Does the Method of Biopsy Affect the Incidence of Sentinel Lymph Node Metastases?

More detailed examination of the sentinel lymph node (SLN) in breast cancer has raised concerns about the clinical significance of micrometastases, specifically isolated tumor cells detected only through immunohistochemical (IHC) staining. It has been suggested that these cells do not carry the same biologic implications as true metastatic foci and may represent artifact. A retrospective institutional review board-approved review was conducted on clinically node-negative breast cancer patients who underwent SLN biopsy (SLNB) between 1997 and 2003. Retrospective analysis of tumor characteristics and the method of the initial diagnostic biopsy were correlated with the presence and nature of metastatic disease in the SLN. Of 537 SLNBs, 123 (23%) were hematoxylin-eosin (H&E) positive. SLN positivity strongly correlated with tumor size (p<0.001) and tumor grade (p=0.025), but not with the method of biopsy (needle versus excisional biopsy). Prior to July 2002, we routinely evaluated H&E-negative SLNs with IHC (n=381). Of the 291 H&E-negative patients, 26 had IHC-only detected micrometastases (9%). The likelihood of detecting IHC-only metastases did not correlate with tumor size or grade, but was significantly higher in patients undergoing excisional biopsy than core needle biopsy. While the method of biopsy has no demonstrable effect on the likelihood of finding metastases in the SLN by routine serial sectioning and H&E staining, it may significantly impact the likelihood of finding micrometastases by IHC. IHC should not be used routinely in the evaluation of the SLN and caution should be used when basing treatment decisions (completion axillary lymph node dissection or adjuvant therapy) on IHC-only detected micrometastases.     

超声引导下乳腺病变空芯针穿刺活检临床价值研究

目的 评价超声引导空芯针穿刺活检（US-CNB）在乳腺病变术前诊断中的应用价值。方法 宁夏医科大学附属医院肿瘤外科2007年8月至2009年5月行超声引导空芯针穿刺活检病人115例,结合手术后病理切片,对空芯针穿刺活检标本和切除活检（EP）标本的病理组织学诊断进行比较和分析。结果 115例乳腺疾病病人经空芯针穿刺活检组织学诊断浸润性导管癌81例,浸润性小叶癌3例,导管内癌2例,交界性肿瘤1例,导管上皮不典型增生2例,其他良性病变26例。US-CNB与切除活检的病理诊断符合率为93.9%,kappa=0.891（P＜0.01）。US-CNB 病理诊断的敏感性为95.6%,特异性为100%,假阴性4.39%,无假阳性。结论 超声引导下空芯针穿刺活检是一种敏感性高、特异性强的乳腺病变诊断方法,对少数特殊类型乳腺病变的诊断存在一定的局限性,对于任何可疑病变或不典型增生改变均应做切除活检。     

埋没导引缝合法矫正隆乳术后双侧乳房不对称

目的：介绍一种处理隆乳术后双侧乳房不对称的方法。方法：2009年3月～2009年12月笔者应用埋没导引缝合法处理6例假体置入后双侧乳房不对称患者。结果：经过术后3～6个月的随访,5例患者取得了满意的效果,且没有出现复发,1例患者调整无效后行小切口切开矫正。结论：埋没导引缝合法是处理隆乳术后双侧乳房不对称简单、可靠、值得推荐的方法。     

立体定向脑内病灶活检的临床意义

目的 探讨先进图像引导立体定向脑组织活检术方法 ,明确其在神经系统疾病诊断中的意义.方法 回顾性分析1987年12月至2009年1月立体定向脑内病灶活检的1187例病历资料,其中男性694例(58.5%),女性493例(41.5%);年龄1～85岁(平均39.7岁).CT(含正电子发射断层扫描)引导活检607例,MRI(含氢质子磁共振波谱成像)引导活检580例;采用常规框架立体定向活检手术726例,采用无框架立体定向机器人活检手术461例(含定向引导神经内镜活检).早期450例立体定向手术定位,采用CT或MRI图像测量靶点坐标方法 ,不能立体显示穿刺途径;后期737例立体定向手术定位,采用计算机三维重建病灶方法 ,能够立体显示穿刺路径.结果 活检明确组织病理学诊断1156例(活检阳性诊断率97.4%).本组中983例(82.8%)获得肿瘤学病理诊断,主要包括神经胶质瘤、转移性肿瘤、原发性淋巴瘤、生殖细胞瘤等;173例(14.6%)为非肿瘤性病变,其中包括多发硬化和瘤样脱髓鞘病变、神经变性疾病、炎性病变、寄生虫病等.活检穿刺手术并发少量血肿(<10 ml)而无神经功能障碍20例(1.7%),较大血肿(>10ml)需要外科处理(置管引流或开颅血肿清除)9例(0.8%);活检出血导致死亡3例(0.3%).本组无颅内感染病例.结论 先进影像技术引导的立体定向脑组织活检术是一种微侵袭、可靠的脑内疾病确定诊断手段.生化成像、功能成像技术的发展,为立体定向引导的活检技术赋予了崭新的内容.     

