Wen Jiabing,Li Yong,Xiao Yaling,et al.Value of lymph node biopsy in screening children with lymphoma-associated hemophagocytic syndrome[J].Journal of Clinical Pediatric Surgery,2023,22(03):267-271.[doi:10.3760/cma.j.cn101785-202207057-012]
淋巴结活检在儿童淋巴瘤相关噬血细胞综合征筛查中的应用
- Title:
- Value of lymph node biopsy in screening children with lymphoma-associated hemophagocytic syndrome
- 关键词:
- 淋巴结活检; 噬血细胞综合征; 噬血细胞性淋巴组织增多症; 淋巴瘤
- 摘要:
- 目的 探讨淋巴结活检在筛查儿童淋巴瘤相关噬血细胞综合征中的作用。方法 回顾性分析湖南省儿童医院2012年1月1日至2021年12月31日临床诊断为噬血细胞性淋巴组织细胞增多症(hemophagocytic lymphohistiocytosis,HLH)的513例患儿以及808例非HLH但行淋巴结活检的患儿资料,将HLH患儿中行淋巴结活检的患儿纳入活检组(61例),未行淋巴结活检患儿纳入未活检组(452例),行淋巴结活检且结果为阴性的患儿纳入活检阴性组(56例),将808例非HLH患儿常规活检(包括淋巴结活检及其他各种脏器组织活检)确诊的淋巴瘤患儿纳入非HLH淋巴瘤组(73例)。比较HLH患儿与非HLH患儿活检淋巴瘤阳性率的差异,HLH患儿中活检组与未活检组在性别、年龄及病死率上的差异,HLH活检阴性组与非HLH淋巴瘤组在性别、年龄、脏器影像学异常、淋巴结/肿块组织大小上的差异。结果 513例HLH患儿共61例行淋巴结活检,发现合并淋巴瘤5例;808例常规活检患儿发现淋巴瘤73例;HLH活检与常规活检发现淋巴瘤的概率差异无统计学意义(χ2=0.049,P=0.825);HLH患儿活检组与未活检组年龄差异有统计学意义(t=2.024,P=0.043),性别、病死率差异无统计学意义(χ2=0.966,P=0.326;χ2=1.432,P=0.233);HLH患儿活检阴性组与非HLH淋巴瘤组患儿的性别构成差异无统计学意义(χ2=4.490,P=0.503),但年龄构成、影像学异常、活检淋巴结(组织)大小差异均有统计学意义(t=4.297,P＜0.001;χ2=15.486,P＜0.001;Z=8.354,P＜0.001);结论 HLH患儿行手术活检并未明显增加死亡风险,但活检阳性率偏低,应进一步完善活检指征;淋巴结大小及脏器影像学异常在非恶性肿瘤继发的HLH患儿与非HLH淋巴瘤患儿之间存在明显差异,提示二者可作为HLH患儿是否进一步完善淋巴瘤筛查的指征。
- Abstract:
- Objective To explore the value of lymph node biopsy in screening children with lymphoma-associated hemophagocytic syndrome (HPS).Methods From January 1,2012 to December 31,2021,clinical data were retrospectively reviewed for 513 HPS children and 808 children with lymph node biopsy.They were divided into biopsy and non-biopsy groups while lymphoma-negative children with HLH biopsy were classified as biopsy-negative group and those with a diagnosis of lymphoma lymphoma group.The differences were compared in positive biopsy rate of lymphoma between HLH and non-HLH children.And the differences in gender,age and mortality were compared between biopsy and non-biopsy HLH groups.Also the differences in gender,age,organ imaging abnormalities and lymph node/tissue were compared between HLH biopsy-negative and lymphoma groups.Results A total of 61 lymph node/tissue biopsies were performed in 513 HLH children.Five cases of lymphoma were found and 73 cases of lymphoma detected in 808 children with routine biopsy during the same period.The probability of detecting lymphoma in HLH biopsy was no different from conventional biopsy (χ2=0.049,P=0.825); difference in age existed between biopsy and non-biopsy groups (t=2.024,P=0.043).However,no significant difference existed in gender or mortality (χ2=0.966,P=0.326; χ2=1.432,P=0.233); no difference existed in gender composition between children with negative HLH lymph node biopsy and those with confirmed lymphoma.However,differences existed in age composition,imaging abnormalities and size of biopsy lymph nodes (tissues) (χ2=4.49,P=0.503; t=4.297,P<0.001; χ2=15.486,P<0.001; Z=8.354,P<.001).Conclusion Surgical biopsy in HLH children does not significantly elevate the risk of mortality.However,the positive rate of biopsy is low and biopsy indications should be further refined.There were significant differences in lymph node size and organ imaging abnormalities between HLH children secondary to non-malignant tumors and those with diagnosed lymphoma.It hints that the two may be employed as indicators to further improve lymphoma screening in HLH children.
参考文献/References:
[1] 中国抗癌协会淋巴瘤专业委员会.淋巴瘤相关噬血细胞综合征诊治中国专家共识[J].中华医学杂志,2018,98(18):1389-1393.DOI:10.3760/cma.j.issn.0376-2491.2018.18.004. Lymphoma Specialty Committee,China Anti-Cancer Association.Chinese Expert Consensus on Diagnosing&Treating Lymphoma-related Hemophagocytic Syndrome[J].Natl Med J China,2018,98(18):1389-1393.DOI:10.3760/cma.j.issn.0376-2491.2018.18.004.
