超声引导下细针穿刺结合BRAF V600E检测在诊断甲状腺癌的价值

目的 探讨超声引导下细针穿刺抽吸细胞学检查(US-FNA)结合BRAF V600E基因检测在诊断甲状腺乳头状癌的价值.方法 选取60例甲状腺乳头状癌患者,行超声引导下细针穿刺抽吸细胞学检查,分析US-FNA结合BRAFV600E基因检测在甲状腺乳头状癌中的灵敏度、特异度、阳性预测值、阴性预测值.结果 术后病理组织学检查...     

超声引导下粗针、细针穿刺活检在直径>1 cm可疑甲状腺结节中诊断应用

目的探讨超声引导下细针穿刺细胞学检查、粗针穿刺组织学检查在直径>1 cm可疑甲状腺结节诊断中的应用价值。方法选取自2016年10月至2019年8月曲靖市第一人民医院收治的176例直径>1 cm的可疑甲状腺结节患者为研究对象。所有患者均先在超声引导下进行细针穿刺细胞学检查或粗针穿刺组织学检查。记录两种方法诊断可疑甲状腺结节的大小,假阳性率、假阴性率、诊断符合率,以及并发症情况。结果 64例患者进行了粗针穿刺组织学检查,其中,12例患者结节直径1～2 cm,27例患者结节直径2～3 cm,25例患者结节直径>3 cm。112例患者进行了细针穿刺细胞学检查,其中,43例患者结节直径1～2 cm,48例患者结节直径2～3 cm,21例患者结节直径>3 cm。两种方法检测的假阳性率、假阴性率比较,差异有统计学意义(P<0.05)。两种方法检测的诊断符合率比较,差异无统计学意义(P>0.05)。粗针穿刺组织学检查的并发症发生率为40.6%(26/64),高于细针穿刺细胞学检查的8.9%(10/112),差异有统计学意义(P<0.05)。结论超声引导下粗针与细针穿刺活检诊断直径>1 cm的可疑甲状腺结节,均有效、可行。在保证患者安全的前提下,可根据患者要求及临床推荐、超声评估等多种手段,选择适当的穿刺活检方法对结节进行诊断。     

甲状腺乳头状癌术后超声引导下淋巴结穿刺195例的临床分析

目的分析甲状腺乳头状癌术后颈部复发、转移性淋巴结的超声表现,探讨超声引导下细针穿刺细胞学检查在甲状腺乳头状癌术后颈部淋巴结转移的应用价值。方法收集我院甲状腺乳头状癌术后接受颈部淋巴结超声引导下细针穿刺的195例患者的资料,分析转移性淋巴结超声影像学特点与病理结果的关系。结果 195例患者中共277枚淋巴结接受穿刺检查,其中86例(123枚)淋巴结为转移性,占穿刺淋巴结的44.4%,复发或转移的淋巴结多分布于颈部III区(33.3%)及IV区(42.3%),超声特征性表现为长径/短径(L/S)比值小、回声分布不均匀、常伴有点状强回声、Adler血流分级2~3级,与非转移性淋巴结相比,差异有统计学意义(P0.01)。结论甲状腺癌术后颈部转移性淋巴结具有特征性超声表现,超声引导下的颈部淋巴结细针穿刺细胞学检查是一种简便且安全有效的确诊手段,有助于指导患者的进一步治疗。     

