影响CT引导下胸膜病变同轴活检诊断准确率及相关并发症的因素分析

目的探讨影响CT引导下同轴活检诊断胸膜恶性病变的准确率和相关并发症的因素。方法分析88例接受CT引导下胸膜病变穿刺活检的病例资料,最终诊断结果依据病理诊断或临床随访。采用单因素及多因素分析CT引导下影响穿刺活检诊断胸膜恶性病变的准确率及相关并发症发生的主要因素。结果 88例患者中CT引导下同轴活检诊断胸膜恶性病变56例,良性病变28,性质待定4例;其诊断胸膜恶性病变的准确率、敏感度、特异度分别为89.29%(75/84)、86.15%(56/65)、100%(19/19)。穿刺活检过程中发生气胸14例,单因素分析提示无影响CT引导下胸膜病变同轴活检诊断准确率的相关因素;多因素分析提示穿刺部位病变大小/胸膜厚度是气胸发生的危险因素(OR:8.744),而胸腔积液是气胸发生的保护因素(OR:0.171)。结论 CT引导下胸膜病变同轴活检是相对安全的技术并且诊断准确率较高,值得临床推广应用。     

CD147 检测对细针穿刺细胞学可疑恶性的甲状腺结节的诊断价值

目的：探讨CD147检测在细针穿刺活检未能明确细胞学诊断的甲状腺结节中的临床应用价值。 方法：选择2013年10月—12月收治的甲状腺结节患者，对术后手术标本进行细针穿刺涂片，用Bethesda甲状腺细胞学报告系统评价腺细胞病理学，选择36例“可疑恶性肿瘤”标本行免疫组化CD147染色分析。CD147阳性者作恶性诊断，结果与手术后石蜡病理结果比较。 结果：CD147检测诊断良性病变19例（52.78%），恶性病变17例（47.22%），术后病理检查诊断良性病变16例（44.44%），恶性病变20例（55.56%）；甲状腺恶性标本中CD147的阳性表达率明显高于良性标本（P<0.05）。CD147的表达与甲状腺结节是否钙化（CD147阳性率89.47%）及淋巴转移（CD147阳性率100%）有关（P<0.05）。细针穿刺细胞学联合CD147免疫组化染色鉴别甲状腺结节良、恶性的准确性和敏感度分别为91.67%和85.0%。 结论：CD147可以作为甲状腺肿瘤细胞学诊断分子生物学标志物，细针穿刺细胞学联合CD147免疫组化分析，有助于提高甲状腺癌的术前检出率。     

执笔式持续负压穿刺器在肺占位穿刺活检术中的应用

目的探讨持续负压穿刺器在肺占位穿刺活检术中的应用价值。方法对26例肺占位性病变采用分体式切割活检枪与友谊式持续负压细针穿刺器连接穿刺——改良穿刺活检法取样（改良组）,并与传统活检枪穿刺方法（传统组）26例进行对照。结果改良组恶性病变诊断准确率为95．24％（20／21）,良性病变诊断准确率为100．00％（5／5）,改良组总诊断准确率为96．15％（25／26）。传统组恶性病变诊断准确率为85．71％（18／21）,良性病变诊断准确率为60．00％（3／5）,总诊断准确率为80．77％（21／26）。改良组穿刺活检次针（改良法）与首针（常规法）诊断准确率差异有统计学意义（P〈0．05）。结论持续负压细针穿刺器用于肺穿刺活检,能获得满意的组织学及细胞学标本．具有一针两用的优点．提高了肺占位病变的穿刺活检诊断准确率．方法简单．值得临床推广府用。     

超声造影联合穿刺活检在肺周围型病变定性诊断中的应用

目的探讨CEUS联合穿刺活检在肺周围型病变定性诊断中的应用价值。方法对158例肺周围型病变患者行经皮穿刺活检术,其中97例术前行CEUS检查(试验组),61例术前仅行常规超声检查(对照组)。比较两组穿刺次数、诊断阳性率及并发症情况。绘制CEUS时间-强度曲线(TIC),比较试验组中良性与恶性病变TIC的上升时间(RT)、达峰时间(TTP)、曲线上升斜率(WIS)及峰值强度(PI)。观察并记录良恶性病变的增强特征。结果试验组和对照组穿刺病理诊断阳性率分别为94.85%(92/97)和83.61%(51/61),差异有统计学意义(P=0.02);平均穿刺次数分别为(2.11±0.48)次和(2.20±0.44)次,两组间差异无统计学意义(P=0.18);并发症发生率分别为2.06%(2/97)和4.92%(3/61),差异无统计学意义(P=0.32)。RT、WIS及PI在良恶性病变间差异有统计学意义(P均0.05),TTP差异无统计学意义(P=0.08)。试验组良恶性病变均以不均匀增强为主,良性病变中占77.50%(31/40),恶性病变中占88.46%(46/52),其增强特征差异无统计学意义(P=0.16)。结论 CEUS在肺周围型病变的定性诊断中具有一定价值,对经皮肺穿刺活检具有指导意义。     

