甲状腺结节超声引导下粗针穿刺组织学活检的有效性研究

目的研究甲状腺结节超声引导下粗针穿刺(US－CNB)组织学活检的有效性，探讨其对甲状腺结节的诊断价值。 方法回顾性分析2009年6月至2016年6月行术前US－CNB的2 051例患者的2 286个结节的病理诊断，将其中在本院行手术切除的530个甲状腺结节纳入本研究。以术后组织病理学为金标准，采用SPSS 19.0统计软件分析处理数据，分析US－CNB病理诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度，并用ROC曲线对比粗针穿刺活检病理结果及手术病理结果。 结果US－CNB的2 286个甲状腺结节中仅2例取材不成功，2 284个(99.9%)结节取材切片成功，得到组织病理诊断；530个术后结节的US－CNB的诊断敏感度、特异度、阳性预测值、阴性预测值、准确度分别99.8%、86.5%、98.6%、97.8%和98.5%。 结论由于US－CNB对甲状腺结节有很高的取材成功率及病理诊断准确率，从而对甲状腺结节有很高的术前诊断价值。     

A Minimum Of 100 Tumor Cells in a Single Biopsy Sample Is Required to Assess Programmed Cell Death Ligand 1 Expression in Predicting Patient Response to Nivolumab Treatment in Nonsquamous Non–Small Cell Lung Carcinoma

IntroductionProgrammed death ligand 1 (PD-L1) expression is a predictive biomarker for patient response to nivolumab in nonsquamous NSCLC. However, the number of biopsy samples and tumor cells (TCs) required to assess PD-L1 expression remains unclear.MethodsA total of 222 biopsy samples from 80 patients with nonsquamous NSCLC treated with nivolumab were collected. Number of TCs and PD-L1 score were compared among the sample containing the largest number of TCs (Max-TC), the sample containing the smallest number of TCs (Min-TC), and the total samples from each patient. The impact of the number of samples and TCs on the prediction of patient response to nivolumab with use of PD-L1 scores was evaluated.ResultsThere was a mismatch in PD-L1 scores less than 1% and those of at least 1% between Max-TC and the total samples in one patient (1%) and between Max-TC and Min-TC in six patients (8%). The optimal number of TCs to match PD-L1 expression less than 1% versus at least 1% between Max-TC and Min-TC was 100 (sensitivity = 0.676 and 1 – specificity = 0.333). PD-L1 expression of at least 1% in Min-TCs containing at least 100 TCs was associated with longer progression-free survival (median 7.6 versus 1.8 months [p < 0.01]) and overall survival (median not reached versus 9.9 months [p = 0.04]) compared with PD-L1 expression less than 1%. However, there were no differences in progression-free survival (median 3.9 versus 2.3 months [p = 0.37]) or overall survival (median 9.7 versus 7.6 months [p = 0.60]) between PD-L1 expression of at least 1% and PD-L1expression less than 1% in Min-TCs containing fewer than 100 TCs.ConclusionSingle biopsy samples containing at least 100 TCs are required to evaluate PD-L1 expression for predicting patient response to nivolumab.     

The diagnostic significance of repeat ultrasound-guided biopsy of musculoskeletal soft-tissue lesions with initially inconclusive biopsy results

IntroductionTo determine the diagnostic yield of repeat ultrasound (US)-guided biopsy of musculoskeletal soft-tissue lesions with initially inconclusive biopsy results, and to explore predictive factors for success of repeat biopsy.Materials and methodsThis retrospective study included 42 patients who underwent a repeat (second) US-guided biopsy session to target a musculoskeletal soft-tissue lesion because an initial US-guided biopsy session provided inconclusive results. Both biopsy sessions were performed in a tertiary referral center for soft-tissue sarcomas.ResultsThe diagnostic yield of repeat US-guided biopsy was 47.6%. Malignant nature of the lesion (P = 0.031), sharp lesion borders on US (P = 0.011), and good to very good lesion visibility on US (P = 0.017) were significantly associated with a diagnostic repeat US-guided biopsy. There was also a trend towards significance (P = 0.073) for a higher number of biopsy passes through the lesion. Other patient characteristics (age and gender), magnetic resonance imaging features (lesion homogeneity on T1-weighted, T2-weighted, and gadolinium chelate enhanced sequences, borders, enhancement pattern, depth and size), US features (lesion appearance, vascular flow, and depth), biopsy-related factors (days between initial and repeat US-guided biopsy, needle diameter, maximum length of acquired samples), and operator-related factors (same or different radiologists/pathologists for initial and repeat biopsies), were not associated with the diagnostic success of the repeat US-guided biopsy.ConclusionsRepeat US-guided biopsy of a musculoskeletal soft-tissue lesion with initially inconclusive biopsy results can be useful to establish a final diagnosis. Lesion features on US (borders and visibility) may be used to prospectively determine the utility of a repeat US-guided biopsy.     

