腹膜后肿块超声诊断研究及临床意义

目的：研究不同病理性质腹膜后肿块的块像图特征,最终寻找出一些超声诊断规律。方法：应用超声检查经手术病理证实的腹膜后肿块83例,并对其超声图像进行综合分析。结果：表明（1）腹膜后肿块超声定位有八种声像图特征;（2）肿块内部回声特征与病理结构相关;（3）肿块好发部位与病理性质相关,本组与手术病理对照,超声诊断符合率83％（69／83）,结论这些超声定位特征对腹膜后肿块及时诊断以及与非腹膜后肿块鉴别诊断具有重要的临床价值,结合内部回声特征与好发部位还可有助于对肿块病理性质的诊断。     

Three-dimensional volume off-line analysis as compared to real-time ultrasound for assessing adnexal masses

Objective

To assess the agreement between three-dimensional volume off-line analysis as compared to real-time ultrasound for assessing adnexal masses.

Study design

Ninety-nine non-consecutive women diagnosed as having an adnexal mass were assessed by transvaginal power Doppler ultrasound. One single examiner performed all ultrasound examinations. Based on the examiner's subjective evaluation using gray scale and Doppler ultrasound findings a presumptive diagnosis (benign or malignant) was provided after real-time ultrasound was performed. Once real-time was done a 3D volume of the adnexal mass was acquired and stored by this examiner. Two examiners, unaware of the real-time ultrasound results, evaluated the 3D volumes using multiplanar display and virtual navigation and also had to provide a presumptive diagnosis (benign or malignant). These two examiners, like the first one, had information about patient's age, menopausal status and complaints. All women underwent surgery or were followed-up until cyst resolution. Histologic diagnosis was used as gold standard. Cysts that resolved spontaneously were considered as benign for analytical purposes. The Kappa index was used to assess the agreement between real time ultrasound and 3D volume analysis. Sensitivity and specificity of both methods were calculated and compared using McNemar test.

Results

Forty-one masses were malignant and 58 were benign. Agreement between real-time ultrasound and 3D volume analysis was good for both off-line examiners (Kappa index: 0.82, 95% CI: 0.70–0.93 and 0.78, 95% CI: 0.65–0.90). Sensitivities for real-time ultrasound and 3D volume analyses were 100%, 93% and 90%, respectively (p > 0.05). Specificities for real-time ultrasound and 3D volume analyses were 91%, 84% and 86%, respectively (p > 0.05).

Conclusions

Off-line 3D volume analysis may be a useful method for assessing adnexal masses, showing a good agreement with real-time ultrasound and having a similar diagnostic performance.     

Benign and malignant salivary gland diseases in children A retrospective study of 549 cases from the Salivary Gland Registry, Hamburg

Objective

Tumors of salivary glands in children are rare. Basically all types of salivary gland diseases during the period of childhood are described. The incidences of salivary gland tumors in children (0–14 years) differ completely from those in adults. Especially the malignant neoplasms are very rarely described in literature. Only some collective reviews and case reports try to summarize frequency, distribution concerning sex and age, morphology and localization.

Methods

In our study we were able to draw data from the Hamburg Salivary Gland Registry, concerning the last 25 years regarding histopathological diagnosis, age, gender and localisation of the pathologies. Findings were compared to other studies. Most of the specimens were presented by the Clinic for Otorhinolaryngology and Head and Neck Surgery, University Hamburg, Eppendorf. As a reference centre for salivary gland diseases some material was sent by other institutions.

Results

This study will give a detailed survey of salivary gland diseases and tumors in children up to the age of 14 which have undergone surgical therapy/biopsy. We present the general distribution of the different tumors/diseases, the distribution in certain age groups and the various locations. 549 cases could be examined. Comparing the distribution of malignant tumors with other studies, the epithelial–myoepithelial carcinomas followed by salivary duct carcinomas represent the largest group in childhood.

Conclusions

The study shows that comparing to adulthood different tumors play an important role in adolescence. The distribution of tumors in childhood may help in diagnostic. Further many salivary gland diseases in childhood underwent surgery/biopsy although this is not supposed to be the proper treatment. The study shows that the right diagnosis most often can only be reached by surgery and histology.     

