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Is invaziv attempt the only option for the differentation of malign and benign lenfadenopaty ?

Yıl 2012, Cilt: 3 Sayı: 1, 1 - 9, 31.07.2012

Öz

Aim: The aim of the study is to evaluate efficacy of B mod US and colour dopler US on the seperator diaognosis of benign and malign servikal lymph nods by comparing İİAB results, and display the fact that whether colour doppler US has a great positive effect upon the diagnosis value of B mod US analysis when they are combined.

Material and Method: 37 patients were included into the study. B mod US and colour doppler US were practiced onto all the facts. The analysis was done with SDU2200 shimadzu Tokyo Japan colored doppler device by having the usage of 7.5 mhz lineer transduser. The biggest servikal lymph nod was added to study. The efficiency of B mod US and colour doppler US facts was rated in the values of sensibility, specifity, positive and negative provisions by taking the basis of hispatologic results.

Findings: In the fact that when the 37 patients that were taken up into the study, were evaluated with one of the B mod US and colour doppler US or with both of them, the lymph nods that take malign diagnosis are thought as malign, according to both investigations, when lymph nods that take benign diagnosis are assumed as benign, they are thought as 16 lymph nods malign and 21 lymph nods benign.

Conclusion: When rounded shape define for B mod US with malignancy, longitunidal/transvers diameter percentage, loss of hiler ekojenite, contour lobulation and lymph nods whose nekroz existence criterias are positive as at least two of those, are assumed as malign, the rates of sensitivite and spesifty are clearly high. In addition to these findings, it is thought that vaskuler patern and spectral wave analysis that is looked up into the benign and malign lymph nods, redoubles the rates of sensitivity and specifity and it is also thought that it decreases the number of false negative facts noticeably.

Kaynakça

  • Ahuja A, Ying M. An overview of neck node sonography. Invest Radiol 2002; 37:333-42.
  • Vassallo P, Edel G, Roos N, Naguib A, Peters PE. In-vitro high-resolution ultrasono graphy of benign and malignant lymph nodes. A sonographic- pathologic correlation. Invest Radiol 1993; 28:698-705.
  • Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. Am J Roentgenol 1992;158:961-9
  • Luigi Solbiati, Giorgio Rizzatto. Ultrasound of Superficial Structures. Edinburgh, Churchill Livingstone 1995; 517-29
  • Van den Brekel MW, Castelijns JA, Stel HV, Luth WJ, Valk J, van der Waal I, et al. Occult metastatic neck disease: detection with US and US-guided fine–needle aspiration cytology. Radiology 1997;180:457-61
  • Adibelli ZH, Unal G, Gül E, Uslu F, Koçak U, Abali Y. Differentiation of benign and malignat cervikal lymph nodes:Value of B mode and color doppler sonography. Eur J Radiol 1998;28:230-4
  • Ahuja A, Ying M, King W, Metreweli C. A practical approach to ultrasound of cervical Iymph nodes. J Laryngol Otol 1997;111:245-56
  • Rubaltelli L, Prota E, Salmaso R, Bortoletto P, Candiani F, Cagol P. Sonography of abnormal lymph nodes in vitro: correlation of sonographic and histologic findings. Am J Roentgenol 1990;155(6):1241-4
  • Evans RM, Ahuja A, Metreweli C. The linear echogenic hilus in cervical lymphadenopathy-a sign of benignity or malignancy?. Clin Radiol 1993;47(4):262-4
  • Mountford RA, Atkinson P. Doppler ultrasound examination of pathologically enlarged lymph nodes. Br J Radiol 1979;52(618):464-7
  • Swischuk LE, Desai PB, John SD. Exuberant blood flow in enlarged lymph nodes: findings on color flow Doppler. Pediatr Radiol 1992;22(6):419-21
  • Ahuja AT, Ying M, Ho SS, Metreweli C. Distribution of intranodal vessels in differentiating benign from metastatic neck nodes. Clin Radiol 2001;56:197-201
  • Wu CH, Hsu MM, Chang YL, Hsieh FJ. Vascular pathology of malignant cervical Iymphadenopathy: qualitative and quantitative assessment with power Doppler ultrasound. Cancer 1998;83:1189-96
  • Steinkamp HJ, Mueffelmann M, Böck JC, Thiel T, Kenzel P, Felix R. Differential diagnosis of Iymph node lesions: a semiquantitative approach with colour Doppler ultrasound. Br J Radiol 1998;71:828-33
  • Vassallo P, Wernecke K, Roos N, Peters PE. Differentiation of benign from malignant superficial Iymphadenopathy: the role of high - resolution US. Radiology 1992;183:215-20
  • Wu CH, Chang YL, Hsu WC, Ko JY, Sheen TS, Hsieh FJ. Usefulness of Doppler spectral analysis and power Doppler sonography in the differentiation of cervieal Iymphadenopathies. AJR Am J Roentgenol 1998;171:503-9
  • Cosgrove DO, Bamber JC, Davey JB, McKinna JA, Sinnett HD. Color Doppler signals from breast tumors.Work in progress. Radiology 1990;176:175-80
  • Na DG, Lim HK, Byun HS, Kim HD, Ko YH, Baek JH. Differantial diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. Am J Roentgenol 1997;168:1311-6
  • Tschammler A, Gunzer U, Reinhart E, Höhmann D, Feller AC, Müller W, et al. The diagnostic assessment of enlarged Iymph nodes by qualitative and semiquantitative evaluation of Iymph nede perfusion with color-coded duplex sonography. Fortschr Roentgebstr 1991;154:414-8
  • Chang DB, Yuan A, Yu CI, Luh KT, Kuo SH, Yang PC. Differentiation of benign and malignant cervical lymph nodes with color Doppler sonography. Am J Roentgenol 1994;162(4):965-8
  • Ying M, Ahuja A, Brook F, Metreweli C. Power Doppler sonography of normal cerviealIymph nodes. J Ultrasound Med 2000;19:511-7
  • Steinkamp HJ, Knöbber D, Schedel H, Mäurer J, Felix R. Recurrent cervical lymph- adenopathy: Differential diagnosis with color- duplex sonography. Eur Arch Otorhinolaryngol 1994;251:404-9

