人肝癌及癌周组织中γ-谷氨酰转肽酶、甲胎蛋白癌胚抗原的表达

用丫-谷氨酞转肽酶-甲胎蛋白(GGT-AFP)双染色法研究了人肝癌及癌周组织中GGT,AFP的表达,同时观察了癌胚抗原(CEA)的分布.20例肝癌组织中,11例GGT阳性,10例AFP阳性.13例CEA阳性.在癌周组织中,6例GGT阳性,2例AFP阳性,20例CEA阳性.证实肝细胞癌可表达GGT,AFP,增生结节属癌前期病变,与肝癌的发生有关,GGT,AFP的增高与肝癌密切相关,CEA无特异性.     

声触诊组织成像量化技术联合C-TIRADS与K-TIRADS对甲状腺结节的诊断效能比较

目的探讨声触诊组织成像量化(VTIQ)技术联合中国超声甲状腺影像报告系统(C-TIRADS)和韩国甲状腺影像分级系统(K-TIRADS)对甲状腺结节良恶性的诊断效能。 方法回顾性选择160例甲状腺结节患者,按病理结果分为良性组和恶性组。所有患者均经常规超声检查、VTIQ检查,根据C-TIRADS、K-TIRADS分级标准进行分级。ROC曲线分析C-TIRADS、K-TIRADS单独诊断或联合VTIQ对甲状腺结节良恶性的诊断效能。 结果两种系统单独应用时,K-TIRADS灵敏度低于C-TIRADS,但K-TIRADS特异性更高。与C-TIRADS、K-TIRADS比较,K-TIRADS和C-TIRADS联合VTIQ对甲状腺结节的诊断效能均有所增加,C-TIRADS联合VTIQ后特异度和灵敏度高于K-TIRADS联合VTIQ(P＜0.05)。 结论C-TIRADS或K-TIRADS联合VTIQ对甲状腺结节良恶性的诊断效能高于单独诊断,C-TIRADS联合VTIQ更有利于甲状腺良恶性判断。     

C-TIRADS及BRAFV600E基因检测对细针穿刺细胞学难以定性的甲状腺结节的诊断价值

目的 探讨中国版甲状腺影像数据与报告系统（C-TIRADS）、BRAFV600E 基因检测及二者联合对细针穿刺细胞学难以定性的甲状腺结节的诊断价值。方法 纳入我院2020年1月—2021年4月的甲状腺手术患者53例行回顾性分析,术前完成超声、细针穿刺抽吸及BRAFV600E基因检测,选取细针穿刺细胞学难以定性的患者作为研究对象,53例患者共62个结节。以手术病理结果作为金标准,比较C-TIRADS、BRAFV600E基因检测及二者联合诊断对甲状腺结节的诊断效能。结果 C-TIRADS诊断甲状腺癌的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为92.50%、50.00%、77.08%、78.57%、77.42%。BRAFV600E基因诊断甲状腺癌的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为55.00%、100.00%、100.00%、55.00%、70.97%。C-TIRADS联合BRAFV600E基因诊断甲状腺癌的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为95.00%、50.00%、77.55%、84.62%、79.03%。C-TIRADS及联合诊断对甲状腺癌诊断的敏感性高于BRAFV600E基因检测（P<0.001）,BRAFV600E基因检测特异性及阳性预测值高于C-TIRADS及联合诊断（P<0.05）。C-TIRADS、BRAFV600E基因检测及联合诊断对甲状腺癌诊断的阴性预测值和准确性差异无统计学意义（P>0.05）。结论 C-TIRADS及BRAFV600E基因检测对于细胞学难以定性的甲状腺结节均有良好的诊断效能,术前联合应用可以更好地评估甲状腺结节     

Cost-effectiveness of fine-needle-aspiration cytology of thyroid nodules with intranodular vascular pattern using two different needle types

