骨髓活检在转移性癌病理诊断中的作用

目的探讨骨髓活检诊断转移性癌的价值。方法收集我院2002年~2005年21例骨髓活检诊断为转移性癌的病例,结合组织学和免疫组化检测的结果,分析骨转移性癌与临床的关系。结果21例骨转移性癌占同期骨髓活检总病例数的0.31%(21/7006)。临床表现为局部或全身性骨痛,三系下降。影像学检查所有病例均见局部或全身性骨病变。光镜下骨小梁间区基质不同程度纤维组织增生,异型上皮样细胞散在或片状分布,腺样、小梁状或实体巢状排列。最后病理诊断证实胃肠道癌5例、肺癌5例、乳腺癌5例和前列腺癌4例,肝癌和甲状腺癌各1例。其中免疫组化胃肠道癌CA19-9阳性,肺癌TTF-1阳性而TG阴性,甲状腺癌TTF-1和TG均阳性,乳腺癌E-Cadherin阳性,前列腺癌PSA阳性,肝癌HepPar1阳性。结论对于临床不明原因的骨痛或贫血患者,影象学又表现局部或全身性骨病变时,建议进行骨髓活检,当病理学见骨髓内异型上皮样细胞浸润,纤维组织增生时提示骨髓转移性癌,免疫组化进一步明确原发肿瘤。     

磁共振成像在诊断淋巴瘤骨髓浸润中的临床应用

目的 探讨磁共振成像(MRI)在诊断淋巴瘤骨髓浸润及病程分级中的应用价值。方法 39例经临床诊断的淋巴瘤患者,行骨髓MRI平扫、增强定量检查及同位素骨髓扫描。回顾性分析39例淋巴瘤患者的骨髓MRI表现、病变骨髓强化后的MRI增强率,并与骨髓穿刺及同位素骨髓扫描结果进行比较。结果 39位患者中,MRI发现骨髓浸润12例,另27例未见骨髓异常信号灶。MRI增强扫描定量分析提示浸润性病变存在异常强化;统计学分析提示异常骨髓强化率明显高于正常骨髓。结论 MRI能一次性对大范围骨髓组织进行检查,根据MRI影像进行骨髓穿刺,有助于诊断淋巴瘤骨髓浸润、临床分级及制定化疗方案。     

CT导向穿刺活检在骨骼病变诊断中的价值

目的探讨CT导引活检在骨骼病变的临床应用价值.方法对52例骨骼病变行CT导引下活检,每例常规取材2～3次.29例病灶区或灶周硬化明显者应用了Ackermann骨钻针,17例骨质破坏明显者应用了核心切割针,6例囊性或有明显液化区的病灶则细抽吸针.结果活检的诊断准确率90.4%(47/52).5例假阴性者包括2例增生硬化性病灶,3例液化性.结论 CT导引下骨骼活检是诊断骨病变重要手段,是一种安全、准确而有效的方法,对临床治疗决策具有重要的指导价值.     

肺部小结节的CT引导经皮肺穿刺活检

目的:评价CT引导肺小结节经皮穿刺术的准确性、并发症及诊断价值。方法:选择1991年8月至1997年5月间行经皮肺穿刺术的158例患者中,病灶直径为0.5-2.0 cm平均(1.7±0.4)cm的35例(35个结节),共做了38次穿刺,所采组织同时作细胞学和组织学检查。经手术者病理与穿刺结果对照,其余经临床随访而明确诊断。结果：35例中癌24例(原发支气管肺癌19例,转移癌5例),穿刺阳性者共21例,3例假阴性,无假阳性。穿刺确诊11例良性病变,并经手术和随访证实。阳性和阴性预测值分别为100％和79％。共有5例（13％）发生气胸,无1例经闭式引流或抽气处理。结论：肺小结节经皮肺穿刺术与较大结节或肿块穿刺比较同样具很高的敏感性,且临床价值更大,值得推广。     

Diagnostic efficiency and complication rate of CT-guided lung biopsy: a single center experience of the procedures conducted over a 10-year period

Background  Computed tomography (CT)-guided transthoracic lung biopsy is a well-established technique for the diagnosis of pulmonary lesions. The objective of this study was to evaluate the diagnostic efficiency and complication rate of CT-guided lung biopsy in a Chinese population.