超声TI-RADS分类与细针穿刺活检在诊断甲状腺恶性结节中的临床应用

目的探讨甲状腺影像报告和数据系统分类（TI-RADS）与细针穿刺活检（FNA）在诊断甲状腺恶性结节中的临床应用价值。 方法回顾性分析我院于2020年1月至2020年12月期间常规甲状腺超声检查中TI-RADS分类≥3类的585例患者的588个甲状腺结节,所有患者均接受甲状腺细针穿刺细胞学活检,其中266个甲状腺结节手术切除,以大体病理为金标准,评价超声TI-RADS分类与细针穿刺活检诊断甲状腺恶性结节的效能。 结果588个甲状腺结节细胞学病理诊断恶性243例、良性193例、性质不确定152例,超声TI-RADS 3、4、5类甲状腺恶性结节的阳性率分别为3.01%（4/133）、38.87%（110/283）、75.00%（129/172）;266个结节手术切除,大体病理诊断恶性211例、良性55例,细针穿刺活检诊断甲状腺恶性结节的敏感性、特异性、准确性分别为98.46%、93.02%、97.48%,阳性预测值为98.46%,阴性预测值为93.02%,阳性似然比为14.11,阴性似然比为0.017;穿刺感硬及有砂粒感诊断为甲状腺恶性结节的准确性明显高于穿刺感软及无砂粒感,差异有统计学意义（χ² = 70.206,65.083;P = 0.000,0.000）;超声TI-RADS分类及细针穿刺活检诊断甲状腺恶性结节的ROC曲线下面积分别为0.881及0.954。 结论超声TI-RADS分类结合细针穿刺活检对甲状腺恶性结节有较高的诊断价值,可更准确、更安全地判断甲状腺结节的良恶性,值得临床推广。     

超声引导下甲状腺细针穿刺活检的临床价值分析

目的探讨超声引导下甲状腺细针穿刺活检的临床价值。方法选取超声引导下甲状腺细针穿刺活检(US-FNAB)的994例患者,分析其穿刺前后的甲状腺手术疾病构成变化和甲状腺微小乳头状癌(PTMC)细胞学特征。结果 994例患者中,317例采取手术切除,其中US-FNAB的准确度为98.4%,特异度为93.2%,敏感性为99.6%。本文中251例经组织学诊断确诊为甲状腺癌(PTC),在最大径不低于1cm时有90.68%病例已经细胞学诊断明确,但是在PTMC时仅有35.55%病例经细胞学明确诊断。在PTMC细胞学特征方面20.00%的病例可见到典型的乳头状结构,并且98.88%的病例可以见到单层片块状结构。结论在超声引导下采用甲状腺细针穿刺活检可大幅度提高甲状腺癌患者的检出率。     

超声引导粗针活检在诊断甲状腺结节中的应用价值

目的：探讨超声引导下粗针活检（ultrasound-guided core-needle biopsy,US-CNB）在诊断甲状腺结节中的应用价值。方法将术前超声诊断为甲状腺恶性结节的120例患者分为两组,观察组60例,采用超声引导下粗针活检;对照组60例,采用超声引导下细针穿刺细胞学检查（fine needle aspiration cytology ,FNAC）。比较两组病例取材满意度、诊断准确性和安全性。结果观察组取材满意度、诊断准确性明显高于对照组,差异具有统计学意义（P＜0.05）。两组敏感性、特异性、阳性预测值、阴性预测值和并发症比较,差异无统计学意义（P＞0.05）。结论超声引导下粗针活检甲状腺结节取材满意度和诊断准确性高于细针活检,同时也安全可靠,更值得临床推广应用。     

超声引导下细针穿刺不同直径甲状腺结节诊断的临床应用价值

目的 探讨超声引导下细针穿刺抽吸活检用于不同直径甲状腺结节的标本获取情况及诊断价值。方法 选取126例甲状腺结节患者，29例患者甲状腺结节直径<5 mm为A组，42例患者甲状腺结节直径5～10 mm为B组，55例甲状腺结节直径>10 mm为C组。比较三组超声引导下细针穿刺抽吸活检的细胞学检查结果；以常规病理学诊断或随访结果为金标准，以Kappa分析超声引导下细针穿刺抽吸活检诊断不同直径甲状腺结节良恶性与金标准的一致性。结果126个甲状腺结节穿刺成功率为100%,超声引导下细针穿刺抽吸活检诊断直径<5 mm、5～10 mm、>10 mm的甲状腺结节良恶性均有较好的价值，敏感性分别为85.7%、84.6%、88.2%,特异性分别为90.9%、93.1%、86.8%,Kappa值分别为0.731、0.777、0.716,细胞学检查结果显示，A组恶性结节8个、良性结节21个，B组恶性结节13个、良性结节29个，C组恶性结节20个、良性结节35个，三组超声引导下细针穿刺抽吸活检的细胞学检查结果差异无统计学意义(P>0.05);病理组织活检结果显示，A组恶性结节7个、...     