Objective: To compare the cytological findings of hypoechoic thyroid nodules with intranodular vascular pattern (pattern II) obtained by two different needles (Neolus 25 gauge, Chemil, Wenzhou, China vs Yale Spinal 25 gauge, Becton Dickinson, Madrid, Spain) in euthyroid patients and to evaluate their cost-effectiveness. Methods: From January 2001 to December 2003, 480 euthyroid patients with a hypoechoic thyroid nodule pattern II were referred for US-FNAC. The nodules were alternatively evaluated by Neolus or by Yale Spinal with the stylet (YS+) or without the stylet (YS−), in order to evaluate if the cytological results could be due to the presence of the stylet or to the different length of the two needles. For each nodule two passes were performed and the material was obtained by capillary action. Material was smeared on slides, fixed, and stained by Papanicolaou techniques. Cytological specimens were evaluated in blind by the same experienced cytopathologist. Results: Inadequate cytological specimens because of blood contamination were present in 30 (18.7%) samples by Neolus needle and in 22 (13.8%) by YS− compared to only 5 (3.1%) by YS+. In 6 (20%) cases of the 30 repeated US-FNAC by Neolus and in 4 (18%) of the 22 US-FNAC by YS−, material remained inadequate for diagnosis because of blood contamination. All the five repeated samples obtained by YS+ became adequate for diagnosis and resulted benign nodules. Direct costs of US-FNAC procedure are currently Э 72.30 including cytological examination. The cost of Neolus and Yale needles is Э 0.19 and Э 3.0, respectively. The estimated total cost to obtain a cytological diagnosis by a Neolus needle (160 + 30 repeated US-FNAC) was Э 13809.2 vs Э 12919.5 by Yale Spinal needle (160 + 5 repeated US-FNAC). Conclusion: This study demonstrates that the use of Yale Spinal needles greatly reduces inadequate cytological specimens, and therefore limits both direct and indirect costs.     

Computer-Assisted Detection of Pulmonary Nodules: Preliminary Observations Using a Prototype System with Multidetector-Row CT Data Sets

The continued revolution in multidetector-row CT (MDCT) scanning increases the quality of lung imaging but at the cost of a greater burden of data for review and interpretation. This article discusses our preliminary experience with prototype software for lung nodule detection and characterization using MDCT data sets. We discuss the potential role of computer-assisted detection (CAD) as applied to the automatic detection of lung nodules. We also review the process of CAD, outline its potential results, and explore how it may fit into existing radiology practice. Finally, we discuss MDCT data-acquisition parameters and how they may affect the performance of CAD.     

Iris (Lisch) nodules in neurofibromatosis

A group of 30 patients ranging from 4 to 56 years of age with the peripheral form of neurofibromatosis were evaluated for the presence of iris (Lisch) nodules. These nodules were observed in 73% of our cases and their presence was directly related to the severity of the skin manifestations of the disease. It is concluded that Lisch nodules are pathognomonic for neurofibromatosis and thus, their presence should be looked for in all suspected cases.     

肺结节患者的临床特征在判断良恶性中的意义

目的探究肺结节特点与其病理结果的相关性,分析患者临床特征（临床因素、检验结果、胸部CT影像特征）对判断肺结节良恶性的临床意义。 方法回顾性分析147例肺结节患者,根据病理活检结果分为良性组39例,恶性组108例。比较两组患者的一般情况（性别、年龄、吸烟史、恶性肿瘤家族史）、肺癌4项[癌胚抗原（CEA）、鳞状上皮细胞抗原（SCCAg）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19片段（Cyfra21-1）]以及高分辨率CT征象,评估差异有统计学意义的因素在鉴别良恶性肺结节中的效能。 结果两组患者在性别、吸烟史、4个肺癌指标（CEA、SCCAg、NSE、Cyfra21-1）、结节大小、结节边缘、毛刺征的比较,差异均无统计学意义（均P＞0.05）,在年龄、恶性肿瘤家族史、结节形态、分叶征、空泡征、胸膜牵拉征、血管集束征的比较,差异均有统计学意义（均P＜0.05）。在高分辨率CT征象中,分叶征对判断肺结节良恶性的效能最高,敏感度达79.6%。Logistic线性回归分析显示磨玻璃结节、分叶征、空泡征都是恶性的危险因素（均P＜0.05）。 结论患者的年龄、恶性肿瘤家族史、结节形态（磨玻璃结节）、分叶征、空泡征、胸膜牵拉征、血管集束征对鉴别肺结节良恶性有一定的参考意义。     