支气管内超声引导针吸活检术（EBUS-TBNA）临床应用的初步体会

目的探讨支气管内超声引导针吸活检术（endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA）在明确纵隔和肺门肿大淋巴结定性诊断中的应用价值。方法2009年9~11月,对25例胸部CT检查提示纵隔和（或）肺门淋巴结肿大（短径〉1 cm）进行EBUS-TBNA检查,阴性者进一步接受纵隔镜检查或胸腔镜、开胸手术加以确证。结果本组25例共穿刺32组淋巴结。EBUS-TBNA明确淋巴结恶性转移者15例;EBUS-TBNA阴性者10例,其中1例开胸术后证实隆突下淋巴结转移。EBUS-TBNA在纵隔和肺门肿大淋巴结良恶性鉴别诊断中的敏感性、特异性和准确性分别为94%（15/16）,100%（9/9）和96%（24/25）。所有患者检查耐受良好,无任何相关并发症发生。结论EBUS-TBNA是评价纵隔及肺门淋巴结安全有效的方法。     

CT引导下经皮穿刺肺活检术中影响针胸膜夹角的因素

目的探讨CT引导下经皮肺穿刺活检术中影响针胸膜夹角的因素。方法 828例肺内孤立性病变患者接受CT引导下经皮穿刺肺活检,分别记录病变大小、病变部位、穿刺点位置及进针深度等。将以上变量与针胸膜夹角进行统计学分析。结果位于双肺上叶的病变与小的针胸膜夹角有关;不同病变大小、不同进针深度的针胸膜夹角病例数分布不一致;不同穿刺点位置的针胸膜夹角病例数分布一致。病变在20～29mm时,针胸膜夹角与穿刺例数无相关关系。结论病变部位可能影响针胸膜夹角,尤其是双肺上叶的病变与针胸膜夹角大小有密切关系。     

电阻抗谱技术在甲状腺癌诊断中的研究进展

目的总结电阻抗谱技术的基本原理及其在甲状腺癌诊断方面的最新进展。方法通过复习国内外文献,对电阻抗谱技术在甲状腺癌诊断上的应用前景进行综述和分析。结果电阻抗谱是一种人体功能性成像技术,其测量结果客观,不易受人为因素影响,能有效诊断早期甲状腺癌,并能与细针穿刺细胞学检查结果互补,提高甲状腺癌的诊断准确率,从而减少不必要的手术。结论在甲状腺癌的诊断上,电阻抗谱技术有望成为诊断早期甲状腺癌的一种新技术,并作为一种辅助性临床诊断方法辅助细针穿刺细胞学检查对甲状腺癌的诊断。     

A prospective evaluation of novel methods to intraoperatively distinguish parathyroid tissue utilizing a parathyroid hormone assay

BACKGROUND: Frozen section analysis has traditionally been used to confirm the identity of parathyroid tissue intraoperatively; however, it is time-consuming and costly and requires the excision of a significant portion of tissue. An intraoperative biopsy and analysis with a parathyroid hormone (PTH) assay is a possible alternative; however, this technique has not been perfected. METHODS: Two hundred twenty-three tissue specimens were collected prospectively from patients undergoing neck exploration. Each specimen was sampled intraoperatively using three different biopsy techniques: a fine-needle aspiration (FNA) with 10 passes of a needle (FNA10), a FNA with 20 passes of a needle (FNA20), and a tissue biopsy of approximately 1.0 mm3 (BIOPSY). The PTH concentration of each sample was determined via the Elecsys 1010 PTH immunoassay. The final tissue diagnosis was determined by histology or operative data. RESULTS: Parathyroid samples from all techniques had higher median PTH concentrations than nonparathyroid samples. However, the accuracies for the detection of parathyroid tissue varied markedly (PTH cutoff of 1000 pg/ml): the accuracies of the FNA10 and FNA20 were 71 and 80%, respectively, while the BIOPSY was 99% accurate. CONCLUSIONS: This is the first prospective study evaluating multiple methods to diagnose parathyroid tissue intraoperatively using a rapid PTH assay. We conclusively show that the BIOPSY technique is 99% accurate for the diagnosis of parathyroid tissue, and therefore, should be the method of choice when the intraoperative confirmation of parathyroid tissue is needed.     

The diagnostic value of image guided percutaneous fine needle aspiration biopsy in equivocal mediastinal masses

Background and aims The aim of this study was to assess the diagnostic value of image guided percutaneous fine needle aspiration (FNA) biopsy in equivocal mediastinal masses.Patients Sixty-six patients with an equivocal mediastinal mass who underwent FNA biopsy between 1993 and 2003 were eligible for final analysis. The cytological and definitive diagnosis of masses were grouped as primary 22 (33%)−30 (46%) and secondary (metastatic) neoplasms 18 (27%)−18 (27%) and nonneoplastic lesions 20 (30%)−18 (%27) respectively.Results The diagnostic accuracy (%95 C.I.) of FNA biopsy for primary mediastinal neoplasms, secondary neoplasms and nonneoplastic lesions were found to be 93.3 (83.8–98.2)%, 100 (95.1–100)%, 93.3 (83.8–98.2)%, respectively.Conclusion Image guided percutaneous FNA biopsy is a safe and highly accurate diagnostic method for equivocal mediastinal masses.     

电温针辅助治疗脑卒中并偏瘫的临床疗效

目的 探讨电温针辅助治疗脑卒中偏瘫的临床疗效.方法 将106例脑卒中偏瘫的患者,按随机数字表法分为研究组和对照组各53例,对照组给予常规药物治疗,研究组在常规药物治疗的基础上配合电针加温针治疗.治疗前及治疗后3个月分别采用Fugl-Meyer量表、Barthel指数及美国国立卫生研究院脑卒中量表(NIHSS)对两组患者进行肢体运动功能、日常生活活动能力及神经功能进行评估,比较两组患者的临床疗效.结果 治疗前两组Fugl-Meyer、Barthel指数及NIHSS评分比较,差异无统计学意义(P＞0.05).治疗3个月后,两组Fugl-Meyer评分及Barthel指数均较治疗前升高(P＜0.05),且研究组高于对照组(P＜0.05);两组NIHSS评分均较治疗前降低(P＜0.05),且研究组评分低于对照组(P＜0.05).结论 在常规药物治疗的基础上,使用电温针治疗能改善脑卒中并偏瘫患者生活能力及运动功能,提高临床疗效.