頸部リンパ節に対する穿刺吸引細胞診の正診率

Diagnosis with Fine Needle Aspiration Biopsy for Cervical Lymph Nodes

　はじめに

　穿刺吸引細胞診（fine needle aspiration biop-sy：FNA）は，安全かつ容易に検体の採取が可能な手技として有用であり，頸部腫瘤の早期診断に大いに貢献している。さらに近年は超音波断層装置の進歩とともに，超音波ガイド下のFNAも行われるようになり，FNAはさらに有用なものになった^1,2）。京都府立医科大学耳鼻咽喉科では，平成2年以降，耳鼻咽喉科医自らが超音波検査を施行し，必要症例には超音波ガイド下にFNAを行っている。

　今回，超音波ガイド下，非ガイド下も含めて，頸部リンパ節に対するFNAの正診率を悪性リンパ腫，扁平上皮癌の頸部リンパ節転移，甲状腺癌の頸部リンパ節転移に分けて検討した。

Ultrasonography (US) is a very useful examina-tion to evaluate cervical lymph node swelling in head and neck cancer, and fine needle aspiration biopsy (FNA) often performed under US. In this study, we investigated diagnostic accuracy of FNA in lymph node metastasis of head and neck cancerand malignant lymphoma. FNA was performed with US guiding or US non-guiding. A sensitivity of FNA was correlated with the size of lymph nodes in cervical metastasis of head and neck carcinomas. A sensitivity of lymph node ranged from 10 mm to 20 mm in the maximum diameter was at about 40%, from 20 mm to 30 mm at about 80%. There showed no difference of sensitivity in FNA between metas-tasis of squamous cell carcinoma and papillary carcinoma, while sensitivity of FNA in lymph node of malignant lymphoma was much poor. FNA in the submandibular region was more difficult than other cervical regions because this region was masked by the mandible and submandibular gland.