Malign ve Benign Lenfadenopati ayrımında invaziv girişim tek seçenek mi?

Yıl 2012, Cilt: 3 Sayı: 1, 1 - 9, 31.07.2012

Öz

Amaç: Çalışmanın amacı benign ve malign servikal lenf nodlarının ayırıcı tanısında B mod US ve renkli doppler US bulgularının etkinliğini İİAB sonuçları ile karşılaştırarak değerlendirmek, kombine edildiklerinde renkli doppler US'nin B mod US incelemenin tanı değerine katkısı olup olmadığı ortaya koymaktır.
Gereç Yöntem: Çalışmaya 37 hasta dahil edildi. Tüm olgulara B-mod US ve renkli doppler US incelemeleri uygulandı. İnceleme SDU2200, Shimadzu, Tokyo, Japan renkli doppler cihazıyla 7.5 MHz'lik lineer transdüser prob kullanılarak yapıldı. Çalışmaya en büyük servikal lenf nodu dahil edildi. Histopatolojik sonuçlar temel alınarak B mod US ve renkli doppler US bulgularının etkinliği duyarlılık, özgüllük, pozitif ve negatif öngörü değerleri şeklinde hesaplandı.
Bulgular: Çalışmaya dahil edilen 37 olgunun B mod US ve renkli doppler US'den herhangi birisi ile ya da her ikisi birlikte değerlendirilmesinde; malign tanı almış lenf nodları malign, her iki incelemeye göre benign tanı alan lenf nodları benign kabul edildiğinde 16 lenf nodu malign, 21 lenf nodu benign olarak düşünülmüştür.
Sonuç: B mod US ile malignite için tanımlanan yuvarlak şekil, longitudinal/transvers çap oranı, hiler ekojenite kaybı, kontur lobülasyonu ve nekroz varlığı kriterlerinden en az ikisi pozitif olan lenf nodları malign kabul edildiğinde sensitivite ve spesifite oranları belirgin yüksek olup, bu bulgulara ek olarak benign ve malign lenf nodlarında bakılan vasküler patern ve spektral dalga analizinin sensitivite ve spesifite oranlarını arttırdığı ve yalancı negatif olgu sayısını belirgin şekilde azalttığı düşünülmüştür. 