Methods  CT-guided cutting needle lung biopsies were performed in our institution on 1014 patients between January 2000 and October 2010. A chest radiograph was taken after the biopsy. Data about basic patient information, final diagnosis, and complications secondary to biopsy procedure (pneumothorax and bleeding) were extracted.

Results  The diagnostic efficiency of CT-guided lung biopsy was 94.8%; only 53 patients did not get a final diagnosis from lung biopsy. Final diagnoses found 639 malignant lesions (63.0%) and 322 benign lesions (31.8%). Pneumothorax occurred in 131 patients and 15 required insertion of an intercostal drain. Small hemoptysis occurred in 41 patients and mild parenchymal hemorrhage occurred in 16 patients. The overall complication rate was 18.5%.

Conclusions  CT-guided cutting needle biopsy of pulmonary lesions is a relatively safe technique with a high diagnostic accuracy. It can be safely performed in clinical trials.

 

     

骨髓活检与涂片联合应用于MDS诊断探讨

对我院1994～1996年经临床、外周血象,骨髓涂片和骨髓活检确诊为骨髓增生异常综合征(MDS)的32例患者资料,进行了研究观察.外周血和骨髓涂片根据法美英协作组(FAB)分型标准,骨髓活检采用塑料包埋半薄切片.结果:组织病理形态分类对以涂片为基础的FAB分型是很好的补充.两者相结合是诊断MDS非常有效的方法.     

Changes in pathological pattern and treatment regimens based on repeat renal biopsy in lupus nephritis

Background  Relapses occur frequently in patients with lupus nephritis. Renal biopsy is the gold standard for assessing renal activity and hence guiding the treatment. Whether repeat renal biopsy is helpful during flares of lupus nephritis remains inconclusive. In the present study, we retrospectively reviewed the patients with lupus nephritis who had more than one renal biopsy with the hope to find the clinical value of repeat biopsy.

Methods  Patients who had a diagnosis of lupus nephritis and two or more renal biopsies were selected from the database of the patient pathology registration at this renal division. Renal biopsy was evaluated according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification of lupus nephritis. The pathological patterns and treatment regimens were analyzed after a repeat biopsy.

Results  We identified 44 systemic lupus erythematosus patients with serial renal biopsies. In total, there were 94 renal biopsies. Overall, the pathological transition occurred in 64% instances according to the ISN/RPS class. When the transition was analyzed according to proliferative, membranous or mix lesions, it showed different profile: 35% in patients with proliferative lesion, 23.5% patients with mix lesions, 100% in patients with pure membranous lesion. The pathological transition could not be predicted by any clinical characteristics. After the repeat renal biopsy, 34% of patients had a change in their treatment regimens.

Conclusions  The pathological conversion was very prevalent in patients with lupus nephritis. However, the transitions became less prevalent when they were analyzed according to pure membranous, proliferative, and mix lesion. Repeat biopsy might be helpful to avoid unnecessary increased immunosuppression therapy.

     

18F-FDG PET/CT在诊断多发性骨髓瘤中的临床应用

目的分析多发性骨髓瘤的PET/CT表现,探讨其在诊断多发性骨髓瘤中的作用。方法 19例经骨髓穿刺活检证实为多发性骨髓瘤患者,均行全身PET/CT检查,分析影像形态、功能代谢的特点,并测量平均标准摄取值(SUVmean)。结果 19例患者均表现为全身多发骨病变。CT共检出病灶221处(占全部骨骼病变的85.3%),表现为穿凿样、皂泡样溶骨改变,以中轴骨受累为主,一般位于骨髓腔内,较少形成软组织肿块及髓外侵犯。PET检查198处阳性病灶(76.4%),表现为全身多灶性18F-FDG摄取增高,SUVmean为3.1±1.4(范围1.3-7.4)。PET所示病灶大部分与CT匹配,少数病灶不匹配。PET/CT表现出一定特征,大致可分为:①部分病例中CT表现为多发骨质破坏,而PET累及的不均匀性代谢增高区与之不完全相符。②部分病灶CT未见明确骨质破坏,PET表现为代谢异常增高。③少数病灶CT示骨质破坏并局部软组织肿块形成时,PET显示代谢显著增高,且与CT基本相当。本组有2例常规骨穿阴性的患者在PET/CT引导下活检确诊为多发性骨髓瘤。结论 PET/CT对多发性骨髓瘤诊断具有重要价值,其引导下穿刺活检有利于提高诊断的灵敏度,尤其在常规骨穿假阴性病例中。     