女性单纯声带肥厚和声带小结的嗓音参数分析比较

目的：通过比较和分析单纯声带肥厚和声带小结的嗓音参数的变化,评价这些参数在两种疾病中诊断及疗效。方法：应用Dr.Speech(DSS)软件对成人女性30例单纯声带肥厚和声带小结患者做噪音测试,对其主要声学参数进行比较分析。结果：声带小结的嗓音声学参数、基频微扰、声门噪声能量NEE值均较声厚的各指标高。其中声门噪声能量在声结中异常者占99．6％,声带肥厚占80％,两组之间有显著性差异（P＜0．05）。其频微扰和振幅微扰的异常占有率,两组之间无显著性差异（P＞0．05）。结论：嗓音参数对诊断和区别声带肥厚和声结有一定的价值,特别是声门噪声能量有更高的敏感性,对诊断和治疗声带疾病有一定的价值。     

Is patient age associated with risk of malignancy in a ≥4 cm cytologically benign thyroid nodule?

BackgroundCurrent data regarding the risk of malignancy in a large thyroid nodule with benign fine-needle aspiration biopsy(FNAB) is conflicting. We investigated the impact of patient age on the risk of malignancy in nodules≥4 cm with benign cytology.MethodsWe performed a single-institution retrospective review of patients who underwent surgery from 07/2008–08/2019 for a cytologically benign thyroid nodule ≥4 cm. The relationship between malignant histopathology and patient and ultrasound features was assessed with multivariable logistic regression.ResultsOf 474 nodules identified, 25(5.3%) were malignant on final pathology. In patients <55 years old, 21/273(7.7%) nodules were malignant, compared to 4/201(2.0%) in patients ≥55. Patient age ≥55 was independently associated with significantly lower risk of malignancy(OR:0.2,95%CI:0.1–0.7,p = 0.011). Increasing nodule size >4 cm and high-risk ultrasound features were not associated with risk of malignancy(OR:1.0,95%CI:0.7–1.4,p = 0.980, and OR:9.6,95%CI:0.9–107.8,p = 0.066, respectively).ConclusionsPatients <55 years old are 3.7-fold more likely to have a falsely benign FNA biopsy in a nodule≥4 cm.     

穿刺活检联合微波消融治疗高龄患者肺单发恶性倾向小结节

目的观察CT引导下经皮穿刺肺活检联合同步交叉法微波消融治疗高龄患者肺单发恶性倾向小结节的疗效。方法将48例肺单发恶性倾向小结节高龄患者随机分为2组,每组24例。试验组于穿刺活检后经异穿刺点交叉针道进行微波消融,对照组穿刺活检后经同轴套管同针道行微波消融,对比2组技术成功率、疗效、总有效率及并发症发生率。结果2组穿刺活检和微波消融操作成功率、总有效率及局部控制率均为100%。试验组中、重度气胸发生率为20.83%(5/24),对照组为58.33%(14/24);试验组中、大量胸腔积液发生率为8.33%(2/24),对照组为37.50%(9/24);试验组中、大量咯血发生率为12.50%(3/24),对照组为48.83%(11/24);组间差异均有统计学意义(P均<0.05)。随访6个月,2组患者均未出现并发症。结论CT定位下经皮穿刺肺活检联合同步交叉法微波消融治疗高龄患者肺单发恶性倾向小结节疗效确切,安全性较好。