目的:通过分析细针吸取细胞学检查(fine-needle aspiration cytology, FNAC)在颌面部常见脉管疾病诊断中准确性、特异性,探讨FNAC是否可作为颌面部脉管疾病鉴别诊断的常规方法。方法:采用回顾性研究的方法,对2011年11月至2014年9月在北京大学口腔医院颌面外科激光整形美容门诊就诊的面部肿物患者按照纳入标准和排除标准进行筛选;提取入组病例的关键信息;根据治疗方法分为手术组与非手术组,手术组以手术治疗的术后病理结果为最终诊断依据,非手术组以治疗远期疗效作为最终诊断依据,判断FNAC诊断口腔颌面部脉管疾病准确性。结果:共纳入病例93例,男性51例,女性42例,中位数年龄2.5岁。FNAC诊断脉管疾病结果为阳性的病例67例,其中最终诊断符合脉管疾病63例,不符4例,诊断结果为阴性病例26例,符合脉管疾病5例,不符合脉管疾病21例,对脉管疾病诊断的敏感度为93%,特异度为84%;手术组29例,20例与病理结果相符合(69%), 9例不符。误诊的9例最终病理结果包括脉管畸形3例,神经纤维瘤2例,错构瘤、皮脂腺囊肿、腺淋巴瘤、描述性诊断各1例。非手术组64例,61例与临床诊断符合,3例不符合,不符合病例均为脉管畸形。FNAC结果与最终诊断结果总符合率为86%。结论:FNAC创伤小、结果回报快,对口腔颌面部常见脉管疾病具有辅助诊断的作用,可作为临床筛查手段,具有一定临床应用价值。
Objective:To evaluate the feasibility of fine-needle aspiration cytology (FNAC) in diagnosing vascular abnormality in oral and maxillofacial region. Methods: The method of retrospective study was used. The data from the patients who underwent FNAC from 2011 to 2014 in Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology were collected. All the included patients were divided into surgery group and non-surgery group. The patients in surgery group underwent lesion resection and the postoperative pathological results were gained. The patients in non-surgery group underwent periodical sclerotherapy. The accuracy of FNAC was identified by histopathologic diagnosis in surgery group and the effect of sclerotherapy in non-surgery group. Results: In this study, 93 patients were involved, including 51 males and 42 females. The median age was 2.5 years. Among them, 67 cases were judged as vascular abnormality by FNAC, and 63 cases were in consistent with final diagnosis and 4 cases were not. Among the other 26 cases which were diagnosed as other diseases by FNAC, 5 cases were accorded with final diagnosis. Therefore, the sensitivity of FNAC on diagnosis of vascular abnormity was 93% and its specificity was 84%. Among them, there were 29 cases in the surgery group and 64 cases in the non-surgery group. FNAC results were in consistent with the postoperative pathological results in 20 cases in surgery group (69%), and not consistent with pathological results in 9 cases . The pathological diagnoses included vascular malformations (3 cases), neurofibromas (2 cases), hamartoma (1 case), sebaceous cyst (1 case), adenolymphoma (1 case), and descriptive diagnosis (1 case). In non-surgery group, FNAC results were in consistent with the clinical effect of sclerotherapy in 61 cases (95%). There were 3 misdiagnosed cases. The coincident rate between the result of FNAC and that of pathological or clinical diagnosis was 86%. Conclusion: FNAC is a feasible and minimal invasive method to diagnose vascular abnormality in oral and maxillofacial region.