彩色多普勒超声对浅表软组织肿物的诊断价值

目的探讨高频彩色多普勒超声对浅表软组织肿物的诊断价值。方法回顾性分析2008年111月70例经手术、活检病理证实的浅表软组织肿物的声像图特征,包括肿物的部位、形态大小、内部回声、边界及其与周边组织的关系、长径与厚度比值（L/T）及病变周边与内部血流分布情况。结果超声对浅表肿块病灶的显示率为100%,良性肿瘤有脂肪瘤、表皮囊肿、滑膜囊肿、神经鞘瘤,血管瘤、异物肉芽肿等,恶性肿物包括皮肤纤维肉瘤,转移性腺癌。结论彩色多普勒超声对浅表肿块的检出、定位及物理性质可做出准确的诊断,综合分析肿物的边界、形态、内部回声及血流分布等特点对肿物的良恶性诊断具有重要价值。     

Accuracy of Fine Needle Aspiration Cytology from Breast Masses in Thailand

Objective: To evaluate the accuracy and diagnostic performance of fine needle aspiration FNA cytology indiagnoses of breast masses. Methods: Women who had FNA diagnoses for breast masses and underwentsubsequent histopathologic evaluation during January 2003-December 2006 were accessed from the archive ofthe Anatomical Pathology Department of our institution. Cytologic diagnoses were classified as unsatisfactory,benign, atypical probably benign, suspicious probably malignant, and malignant, and were compared to thehistopathologic diagnoses obtained from core needle biopsy, excisional biopsy, or mastectomy to give an assessmentof the diagnostic performance of FNA. Results: A series of 190 breast masses were identified during the studyperiod. The FNA cytological diagnosis was unsatisfactory due to inadequate specimens in eight cases (4.2%).The diagnoses in the remaining 182 cases were: benign lesions in 98 (53.9%); suspicious for malignancy in 31(17.0%); and malignant in 53 (29.1%). From the subsequent histopathologic diagnoses, 6/98 cases of benigncytology turned out to be malignant lesions (false negatives); 22/31 cases of suspicious cytology were trulymalignant while the other nine were benign; and only 1/53 with malignant cytology was benign (false positive),the lesion being a fibroadenoma . The overall accuracy, sensitivity, specificity, positive predictive value, andnegative predictive value were 91.2% (95% confidence interval [CI], 87.6%-94.8%), 92.5% (95% CI, 88.7%-96.3%), 90.2% (95% CI, 85.9%-94.5%), 88.1% (95% CI, 83.4%-92.8%) and 93.9% (95% CI, 90.4%-97.4%),respectively. Conclusions: FNA cytology is highly accurate for diagnosis of breast masses. However, the clinicianshould correlate FNA cytological results with physical examination and imaging findings to prevent false negativeand false positive events and to obtain optimal management for their patients.     

Fine needle aspiration biopsy: role in diagnosis of pediatric head and neck masses