超声引导下芯针穿刺活检在小儿腹盆腔肿瘤中诊断价值

【】目的 探讨超声引导下芯针穿刺活检在小儿腹盆腔肿瘤中的诊断意义。方法 2013年4月-2016年4月我院收治的经临床或超声诊断出腹盆部肿块,并行超声引导下芯针穿刺活检的105例小儿患者。 结果 穿刺活检结果发现86例恶性肿瘤(其中有30例神经细胞瘤,15例肝母细胞瘤,11例肾母细胞瘤和6例原始神经外胚叶肿瘤/恶性小圆细胞瘤)和19例良性病灶(其中有10例成熟畸胎瘤,3例血管内皮细胞瘤,2例副神经节瘤和2例感染)。活检恶性肿瘤组86例患儿均经手术治疗或手术取材活检,其中有1例恶性小圆细胞瘤和2例成神经细胞瘤手术标本和穿刺活检病理诊断不一致(准确率96.5%)。穿刺活检良性肿瘤准确为100%。5例患儿穿刺活检手术后出现并发症,包括疼痛(2例),穿刺处出血(2例)和感染(1例)结论 超声引导下芯针穿刺活检是检测小儿腹盆腔肿瘤的有效、安全和微创的诊断方法。     

肢体骨肿瘤活检失误临床分析

目的分析临床上骨肿瘤活检手术中的常见失误,降低活检手术给骨肿瘤保肢手术带来的不利影响。方法分析55例骨肿瘤活检手术失误患者的所有临床资料,包括男25例,女30例,平均年龄26．6岁。肿瘤部位包括股骨近端12例,股骨远端13例,胫骨上端17例,胫骨干及胫骨远端3例,腓骨近端2例,肱骨近端及肱骨干5例,桡骨远端3例。肿瘤诊断：骨肉瘤28例,皮质旁骨肉瘤3例,骨巨细胞瘤6例,恶性纤维组织细胞瘤6例,软骨肉瘤6例,恶性淋巴瘤1例,转移癌3例,尤文氏瘤2例。结果55例患者中,17例因为活检手术失误及相关并发症而行截肢手术,占30．9％。4例切除活检失误均为切除范围不足。9例穿刺活检失误中,6例穿刺活检的入路太靠近主要血管神经束,3例发生诊断失误。42例切开活检失误中,以手术入路失误为多,共31例,占73．8％。切开活检并发症中,开窗不当造成病理性骨折2例,止血不彻底形成较大血肿7例,术后引流放置不恰当5例。结论骨肿瘤活检手术失误严重影响骨肿瘤患者的后续治疗,临床上应引起足够的重视。     

Mammtome术诊断乳腺隐匿性病灶和不典型增生

目的探讨Mammtome术对乳腺隐匿性病灶的诊断,及对Mammotome术检出不典型增生的外科治疗策略.方法2003.3～2004.3月对该院14例共16处乳腺隐匿性病灶行超声引导下Mammotome微创旋切术,12例行起声引导下穿刺活检.结果Mammotome术检出14例16处乳腺隐匿性病灶中,5例非典型增生(31.3%),1例乳腺癌(6%);5例非典型增生中2例重度的和1例轻度的非典型增生接受手术,结果证实为重度的和轻度非典型增生,符合率100%.余2例中-轻度非典型增生未手术,给予他莫昔芬口服,随访无复发.12例行超声引导下穿刺活检中非典型增生1例(8.3%),再次手术结果为乳腺癌.结论Mammotome术利于乳腺隐匿性病灶的诊断.对Manmotome术检出不可触及肿块的重度非典型病灶,建议再次手术切除;对中度以下的非典型增生,在超声证实肿块已全切情况下,可避免再次手术,予他莫昔芬口服并随访.     