同轴半自动活检枪在肺小结节穿刺活检中的应用

目的探讨同轴半自动活检枪在肺小结节穿刺活检中的应用价值。方法回顾性分析我院因肺部小结节行CT引导穿刺活检的40例患者资料,以术后病理或影像随访结果为金标准,计算穿刺活检诊断恶性肺小结节的敏感度、特异度和准确率,并分析术中手术相关并发症及穿刺技巧。结果所有患者均完成手术操作,术后病理或影像随访最终诊断为恶性病变29例、良性病变11例。穿刺活检诊断恶性肺小结节的敏感度为89.65%(26/29)、特异度为100%(11/11)、准确率为92.50%(37/40)。手术相关并发症主要为气胸和局部出血。结论采用同轴半自动活检枪对肺小结节患者行穿刺活检,具有较高的准确率、特异度及敏感度,是一种安全有效的诊断方法。     

经会阴前列腺24针饱和穿刺活检与14针活检在PSA＜20μg/L患者中筛检前列腺癌的对比性研究

目的:探讨超声引导下经会阴前列腺24针饱和穿刺活检与14针穿刺活检方案对PSA<20μg/L可疑前列腺癌患者的筛检阳性率及其相关并发症。方法:选取116例可疑前列腺癌患者行经会阴超声引导下14针穿刺活检(14针组),另136例患者,行经会阴24针饱和前列腺穿刺活检(24针饱和组),比较两组前列腺癌筛检阳性率、标本阳性率及穿刺后肉眼血尿、泌尿系感染、尿潴留等并发症的发生率。结果:两组患者平均年龄、穿刺前PSA水平、平均前列腺体积等指标均无统计学差异(P>0.05)。24针饱和组及14针组前列腺癌筛检总体阳性率分别为48.53%和17.24%,存在显著性差异(P<0.001),标本阳性率分别为8.09%和2.83%(P=0.012);其中24针饱和组前列腺尖部肿瘤的检出率(11.76%)显著高于14针组(1.72%,P<0.05)。两组穿刺后尿潴留、泌尿系感染和肉眼血尿等发生率均无统计学差异(P>0.05)。结论:24针经会阴前列腺饱和穿刺活检方法显著提高PSA<20μg/L患者中前列腺癌的筛检阳性率,尤其是增加了前列腺尖部区域的肿瘤筛检阳性率,而并未增加相关并发症。     

超声定位穿刺活检诊断肺周围型占位性病变的临床应用价值

目的分析超声定位穿刺活检在肺周围型占位性病变中的应用价值。方法对105例胸部超声诊断为肺周围型占位性病变的患者,使用超声定位穿刺活检取标本行病理学检查。与术后病理结果比较,记录穿刺活检成功率、诊断正确率、良恶性肿瘤率、良恶性肿瘤最大直径和超声定位活检术后并发症发生率。结果本组100例(95.24%)穿刺活检成功并获取到满意标本。其中恶性病变为68例(68.00%),良性病变32例(32.00%)。与术后病理结果比较,诊断正确率为96.00%。术后并发症率为5.71%。结论超声定位穿刺活检诊断肺周围型占位性病变,具有创伤小、确诊率高、安全、操作简便、并发症少等优点。     

