運用重點式超音波協助一位淋巴瘤病人之病理診斷

Point-of-Care Ultrasound (PoCUS) for the Pathologic Diagnosis in a Patient with Lymphoma

重點式超音波（point-of-care ultra sound，PoCUS）是一種安全、有效的評估工具，能提供臨床工作者即時的訊息、做出醫療決策。本文個案因高度懷疑肺部腫瘤內包含惡性組織，運用PoCUS評估超音波導引切片的可能性，超音波下可見左側肋膜下區域有一6.28×6.01cm不均質性低回音病灶（heterogeneous hypoechoic lesion），都卜勒（Doppler）模式下腫瘤內部沒有血流增加現象，適用超音波導引切片，最後在胸腔超音波導引下順利完成切片，病理報告為瀰漫性大型B細胞淋巴癌（diffuse large B-cell lymphoma），確定診斷後，病患轉至血液腫瘤科病房進一步接受化學治療。案例中的病患，腫瘤位於肺實質，初步懷疑是肺癌，故安排支氣管鏡切月，一般支氣管鏡切片檢體較小，診斷準確率大約7-8成，然而淋巴瘤的診斷需要檢測許多生物標記，支氣管鏡切片檢體大小常不足以做出最終診斷，因此當臨床上懷疑淋巴瘤時，建議以超音波導引切片或外科手術取得足夠檢體，以完成病理診斷。

Point-of-care Ultrasound (PoCUS) provides timely information to clinicians for medical decision making, and it is a safe and effective tool. Because of a highly suspicious malignancy, the case in this essay received PoCUS to evaluate the feasibility of ultrasound-guided lung tumor biopsy. Sonography revealed a 6.28×6.01cm heterogeneous hypoechoic lesion in the left lateral subpleural area. Absence of intra-tumor blood flow was confirmed by Doppler ultrasound. An ultrasound-guided biopsy was feasible. Then, tissue biopsy was performed under thoracic ultrasound guidance. The pathologic diagnosis was diffuse large B-cell lymphoma. After diagnostic tests were completed, this patient was transferred to the hematology ward for further chemotherapy. This case with lung parenchyma tumor was initially suspected to be lung cancer, and arranged bronchoscopic biopsy first. The sensitivity of bronchoscopic biopsy is approximately 70-80%. However, many biomarkers are necessary for lymphoma diagnosis. The bronchoscopic specimen may not be adequate for a final diagnosis. If the physician suspects lymphoma clinically, ultrasound-guided biopsy or surgical biopsy is suggested to obtain an adequate specimen to complete pathologic diagnosis.