Kaynakça

  • Ahuja A, Ying M. An overview of neck node sonography. Invest Radiol 2002; 37:333-42.
  • Vassallo P, Edel G, Roos N, Naguib A, Peters PE. In-vitro high-resolution ultrasono graphy of benign and malignant lymph nodes. A sonographic- pathologic correlation. Invest Radiol 1993; 28:698-705.
  • Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. Am J Roentgenol 1992;158:961-9
  • Luigi Solbiati, Giorgio Rizzatto. Ultrasound of Superficial Structures. Edinburgh, Churchill Livingstone 1995; 517-29
  • Van den Brekel MW, Castelijns JA, Stel HV, Luth WJ, Valk J, van der Waal I, et al. Occult metastatic neck disease: detection with US and US-guided fine–needle aspiration cytology. Radiology 1997;180:457-61
  • Adibelli ZH, Unal G, Gül E, Uslu F, Koçak U, Abali Y. Differentiation of benign and malignat cervikal lymph nodes:Value of B mode and color doppler sonography. Eur J Radiol 1998;28:230-4
  • Ahuja A, Ying M, King W, Metreweli C. A practical approach to ultrasound of cervical Iymph nodes. J Laryngol Otol 1997;111:245-56
  • Rubaltelli L, Prota E, Salmaso R, Bortoletto P, Candiani F, Cagol P. Sonography of abnormal lymph nodes in vitro: correlation of sonographic and histologic findings. Am J Roentgenol 1990;155(6):1241-4
  • Evans RM, Ahuja A, Metreweli C. The linear echogenic hilus in cervical lymphadenopathy-a sign of benignity or malignancy?. Clin Radiol 1993;47(4):262-4
  • Mountford RA, Atkinson P. Doppler ultrasound examination of pathologically enlarged lymph nodes. Br J Radiol 1979;52(618):464-7
  • Swischuk LE, Desai PB, John SD. Exuberant blood flow in enlarged lymph nodes: findings on color flow Doppler. Pediatr Radiol 1992;22(6):419-21
  • Ahuja AT, Ying M, Ho SS, Metreweli C. Distribution of intranodal vessels in differentiating benign from metastatic neck nodes. Clin Radiol 2001;56:197-201
  • Wu CH, Hsu MM, Chang YL, Hsieh FJ. Vascular pathology of malignant cervical Iymphadenopathy: qualitative and quantitative assessment with power Doppler ultrasound. Cancer 1998;83:1189-96
  • Steinkamp HJ, Mueffelmann M, Böck JC, Thiel T, Kenzel P, Felix R. Differential diagnosis of Iymph node lesions: a semiquantitative approach with colour Doppler ultrasound. Br J Radiol 1998;71:828-33
  • Vassallo P, Wernecke K, Roos N, Peters PE. Differentiation of benign from malignant superficial Iymphadenopathy: the role of high - resolution US. Radiology 1992;183:215-20
  • Wu CH, Chang YL, Hsu WC, Ko JY, Sheen TS, Hsieh FJ. Usefulness of Doppler spectral analysis and power Doppler sonography in the differentiation of cervieal Iymphadenopathies. AJR Am J Roentgenol 1998;171:503-9
  • Cosgrove DO, Bamber JC, Davey JB, McKinna JA, Sinnett HD. Color Doppler signals from breast tumors.Work in progress. Radiology 1990;176:175-80
  • Na DG, Lim HK, Byun HS, Kim HD, Ko YH, Baek JH. Differantial diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. Am J Roentgenol 1997;168:1311-6
  • Tschammler A, Gunzer U, Reinhart E, Höhmann D, Feller AC, Müller W, et al. The diagnostic assessment of enlarged Iymph nodes by qualitative and semiquantitative evaluation of Iymph nede perfusion with color-coded duplex sonography. Fortschr Roentgebstr 1991;154:414-8
  • Chang DB, Yuan A, Yu CI, Luh KT, Kuo SH, Yang PC. Differentiation of benign and malignant cervical lymph nodes with color Doppler sonography. Am J Roentgenol 1994;162(4):965-8
  • Ying M, Ahuja A, Brook F, Metreweli C. Power Doppler sonography of normal cerviealIymph nodes. J Ultrasound Med 2000;19:511-7
  • Steinkamp HJ, Knöbber D, Schedel H, Mäurer J, Felix R. Recurrent cervical lymph- adenopathy: Differential diagnosis with color- duplex sonography. Eur Arch Otorhinolaryngol 1994;251:404-9
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Ömer Yılmaz

Zeynep Balta Bu kişi benim

Sevide Tunçbilek Bu kişi benim

Uğur Koşar Bu kişi benim

Yayımlanma Tarihi 31 Temmuz 2012
Gönderilme Tarihi 6 Şubat 2012
Yayımlandığı Sayı Yıl 2012 Cilt: 3 Sayı: 1

Kaynak Göster

Vancouver Yılmaz Ö, Balta Z, Tunçbilek S, Koşar U. Malign ve Benign Lenfadenopati ayrımında invaziv girişim tek seçenek mi?. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2012;3(1):1-9.

SDÜ Sağlık Bilimleri Dergisi, makalenin gönderilmesi ve yayınlanması dahil olmak üzere hiçbir aşamada herhangi bir ücret talep etmemektedir. Dergimiz, bilimsel araştırmaları okuyucuya ücretsiz sunmanın bilginin küresel paylaşımını artıracağı ilkesini benimseyerek, içeriğine anında açık erişim sağlamaktadır.