肺内孤立病灶CT导向切割针活检的准确性和安全性

目的评价肺内孤立病灶CT导向切割针活检的准确性和安全性.方法共145例患者在CT引导下用16G或18G切割针进行穿刺活检.结果组织学检查恶性病变91例,良性病变54例,其中假阴性6例(4.1%),没有发现假阳性.恶性病变和良性病变诊断特异性分别为100%和59.3%,总体诊断准确率84.8%.并发气胸者21例(14.5%),23例出现病灶周围出血(15.9%),8例出现咯血(5.5%).结论 CT引导下肺内孤立病灶切割针活检是一种可靠和相对安全的诊断方法.     

X线导向对骨病变穿刺抽吸活检价值

目的探讨x线导向对骨病变穿刺抽吸活检价值。材料与方法穿刺抽吸活检34例,通过观察x线平片或CT片,确定最佳穿刺活检部位,并在x线导向下行多靶点取材。结果34例中,穿刺成功率占100﹪,诊断准确率91.2﹪。无并发症发生。结论x线导向对骨病变穿刺抽吸活检过程中不受x线辐射影响,是一种简单、安全有效的诊断方法;强调准确的定位和选择最佳穿刺点是提高穿刺活检成功率的关键。     

Bone disease after jejuno-ileal bypass for morbid obesity.

Fifteen patients who had undergone a 14 inches X 4 inches jejuno-ileal bypass operation for obesity, 3 to 4 years earlier, were investigated by iliac bone biopsy, radiology and routine biochemistry, including 25-hydroxy-vitamin D and parathyroid hormone estimations. Two patients had histological osteomalacia which was mild in one. A further 9 patients had abnormal bone biopsies, there being an excess of trabecular bone surface covered by osteoid with a normal or reduced amount of calcification front. Six of these 9 showed an increase in trabecular resorption, although in none were there excessive numbers of osteoclasts. The likely explanation for these findings is that these 9 patients had early osteomalacia with mild hyperparathyroidism, making a total of 11 patients out of 15 with osteomalacia. Radiology and blood chemistry were poor predictors of histological bone disease.     

Percutaneous core needle biopsy versus open biopsy in diagnostics of bone and soft tissue sarcoma: a retrospective study

Background

Biopsy is a crucial step within the diagnostic cascade in patients with suspected bone or soft tissue sarcoma. Open biopsy is still considered the gold standard. However, recent literature suggests similar results for percutaneous biopsy techniques. Therefore, the aim of this retrospective analysis was to compare open and percutaneous core needle biopsy (CNB) regarding their accuracy in diagnosis of malignant musculoskeletal lesions.

Methods

From January 2007 to December 2009, all patients with suspected malignant primary bone or soft tissue tumour undergoing a percutaneous CNB or open biopsy and a subsequent tumour resection at our department were identified and enrolled. Sensitivities, specificities, positive predictive values (PPV), negative predictive values (NPV) and diagnostic accuracy were calculated for both biopsy techniques and compared using Fisher’s exact test.

Results

A total of 77 patients were identified and enrolled in this study. Sensitivity, specificity, PPV, NPV and diagnostic accuracy were 100% for CNB in bone tumours. Sensitivity (95.5%), NPV (91.7%) and diagnostic accuracy (93.3%) for open biopsy in bone tumours showed slightly inferior results without statistical significance (p > 0.05). In soft tissue tumours favourable results were obtained in open biopsies compared to CNB with differences regarding sensitivity (100% vs. 81.8%, p = 0.5), NPV (100% vs. 50%, p = 0.09) and diagnostic accuracy (100% vs. 84.6%, p = 0,19) without statistical significance. The overall diagnostic accuracy was 92.9% for CNB and 98.0% for open biopsy (p = 0.55). A specific diagnosis could be obtained in 84.2% and 93.9%, respectively (p = 0.34).

Conclusion

In our study we found moderately inferior results for the percutaneous biopsy technique compared to open biopsy in soft tissue tumours whereas almost equal results were obtained for both biopsy techniques for bone tumours. Thus, CNB is a safe, minimal invasive and cost-effective technique for diagnosing bony lesions. In soft tissue masses, the indication for percutaneous core needle biopsy needs to be made carefully by an experienced orthopaedic oncologist with respect to the suspected entity, size of necrosis and location of the lesion to avoid incorrect or deficient results.     

