Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지

Diagnostic effectiveness of fine needle aspiration cytology on pediatric cervical lymphadenopathy

소아 경부 림프절 종대의 세침 흡인 세포검사의 진단적 유용성

  • Byun, Jun Chul (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Choe, Byung Kyu (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Hwang, Jin-Bok (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Kim, Heung Sik (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Lee, Sang Sook (Department of Pathology, Keimyung University School of Medicine)
  • 변준철 (계명대학교 의과대학 소아과학교실) ;
  • 최병규 (계명대학교 의과대학 소아과학교실) ;
  • 황진복 (계명대학교 의과대학 소아과학교실) ;
  • 김흥식 (계명대학교 의과대학 소아과학교실) ;
  • 이상숙 (계명대학교 의과대학 병리학교실)
  • Received : 2005.09.14
  • Accepted : 2005.10.19
  • Published : 2006.02.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : There are few reports in Korean literature on the diagnostic efficacy of fine needle aspiration cytology(FNAC) for pediatric cervical lymphadenopathy. This study examined the diagnostic value of FNAC on cervical lymphadenopathy in children. Methods : Data from 57 pediatric patients(aged 0.3 to 14 years) who underwent FNAC due to cervical lymphadenopathy between January 2001 and March 2005 was reviewed retrospectively. Results : Reactive cervical lymphadenitis was the most common result of the FNAC(52.5 percent). Malignant disease were revealed in 14 percent of all cases. The sensitivity, specificity was 86 percent and 96 percent, respectively. The positive and negative predictive values for malignant disease was 75 percent and 98 percent, respectively. There were two false-positive cases on FNAC; one case of Langerhans cell histiocytosis, and another with infectious mononucleosis. A false-negative case on FNAC was found to be acute lymphocytic leukemia. In seven cases(12 percent), the final diagnosis was confirmed by an open biopsy after the FNAC. There were four FNAC cases where the specimen was not satisfactory for making a diagnosis(7 percent). There were no serious complications of the FNAC procedure. Conclusion : FNAC had a high diagnostic efficacy for evaluating children with cervical lymphadenopathy.

목 적: 소아의 경부 림프절 종대에서 세침 흡인 세포검사의 진단적 가치에 대한 자료를 분석한 보고는 국내에서 알려져 있지 않아, 이에 대한 분석을 보고하는 바이다. 방 법: 2001년에서 2005년까지 계명대학교 동산의료원 소아과에 내원하여 경부 림프절 종대가 있어 세침 흡인 세포검사를 시행하였던 환자 57례를 의무 기록을 통해 후향적으로 분석하였다. 세침 흡인 세포검사의 결과와 임상적 최종 진단 결과를 비교 관찰하였다. 결 과: 대상 환자 57례 중 비특이성 경부 림프절염이 52.5%로 가장 많았다. 악성질환은 모두 8례로 전체의 14.0%를 차지하였다. 세침 흡인 세포검사의 악성질환에 대한 진단적 효용성을 보았을 때 민감도 86%, 특이도 96%, 양성 예측률 75%, 음성예측률 98%였다. 위양성인 예는 랑게르한스 조직구증식증 1례와 전염성 단핵구증 1례이었고, 위음성이었던 예는 급성 림프구성백혈병 1례이었다. 세침 흡인 세포검사 후 개방 생검을 한 경우가 7례가 있었다. 검체가 충분하지 못했던 경우가 4례로 7.0%를 차지하였다. 결 론: 소아의 경부 종대는 양성인 반응성 림프절염에 의한 경우가 대부분이나 악성질환에 의한 것일 수도 있으므로 1차적으로 간편하게 시행할 수 있는 세침 흡인 세포검사를 적극적으로 이용하여야 하고 필요시 개방 생검도 실시하여야 하겠다.