OBJECTIVE: To assess the feasibility and role of fine needle aspiration biopsy (FNAB) as a diagnostic tool in children with neck masses. DESIGN: Retrospective chart review. SETTING: Tertiary care children's hospital. PATIENTS: Consecutive series of 71 children with a head and neck mass who underwent FNAB as the primary diagnostic modality. INTERVENTIONS: FNAB was performed and interpreted by a pediatric cytopathologist. Rapid on-site analysis was performed to allow immediate assessment of specimen adequacy and to attain a preliminary diagnosis, after which routine cytologic staining was performed. Flow cytometry was performed on cytological specimens when malignancy was suspected, and open biopsy was performed when the cytologic diagnosis was in question. MAIN OUTCOME MEASURES: Technical feasibility of FNAB in children, complications, cytopathological diagnoses, accuracy of rapid on-site analysis, need for subsequent diagnostic evaluations, clinical outcomes and follow-up. RESULTS: Mean age was 8.4 years (S.D. 5.3 years), with mean follow-up of 4.1 months (S.D. 9.6 months). FNAB was performed under general anesthesia in 54 cases (76%). There were no technical complications. On-site rapid interpretation was completed in 55 cases, 18/55 confirmed adequacy of specimen only, 37/55 yielded a preliminary diagnosis, and in 34/37 cases, was same as final cytopathologic result. Overall, FNAB biopsy demonstrated 64 benign lesions, 3 malignant diagnoses, 2 follicular thyroid neoplasms, and 2 non-diagnostic specimens. FNAB was the only pathological test performed in 54 (76%) cases. The most common diagnosis was reactive lymphoid hyperplasia (n=39), followed by benign granulomatous disease (n=8). Flow cytometry was performed on 7 specimens (non-diagnostic in 5, negative for malignancy in 2). Of the 15 cases with surgical specimens, 3 revealed a pathologic diagnosis different from initial FNAB. There were no cases in which FNAB missed a malignancy, and there were 2 cases where FNAB suggested malignancy, with benign disease subsequently found on open biopsy. CONCLUSIONS: Fine needle aspiration biopsy is developing into a feasible option in diagnosing pediatric neck masses, with its main advantage being its minimally-invasive nature and avoidance of an open surgical procedure for benign persistent lymphadenitis. On-site rapid interpretation can be used successfully to confirm specimen adequacy and to give an accurate preliminary diagnosis for concerned parents. Issues to consider include the need for a specialized pediatric cytopathologist familiar with pediatric differential diagnoses, the need for general anesthesia in many cases, and the possibility of inaccurate diagnosis requiring an open procedure.     

超声引导自动活检技术在盆腔实性肿物诊断中的应用

目的：评价超声引导自动活检技术运用于诊断盆腔实性肿的可行性,方法：采用经腹或经阴道途径地30例患盆腔实性肿物, 难以鉴别其良恶性质的患者,在实时二维超声引导下行自动活检,并将检查结果与术后病理对照,同时研究取材成败的原因。结果（1）手术病例的术后病理诊断与自动活检结果全部吻合;（2）取材成功率80．95％;（3）30例患者中有8例为恶性（26．67％）,（4）30例患者均未见并发症。结论：将超声引导自动活检技术运用于盆腔实性肿物,可进行术前确诊,其取材成功率与病变部位及物理性质有关,与其它术前诊断方法相比,本技术安全,简便,快捷,可靠。     

Characteristics of congenital cystic adenomatoid malformations associated with nonimmune hydrops and outcome

Background/Purpose

In fetuses with congenital cystic adenomatoid malformations of the lung (CCAMs), hydrops fetalis and large masses are associated with poor outcomes. This study attempts to (1) determine sonographic features (in addition to large size) that correlate with hydrops and (2) characterize the features that correlate with outcome among hydropic fetuses.

Method

Charts and sonograms of fetuses with large, unilateral CCAMs were retrospectively reviewed. Mass features evaluated included laterality, macrocystic/microcystic, cystic/solid predominance, degree of mediastinal shift, retrocardiac component, diaphragm eversion, polyhydramnios, and mass-thorax ratio (MTR). Features of hydrops included degree of ascites, scalp and integumentary edema, pleural/pericardial effusion, and placentomegaly.

Results

Thirty-six fetuses with large CCAMs were studied: 27 with and 9 without hydrops. Three sonographic features were significantly associated with hydrops: MTR of at least 0.56, cystic predominance of mass, and eversion of hemidiaphragm. Of 27 fetuses with hydrops, 10 (37%) demonstrated all 3 features compared with none in those without hydrops (P = .04). All 9 nonhydropic fetuses were expectantly managed, and 100% survived. In the hydropic group, none of the expectantly managed fetuses survived, and 10 (43%) of the 21 fetuses who underwent fetal intervention survived.

Conclusion

Three features of large CCAMs were significantly associated with hydrops: MTR, cystic predominance, and diaphragm eversion. Identification of these features will allow clinicians to accurately predict which fetuses may warrant closer follow-up and possible treatment.