The use of computed-tomographic-directed stereotaxis in the diagnosis of intracerebral lesions

The technique of computed-tomographic-directed stereotaxic biopsy of cerebral lesions is described, and our series of 24 procedures on 23 patients without mortality or morbidity is presented. This technique provides neurosurgeons with an improved method of performing cerebral biopsies.     

Bone Marrow Biopsies with a Silverman Needle

Advantages and disadvantages of bone marrow biopsies taken from the posterior iliac crest using the Silverman needle were evaluated. Sixty-three biopsies were carried out in patients on whom previous aspirations of the bone marrow space were unsuccessful. Open surgical biopsy was thus avoided in all but one case. Only local anesthesia was required. In 12 cases the first attempt to obtain material with the Silverman needle was unsuccessful.

Limitations of the method are largely due to crushing of the specimen so obtained, with polarization of nuclei simulating the appearance of fibroblasts seen in cases of myelosclerosis. At times marrow was completely expressed from the spongy bone, leaving a useless specimen of spicules. The quality of histological material is usually inferior to that yielded by successful aspiration.

Despite limitations, the Silverman needle method is considered to be preferable to open biopsy in cases in which attempts at aspiration have failed.

     

CT导引下弹簧芯状活检针肺穿刺活检

①目的 探讨CT导引下应用弹簧芯状活检针肺穿刺活检术的准确性、并发症的发生率及其影响因素。②方法 1998年6月～2001年12月，应用弹簧芯状活检针经皮肺穿刺并经手术病理和临床随访证实．对其中具有完整资料的150例病人进行分析。③结果 对150例病人的150个病灶共进行了200次穿刺活检，其中148例取得了满意的组织学标本，取材成功率为98．7％。其中恶性肿瘤诊断准确率93．2％，假阴性率为6．8％；良性病变诊断准确率为88．7％，假阴性率为11．3％．总诊断准确率为91．3％，假阴性率为8．7％。气胸发生率为11．3％。咯血发生率为8．7%．未发生大出血。④结论 CT导引下弹簧芯状活检针经皮肺穿刺活检对肺内良性病变和恶性肿瘤的诊断准确性较高。     

CT引导下穿刺活检对胸部病变的诊断

目的 :评价 CT引导下穿刺活检在胸部疾病诊断中的价值。方法 :应用 Cook公司生产的自动活检针 ,在 CT引导下对 33例患者的 33个胸部病灶进行活检。结果:33个病灶共进行了 35次穿刺 ,穿刺成功率为10 0 %。诊断恶性病变 13例 ,良性病变 2 0例 ,敏感性为 93.9% (31/ 33) ,特异性为 10 0 .0 %。结论 :CT引导下穿刺活检安全、高效、操作简单 ,可作为常规检查用于胸部疾病介入性诊断。     

胃黏膜高级别上皮内瘤变的内镜识别与手术病理的结果

目的比较并分析胃镜胃黏膜活检示高级别上皮内瘤变(HGIEN)的病灶形态及其与手术病理的关系。方法26730例胃镜检查者中胃黏膜活检示HGIEN者44例,对其行手术治疗,分析内镜直视下病灶的色泽形态、皱襞特征、活检数量、手术大体标本形态及病理学诊断结果。结果全组患者均成功行手术根治,平均每次内镜检查对病灶行活检4.25次。44例患者中浅表病灶26例,其中仅6例(13.6%)经手术证实维持HGIEN诊断,16例(36.4%)为早期胃癌,4例(9.1%)为早期胃癌样进展期胃癌(5型胃癌);18例形似Borrmann各分型病灶,术后均证实为进展期胃癌。结论认真鉴别活检示HGIEN的病灶性质,提高胃镜活检的深度及准确性,并结合色素内镜及固有荧光诊断技术等方法可提高活组织检查对胃癌的诊断率。胃镜胃黏膜活组织检查为HGIEN的患者中相当一部分已存在浸润性癌生长,应积极手术干预,避免延误诊断和治疗。