Keywords

References

  1. Leung AK, Robson WL. Cervical lymphadenopathy in children. Can J Pediatr 1991;3:10-7
  2. Kim DW, Jin SY, Lee DW, Lee CS. Diagnostic usefulness of fine needle aspiration cytology of lymphadenopathy - An analysis of 1,216 cases. Korean J Cytopathol 1997;8:11-9
  3. Mobley DL, Wakely PE Jr, Frable MA. Fine-needle aspiration biopsy : Application to pediatric head and neck masses. Laryngoscope 1991;101:469-72
  4. Buchino JJ, Jones VJ. Fine needle aspiration in the evaluation of children with lymphadenopathy. Arch Pediatr Adolesc Med 1994;148:1327-30 https://doi.org/10.1001/archpedi.1994.02170120089017
  5. Tunkel DE, Baroody FM, Sherman ME. Fine-needle aspiration biopsy of cervicofacial masses in children. Arch Otolaryngol Head Neck Surg 1995;121:533-6 https://doi.org/10.1001/archotol.1995.01890050029006
  6. Ramadan HH, Wax MK, Boyd CB. Fine-needle aspiration of head and neck masses in children. Am J Otolaryngol 1997;18:400-4 https://doi.org/10.1016/S0196-0709(97)90061-2
  7. Ponder TB, Smith D, Ramzy I. Lymphadenopathy in children and adolescents : Role of fine-needle aspiration in management. Cancer Detect Prev 2000;24:228-33
  8. Youn YS, Yoon HY, Kim SY, Sul JY, Song CJ, Kim JM, et al. Clinical evaluation of tissue biopsy for children with neck mass; a single center study. J Korean Pediatr Soc 2005;48:839-44
  9. Byun SC, Kim DS. Clinical invstigation of neck masses in children. J Korean Pediatr Soc 1996;39:1429-42
  10. Kim DK, Kim MS, Lim KH, Ryoo KY. The clinicopathological analysis of cervical masses in infants and children. J Korean Pediatr Soc 1988;31:492-99
  11. Lee CO, Park CI, Jung WH, Choi IJ. Clinical and histopathological studies on superficial lymphadenopathy in pediatric ages. J Korean Pediatr Soc 1982;25:560-70
  12. Peters TR, Edwards KM. Cervical lymphadenopathy and adenitis. Pediatr Rev 2000;21:399-404
  13. Kun M. A new instrument for the diagnosis of tumors. Monthly J Med Sci 1847;7:853
  14. Grieg EG, Gray AC. Lymphatic glands in sleeping sickness. Br Med J 1904;1:252
  15. Lee RE, Valatis J, Kalis O, Sophian A, Schultz E. Lymph node examination by fine needle aspiration in patients with known or suspected malignancy. Acta Cytol 1987;31:563-72
  16. El Hag IA, Chiedozi LC, al Reyees FA, Kollur SM. Fine needle aspiration cytology of head and neck masses. Seven years' experience in a secondary care hospital. Acta Cytol 2003;47:387-92 https://doi.org/10.1159/000326538
  17. Jereb B, Us-Krasovec M, Jereb M. Thin needle biopsy of solid tumors in children. Med Pediatr Oncol 1978;4:213-20 https://doi.org/10.1002/mpo.2950040304
  18. Famularo G, Giustiniani MC, Marasco A, Minisola G, Nicotra GC, Simone CD. Kikuchi Fujimoto Lymphadenitis : Case report and literature review. Am J Hematol 2003;74:60-3 https://doi.org/10.1002/ajh.10335
  19. Chao SS, Loh KS, Tan KK, Chong SM. Tuberculous and nontuberculous cervical lymphadenitis : A clinical review. Otolaryngol Head Neck Surg 2002;126:176-9 https://doi.org/10.1067/mhn.2002.121912
  20. Liu ES, Bernstein JM, Sculerati N, Wu HC. Fine needle aspiration biopsy of pediatric head and neck masses. Int J Pediatr Otorhinolaryngol 2001;60:135-40 https://doi.org/10.1016/S0165-5876(01)00522-5