经直肠实时弹性成像引导靶向穿刺在前列腺病变的应用价值研究

目的本研究主要探讨经直肠实时弹性成像(TRTE)引导靶向穿刺在前列腺病变中的应用价值。方法对符合纳入标准的112例可疑前列腺癌患者进行经直肠前列腺超声检查,在TRTE引导下对可疑病灶进行2针靶向穿刺活检及超声引导下传统12针系统穿刺活检。分析TRTE对前列腺良恶性病变诊断效能及比较TRTE引导下靶向穿刺与系统穿刺诊断的准确性。结果本研究112例患者中,TRTE共诊断前列腺癌54例,良性病变58例,最终病理确诊前列腺癌42例,良性病变70例,诊断的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为88.1%、75.7%、80.3%、0.68、0.91。TRTE引导靶向穿刺诊断前列腺癌针数84针,阳性率37.5%(84/224),系统穿刺诊断前列腺癌针数313针,阳性率23.3%(313/1344),二者具有统计学差异,χ~2=4.08,P0.05。同时行靶向加系统穿刺诊断前列腺癌针数397针,阳性率25.3%(397/1568)。结论 TRTE在前列腺病变诊断中具有较高的灵敏度、特异度、准确度。利用TRTE引导靶向穿刺诊断Pca拥有比系统穿刺更高的准确性,但就目前来讲TRTE引导靶向穿刺尚无法完全取代系统穿刺法,而两者相结合是减少前列腺癌穿刺假阴性率的主要方案。     

经直肠实时弹性成像引导靶向穿刺在前列腺病变的应用价值研究

［摘要］ 目的 本研究主要探讨经直肠实时弹性成像（TRTE）引导靶向穿刺在前列腺病变中的应用价值。方法 对符合纳入标准的112例可疑前列腺癌患者进行经直肠前列腺超声检查,在TRTE引导下对可疑病灶进行2针靶向穿刺活检及超声引导下传统12针系统穿刺活检。分析TRTE对前列腺良恶性病变诊断效能及比较TRTE引导下靶向穿刺与系统穿刺诊断的准确性。结果 本研究112例患者中,TRTE共诊断前列腺癌54例,良性病变58例,最终病理确诊前列腺癌42例,良性病变70例,诊断的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为88.1%、75.7%、80.3%、0.68、0.91。TRTE引导靶向穿刺诊断前列腺癌针数84针,阳性率37.5%（84/224）,系统穿刺诊断前列腺癌针数313针,阳性率23.3%（313/1344）,二者具有统计学差异,χ2=4.08,P<0.05。同时行靶向加系统穿刺诊断前列腺癌针数397针,阳性率25.3%（397/1568）。结论 TRTE在前列腺病变诊断中具有较高的灵敏度、特异度、准确度。利用TRTE引导靶向穿刺诊断Pca拥有比系统穿刺更高的准确性,但就目前来讲TRTE引导靶向穿刺尚无法完全取代系统穿刺法,而两者相结合是减少前列腺癌穿刺假阴性率的主要方案。     

彩色多普勒超声引导下粗针穿刺活检在涎腺肿块中的应用

目的分析彩色多普勒超声引导下粗针穿刺活检在涎腺肿块中的诊断价值。方法回顾性分析56例涎腺肿块经彩色多普勒超声引导下粗针穿刺活检资料。活检病理诊断结果如果为恶性可定为真阳性;如果为良性或未见恶性,结合其他影像学检查并临床随访6个月以上最终确定诊断。计算穿刺活检的成功率、敏感度和特异度,并比较涎腺良、恶性肿块穿刺前的彩色多普勒超声表现。结果彩色多普勒引导下粗针穿刺活检的56例涎腺肿块,穿刺次数1~3次。确诊良性病灶32例,恶性肿瘤23例;1例穿刺病理诊断不明确,后经切除活检确诊为B细胞淋巴瘤。穿刺成功率、敏感度、特异度和假阴性率分别为98.21%(55/56)、95.83%(23/24)、100%(32/32)、4.17%(1/24)。无严重并发症发生。56例良恶性涎腺肿块彩色多普勒超声表现中,肿块的边界、形态、回声均匀性、包膜完整性和血流分级差异均有统计学意义(P均0.05)。结论彩超引导下粗针穿刺活检具有安全、准确、并发症少的优点,可避免不必要的手术,对涎腺病变的诊断有重要作用。     

Mediastinal tumours. A report of 129 cases

Primary mediastinal tumour or cyst was surgically treated in 129 patients (including 19 younger than 12 years) during a 16-year period. All histologic specimens and smears from fine-needle aspiration biopsy were reviewed. Intrathoracic goitre, neurogenic lesions and thymomas comprised 62% of all the tumours. Fifty lesions (39%) were found at routine radiographic examination and were asymptomatic. Eight of these 50 lesions were malignant. Chest pain, fatigue, weight loss and fever were significantly more common in malignant than in benign disease. Despite extensive investigations, the diagnosis was not established preoperatively in 32% of the cases. Chest radiography, CT-scanning and fine-needle aspiration biopsy usually provide satisfactory diagnostic information, thereby substantially reducing the need for other preoperative procedures. Early operative intervention is mandatory in these cases.     

