析的准确性、后续诊断评估的需要、临床结果和随访。结果：平均年龄为 8.4 岁（S.D. 5.3 岁），平均随访时间为 4.1 个月（标准差 9.6 个月）。 54 例（76%）在全身麻醉下进行 FNAB。没有技术上的并发症。 55例完成现场快速判读，18/55仅确认标本充足，37/55做出初步诊断，34/37例与最终细胞病理学结果相同。总体而言，FNAB 活检显示 64 例良性病变、3 例恶性诊断、2 例滤泡性甲状腺肿瘤和 2 例非诊断标本。 FNAB 是 54 例 (76%) 病例中唯一进行的病理检查。最常见的诊断是反应性淋巴组织增生（n = 39），其次是良性肉芽肿性疾病（n = 8）。对 7 个标本进行了流式细胞术（5 个标本未诊断，2 个恶性肿瘤阴性）。在 15 例手术标本中，3 例的病理诊断与最初的 FNAB 不同。没有一例FNAB漏诊恶性肿瘤，有2例FNAB提示恶性肿瘤，随后开放活检发现良性疾病。结论：细针穿刺活检正在发展成为诊断儿童颈部肿块的可行选择，其主要优点是其微创性，避免了良性持续性淋巴结炎的开放手术。现场快速判读可以成功地用于确认样本的充分性，并为有关家长提供准确的初步诊断。需要考虑的问题包括需要熟悉儿科鉴别诊断的专业儿科细胞病理学家、在许多情况下需要全身麻醉，以及需要开放手术的不准确诊断的可能性。 (C) 2008 Elsevier Ireland Ltd. 保留所有权利。
Objective: To assess the feasibility and rote of fine needle aspiration biopsy (FNAB) as a diagnostic tool in children with neck masses. Design: Retrospective chart review.Setting: Tertiary care children's hospital.Patients: Consecutive series of 71 children with a head and neck mass who underwent FNAB as the primary diagnostic modality.Interventions: FNAB was performed and interpreted by a pediatric cytopathologist. Rapid on-site analysis was performed to allow immediate assessment of specimen adequacy and to attain a preliminary diagnosis, after which routine cytologic staining was performed. Flow cytometry was performed on cytological specimens when malignancy was suspected, and open biopsy was performed when the cytologic diagnosis was in question.Main outcome measures: Technical, feasibility of FNAB in children, complications, cytopathological diagnoses, accuracy of rapid on-site analysis, need for subsequent diagnostic evaluations, clinical outcomes and follow-up.Results: Mean age was 8.4 years (S.D. 5.3 years), with mean follow-up of 4.1 months (S.D. 9.6 months). FNAB was performed under general anesthesia in 54 cases (76%). There were no technical, complications. On-site rapid interpretation was completed in 55 cases, 18/55 confirmed adequacy of specimen only, 37/55 yielded a preliminary diagnosis, and in 34/37 cases, was same as final cytopathologic result. Overall, FNAB biopsy demonstrated 64 benign lesions, 3 malignant diagnoses, 2 follicular thyroid neoplasms, and 2 non-diagnostic specimens. FNAB was the only pathological test performed in 54 (76%) cases. The most common diagnosis was reactive lymphoid hyperplasia (n = 39), followed by benign granulomatous disease (n = 8). Flow cytometry was performed on 7 specimens (non-diagnostic in 5, negative for malignancy in 2). Of the 15 cases with surgical specimens, 3 revealed a pathologic diagnosis different from initial FNAB. There were no cases in which FNAB missed a malignancy, and there were 2 cases where FNAB suggested malignancy, with benign disease subsequently found on open biopsy.Conclusions: Fine needle aspiration biopsy is developing into a feasible option in diagnosing pediatric neck masses, with its main advantage being its minimally-invasive nature and avoidance of an open surgical procedure for benign persistent lymphadenitis. On-site rapid interpretation can be used successfully to confirm specimen adequacy and to give an accurate preliminary diagnosis for concerned parents. Issues to consider include the need for a specialized pediatric cytopathologist familiar with pediatric differential diagnoses, the need for general anesthesia in many cases, and the possibility of inaccurate diagnosis requiring an open procedure. (C) 2008 Elsevier Ireland Ltd. All rights reserved.