[2] Lehmberg K,Nichols KE,Henter JI,et al.Consensus recommendations for the diagnosis and management of hemophagocytic lymphohistiocytosis associated with malignancies[J].Haematologica,2015,100(8):997-1004.DOI:10.3324/haematol.2015.123562.
[3] Lehmberg K,Sprekels B,Nichols KE,et al.Malignancy-associated haemophagocytic lymphohistiocytosis in children and adolescents[J].Br J Haematol,2015,170(4):539-549.DOI:10.1111/bjh.13462.
[4] Huang ZZ,Jia YP,Zuo YX,et al.Malignancy-associated hemophagocytic lymphohistiocytosis in children:a 10-year experience of a single pediatric hematology center[J].Hematology,2020,25(1):389-399.DOI:10.1080/16078454.2020.1833505.
[5] Laurent C,Baron M,Amara N,et al.Impact of expert pathologic review of lymphoma diagnosis:study of patients from the French Lymphopath Network[J].J Clin Oncol,2017,35(18):2008-2017.DOI:10.1200/JCO.2016.71.2083.
[6] Assaf N,Nassif S,Tamim H,et al.Diagnosing lymphoproliferative disorders using core needle biopsy versus surgical excisional biopsy:three-year experience of a reference center in Lebanon[J].Clin Lymphoma Myeloma Leuk,2020,20(8):e455-e460.DOI:10.1016/j.clml.2019.11.013.
[7] Ingersoll KF,Zhao Y,Harrison GP,et al.Limited tissue biopsies and hematolymphoid neoplasms[J].Am J Clin Pathol,2019,152(6):782-798.DOI:10.1093/ajcp/aqz107.
[8] Warshavsky A,Rosen R,Perry C,et al.Core needle biopsy for diagnosing lymphoma in cervical lymphadenopathy:meta-analysis[J].Head Neck,2020,42(10):3051-3060.DOI:10.1002/hed.26381.
[9] 吕凡,陈亚青,王立峰,等.超声引导穿刺活检诊断儿童肝脏肿瘤的准确性及安全性研究[J].临床小儿外科杂志,2019,18(1):69-72.DOI:10.3969/j.issn.1671-6353.2019.01.015. Lyu F,Chen YQ,Wang LF,et al.Reliability and safety of ultrasound-guided core needle biopsy in the diagnosis of pediatric hepatoblastoma[J].J Clin Ped Sur,2019,18(1):69-72.DOI:10.3969/j.issn.1671-6353.2019.01.015.
[10] 吕敏,侯良超,林琼琼,等.细针穿刺细胞学检查在门诊诊断儿童颈部肿块的应用价值[J].临床小儿外科杂志,2014,13(1):58-59,70.DOI:10.3969/j.issn.1671-6353.2014.01.017. Lyu M,Hou LC,Lin QQ,et al.Application of fine needle aspiration cytology in outpatient diagnosis of neck masses in children[J].J Clin Ped Sur,2014,13(1):58-59,70.DOI:10.3969/j.issn.1671-6353.2014.01.017.
[11] 黄爽,杨菁,金玲,等.儿童淋巴瘤的误诊分析[J].中国小儿血液与肿瘤杂志,2009,14(6):257-261.DOI:10.3969/j.issn.1673-5323.2009.06.006. Huang S,Yang J,Jin L,et al.Analysis of misdiagnosis in pediatric lymphoma[J].J China Pediatr Blood Cancer,2009,14(6):257-261.DOI:10.3969/j.issn.1673-5323.2009.06.006.
[12] Wang JJ,Wang DJ,Zhang QB,et al.The significance of pre-therapeutic F-18-FDG PET-CT in lymphoma-associated hemophagocytic lymphohistiocytosis when pathological evidence is unavailable[J].J Cancer Res Clin Oncol,2016,142(4):859-871.DOI:10.1007/s00432-015-2094-z.
[13] Wei A,Lu X,Ma HH,et al.18F-FDG PET/CT for identifying the potential primary diseases and predicting prognosis of secondary hemophagocytic lymphohistiocytosis in children[J].Contrast Media Mol Imaging,2022,2022:4849081.DOI:10.1155/2022/4849081.
[14] Tabata C,Tabata R.Possible prediction of underlying lymphoma by high sIL-2R/ferritin ratio in hemophagocytic syndrome[J].Ann Hematol,2012,91(1):63-71.DOI:10.1007/s00277-011-1239-7.
[15] Tsuji T,Hirano T,Yamasaki H,et al.A high sIL-2R/ferritin ratio is a useful marker for the diagnosis of lymphoma-associated hemophagocytic syndrome[J].Ann Hematol,2014,93(5):821-826.DOI:10.1007/s00277-013-1925-8.
[16] Li WP,Zhong Y,Shuang YR,et al.High concentration of miR-133 is a useful marker for the diagnosis of lymphoma-associated hemophagocytic syndrome[J].Cancer Biomark,2017,20(2):159-164.DOI:10.3233/CBM-170054.
备注/Memo
收稿日期:2022-7-29。
基金项目:2020年度湖南省临床医疗技术创新引导项目(2020SK50501)
通讯作者:李勇,Email:liyongpuwaike@163.com