The CT-guided transthoracic biopsy of lung's and mediastinal tumors

The results of 107 CT-guided transthoracic biopsies, conducted during 2005-2010 yy, were analyzed. The authors have shown the advantages of the core biopsy compared with the fine-needle aspiration biopsy (FNAB). Sensitivity of the first for the malignant tumors was 93%, while the FNAB sensitivity was only 75%. Though the core biopsy showed higher complication rates of the procedure. Both methods proved to be easy to use and should be used for the diagnostic purposes in cases of the peripheral lung tumors and mediastinal lymph nodes.     

Diagnostic accuracy of computed tomography-guided percutaneous biopsy of renal masses

OBJECTIVE: Modern imaging modalities increase the detection of small (相似文献   

CT引导下穿刺活检在脊柱病变诊断中的应用

目的　探讨CT引导下经皮穿刺活检对脊椎病变的诊断价值。方法　对 4 2例影像学不能确诊的病例实施CT引导下经皮穿刺细胞学检查和活检术 ,包括颈、胸、腰共 5 2个椎节。结果　全部病例一次穿刺取材成功 ,无一例出现并发症。 39例一次穿刺确诊率 92 8%。确诊病例包括 :孤立性浆细胞瘤 1例 ,转移癌 2 4例 ,结核 5例 ,多发性骨髓瘤 4例 ,恶性淋巴瘤 2例 ,骨感染 3例 ,3例误诊。结论　CT引导下经皮穿刺细胞学检查和活检是诊断脊柱占位性病变安全、有效的方法。     

Fine-needle aspiration biopsy diagnosis of follicular variant of papillary thyroid cancer: Therapeutic implications

Objective: Frozen-section analysis of follicular lesions is often inconclusive because capsular or vascular invasions are the hallmarks of malignancy with this technique and may not be seen in the particular field studied. Using preoperative fine-needle aspiration biopsy specimens, we attempted to identify malignant follicular lesions and compare these results against frozen-section analysis. Methods: A retrospective study of 1000 consecutive thyroid fine-needle aspiration biopsy specimens was performed. Surgical pathologic correlation was available in 179 cases. Results: Fine-needle aspiration biopsy yielded a suspicious or positive rate of 23%. Surgical pathology was available in 179 patients, of which 95% had thyroid cancer. The follicular variant of papillary cancer was identified in 26 cases, or 15% of the positive cases. Frozen-section analysis yielded false-negative results in 7 of these 26 cases (27%). Conclusions: Preoperative recognition of the follicular variant of papillary cancer by fine-needle aspiration biopsy may reduce the overall incidence of false-negative frozen-section findings. (Otolaryngol Head Neck Surgery 1998;119:600-2.)     

Fine-needle puncture and aspiration of pathologic lesions in the abdomen using ultrasound guidance

The aim of this study was the echo-guided fine-needle aspiration puncture of abdominal lesions to be evaluated. 91 punctures of 85 patients with local lesions were performed. In 6 cases the puncture was repeated because of the lack of material for cytologic study just blood presence in the needle. In 47 cases with carcinoma or metastatic masses the puncture allowed aspiration of malignant cells. In 7 cases the puncture was therapeutic aspiration of pus collection and antibiotical application. The accuracy of this method was 92.9%, sensitivity 87.8% and specificity 96.1%. No significant complication to report occurred.     

Combined radiology and cytology in the diagnosis of bone lesionsA retrospective study of 370 cases

Background?Some of the risks with open biopsy can be avoided by fine-needle aspiration biopsy. The diagnostic contribution of radiologic findings has not been systematically studied. Patients and methods?We retrospectively analyzed the validity of combined radiology and fine-needle aspiration cytology for the diagnosis of bone lesions in a consecutive series of 370 patients. The treatment diagnosis was based solely on radiology and cytology in 234 cases, whereas in 136 cases histopathology was also applied. Results?Comparison of radiology and cytology showed diagnostic compliance in 256 cases (69%) and non-compliance in 101 (28%). 13 (3%) cases failed to yield diagnostic material for cytology. Among the 256 compliant cases, the diagnostic error rate was 1% (2 were falsely benign), whereas the corresponding rate was 17% among the 101 non-compliant cases. In the latter group, 36 cases yielded only normal cells at aspiration, out of which 20 proved to have a neoplastic lesion (8 metastases, 12 benign). The overall sensitivity of cytology alone in recognizing malignancy was 90%. The specificity was 95%. Given a malignant or benign diagnosis, the positive predictive value was 97% and the negative predictive value was 84%. Interpretation?Our study suggests that a simple approach based on conventional radiography and fine-needle aspiration cytology offers a valid means of diagnosing bone lesions. Provided there is compliance between radiology and cytology, the risk of false diagnosis is around 1%.     