肺结节活检和病理诊断在当前医疗实践中的必要性和可行性

早期发现和准确诊断肺癌是降低肺癌死亡率的关键。低剂量CT影像是早期肺癌起始筛查的主要方法。本文从病理的角度，重点阐述了肺结节活检在早期肺癌筛查中的重要性和在临床实践中的可行性，以及对于影像发现的肺结节，如何在实践中方便高效取样及合理处理样品，以期达到准确诊断、分型、鉴别诊断和指导临床实践的目的。     

Caliber-persistent labial artery: report of 3 cases

The caliber-persistent labial artery is a vascular anomaly in which a primary arterial branch penetrates into the submucosal tissue without reduction in diameter. Most lesions are benign and do not require treatment, except for complications and/or on patient demands. In this way, noninvasive diagnostic tools are preferred such as high-resolution and color Doppler ultrasonography which allow direct observation of the lesion, assessing its exact location and diameter at every axis, as well as the blood flow velocity. An excisional biopsy of these lesions or even their surgical extirpation could have a fatal outcome with profuse bleeding.     

Tomographic and histomorphometric evaluation of socket healing after tooth extraction using leukocyte- and platelet-rich fibrin: A randomized,single-blind,controlled clinical trial

The use of platelet concentrate in alveolar ridge preservation has been broadly studied. However, no randomized clinical trials with histomorphometric analysis and low risk of bias are available in the literature. We conducted a prospective, single-blind, parallel, randomized, controlled clinical trial to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in socket preservation after tooth extraction. Additionally, the effect of L-PRF on bone formation was analyzed histologically using bone biopsy specimens obtained during implant placement.A total of 48 subjects who underwent a non-molar tooth extraction were randomly assigned to the L-PRF group (n = 24) or the control group (n = 24). Cone-beam computed tomographies were performed immediately after tooth extraction and at 3 months after tooth extraction, prior to implant surgery. A significant difference in bone resorption was registered 1 mm below the crest: 0.93 ± 0.9 mm for the L-PRF group and 2.27 ± 1.2 mm for the control group (p = 0.0001). Histomorphometric analysis showed a higher percentage of new bone formation in the L-PRF group compared with the control group. The values were 55.96 ± 11.97% and 39.69 ± 11.13%, respectively (p = 0.00001). These findings indicate that the administration of L-PRF should always be considered when socket preservation is planned (Clinicaltrials.gov NCT03408418).     

小视野弥散加权成像定位经直肠超声引导前列腺穿刺活检术对前列腺癌的诊断价值

目的 评价小视野弥散加权成像（rFOV DWI）定位经直肠超声（TRUS）引导前列腺穿刺活检术对前列腺癌（PCa）的诊断价值。方法 收集2016年9月至2017年10月期间于TRUS引导下行前列腺穿刺活检的54例患者，术前均接受rFOV DWI检查。根据前列腺影像报告和数据系统对rFOV DWI图像进行评估，采用经会阴途径10点系统穿刺（SB）和rFOV DWI定目标穿刺（rFOV DWI-TB）相结合的穿刺方案。以穿刺病理结果为金标准，计算rFOV DWI的诊断效能，并比较SB、rFOV DWI-TB及SB联合rFOV DWI-TB在PCa检出率和穿刺点阳性率上的差异。结果 54例患者穿刺病理诊断PCa 26例，rFOV DWI诊断PCa的敏感性、特异性、阳性预测值、阴性预测值分别为80．77%、89．29%、87．50%、83．33%，rFOV DWI诊断PCa的AUC为0．916。rFOV DWI对临床显著性PCa的诊断敏感性为95%。SB、rFOV DWI-TB与SB联合rFOV DWI-TB检出率差异均无统计学意义（P>0．05），但SB联合rFOV DWI-TB的检出率显著高于SB（P=0．031）。rFOV DWI-TB穿刺点阳性率显著高于SB（χ²=124．377，P=0．000）。结论 rFOV DWI有助于术前PCa可疑病灶，特别是临床显著性PCa病灶的检出，为TRUS引导前列腺穿刺活检提供目标信息，有较高的临床应用价值。     

Prevalence and diagnostic outcomes of children with duodenal lesions and negative celiac serology

BackgroundCeliac disease diagnostics begin by measuring autoantibodies, which may fail to identify seronegative patients. Duodenal lesion in the absence of antibodies is scarcely studied, especially in children.AimsTo investigate the prevalence and diagnostic outcomes of children with seronegative duodenal lesion in two countries with different disease profiles.MethodsMedical data, including the results of histology and transglutaminase (tTGab) and endomysium (EmA) antibody measurements were collected from 1172 Finnish and 264 Romanian children with systematic duodenal sampling. Database of 509 Finnish children with celiac disease was examined to identify earlier seronegative patients.ResultsCeliac disease was diagnosed in 307 Finnish and 83 Romanian children in the endoscopy cohorts. No seronegative patients were found among 899 celiac disease patients, although some were only tTGab or EmA positive. Non-celiac duodenal lesion was detected in eight Finnish and 32 Romanian children, their most common diagnoses being inflammatory bowel disease and infections, respectively. Six children with morphological lesion received no diagnosis. None of them developed celiac disease during a follow-up of 3–11 years.ConclusionPediatric seronegative celiac disease is exceptional in the era of modern autoantibodies. Other reasons for duodenal lesion should therefore be sought, bearing in mind possible differences across countries.