Needle biopsy for suspicious lesions of the head of the pancreas: Pitfalls and implications for therapy

Controversy continues to exist concerning the optimal diagnostic approach to a pancreatic head lesion suspected of being a neoplasm. The objective of this study was to evaluate the impact of needle biopsy in suspicious pancreatic head neoplasia and its effect on therapy and outcome. Seventy-three patients with symptoms or signs of periampullary neoplasia and a pancreatic head lesion identified on CT scan were reviewed retrospectively. Forty patients with potentially resectable lesions underwent intraoperative transduodenal core needle biopsy of the head of the pancreas. Thirty-three patients underwent CT-guided percutaneous fine-needle aspiration. The sensitivity and specificity of core needle biopsy were 76% and 100%, respectively. One death was directly related to the procedure and therapy was adversely affected in one patient with a false negative result. The sensitivity and specificity of percutaneous fine-needle aspiration were 85% and 92%, respectively, and were not significantly different from the core needle biopsy results (P>0.3). Three false negative fine-needle aspiration biopsies occurred in patients with potentially resectable lesions and a low clinical suspicion for malignancy. In patients with a mass in the head of the pancreas on CT scan, fine-needle aspiration biopsy offers results similar to those of intraoperative transduodenal core needle biopsy. In patients estimated to have resectable disease, a pancreaticoduodenectomy should be performed without a biopsy. For patients with unresectable disease, cytologic examination of fine-needle aspirate should be performed. If this examination is positive, it offers the advantage of facilitating the construction of a rational plan for palliation.     

Combined radiology and cytology in the diagnosis of bone lesions: a retrospective study of 370 cases

BACKGROUND: Some of the risks with open biopsy can be avoided by fine-needle aspiration biopsy. The diagnostic contribution of radiologic findings has not been systematically studied. PATIENTS AND METHODS: We retrospectively analyzed the validity of combined radiology and fine-needle aspiration cytology for the diagnosis of bone lesions in a consecutive series of 370 patients. The treatment diagnosis was based solely on radiology and cytology in 234 cases, whereas in 136 cases histopathology was also applied. RESULTS: Comparison of radiology and cytology showed diagnostic compliance in 256 cases (69%) and non-compliance in 101 (28%). 13 (3%) cases failed to yield diagnostic material for cytology. Among the 256 compliant cases, the diagnostic error rate was 1% (2 were falsely benign), whereas the corresponding rate was 17% among the 101 non-compliant cases. In the latter group, 36 cases yielded only normal cells at aspiration, out of which 20 proved to have a neoplastic lesion (8 metastases, 12 benign). The overall sensitivity of cytology alone in recognizing malignancy was 90%. The specificity was 95%. Given a malignant or benign diagnosis, the positive predictive value was 97% and the negative predictive value was 84%. INTERPRETATION: Our study suggests that a simple approach based on conventional radiography and fine-needle aspiration cytology offers a valid means of diagnosing bone lesions. Provided there is compliance between radiology and cytology, the risk of false diagnosis is around 1%.     

活检相反体位抽气治疗CT引导肺穿刺活检后迟发性气胸

目的探讨采用活检相反体位穿刺抽气治疗CT引导下肺穿刺活检后迟发性气胸的意义。方法收集CT引导下经皮肺穿刺活检后并发迟发性气胸的患者70例,分析采用原活检穿刺点抽气(A组,30例)与活检相反体位穿刺抽气(B组,40例)对治疗该型气胸的效果差异。结果 A组8例完全缓解,14例部分缓解;B组16例完全缓解,22例部分缓解;A、B两组治疗有效率分别为73.33%(22/30)、95.00%(38/40),差异有统计学意义(P0.05)。结论采用活检相反体位穿刺抽气可增加CT引导下肺穿刺活检术后迟发性气胸的治疗有效率,从而减少胸腔闭式引流术的使用率。