常规超声特征联合增强CT检查甲状腺乳头状癌颈部淋巴结转移临床应用

目的 探讨常规超声特征联合增强CT检查甲状腺乳头状癌颈部淋巴结转移中的临床应用。方法 选取甲状腺乳头状癌患者60例，常规超声特征联合增强CT检查作为观察组，单纯CT检查作为CT对照组，单纯超声检查作为对照组，每组的患者均为20例，分析三种方法在甲状腺乳头状癌颈部淋巴结转移中影像表现特征。结果 观察组、CT对照组、对照组的Ⅰ区转移颈部淋巴结的诊断阳性率分别是83.76%、72.07%、72.87%。观察组的Ⅰ区转移颈部淋巴结的诊断阳性率均高于CT对照组和对照组。观察组、CT对照组、对照组的Ⅱ、Ⅲ、Ⅳ区转移颈部淋巴结的诊断阳性率分别是87.50%、70.55%、82.69%。观察组的Ⅱ、Ⅲ、Ⅳ区转移颈部淋巴结的诊断阳性率均高于CT对照组和对照组。观察组、CT对照组、对照组的Ⅴ、Ⅵ区转移颈部淋巴结的诊断阳性率分别是92.31%、72.00%、76.79%。观察组的Ⅴ、Ⅵ区转移颈部淋巴结的诊断阳性率均高于CT对照组和对照组。结论 常规超声特征联合增强CT可显著提高单项CT检查对甲状腺乳头状癌颈部淋巴结转移诊断的准确性。     

超声造影联合细针穿刺手感对甲状腺乳头状癌的诊断价值

 目的 探讨超声造影(contrast enhanced ultrasound, CEUS)和超声引导下细针穿刺细胞学检查(fine-needle aspiration cytology, FNAC,简称“穿刺手感”)及二者联合诊断甲状腺乳头状癌(papillary thyroid carcinoma ,PTC)的价值。方法 回顾性分析2017-09至2020-01解放军总医院海南医院超声诊断科进行超声检查、CEUS及超声引导下穿刺手感患者312例(312个结节),每个结节在穿刺过程中均记录穿刺手感,最终以手术病理结果为金标准。采用特征曲线(ROC)评价CEUS、穿刺手感和两者联合应用的诊断效果。结果 312例中共有良性结节116个,196个诊断为PTC。穿刺手感联合CEUS的准确率(97.450%)高于单独使用CEUS(87.244%)或穿刺手感(63.776%),差异有统计学意义(P<0.05)。CEUS和穿刺手感联合诊断甲状腺结节ROC曲线下面积(0.767)大于单独使用超声造影(0.734)及穿刺手感(0.711),差异均有统计学意义(P<0.05),但CEUS与穿刺手感在诊断PTC ROC曲线下面积差异无统计学意义。结论 CEUS联合穿刺手感对PTC诊断的准确性高于单一使用超声造影或穿刺手感。     

C-TIRADS对甲状腺囊性、囊实性机化皱缩结节与恶性结节的超声鉴别诊断

目的 应用2020甲状腺结节超声恶性危险分层中国指南(C-TIRADS)对甲状腺囊性、囊实性机化皱缩结节与甲状腺乳头状癌的超声显像特点进行鉴别分析,以提高甲状腺囊性和囊实性机化皱缩结节的超声诊断水平.资料与方法 回顾性选取2018年3月—2021年4月泰安市中心医院分院经细针穿刺细胞学检查或手术病理证实的甲状腺囊性、囊...     

Cystic papillary carcinoma of the thyroid gland: a new sonographic sign

Cystic thyroid lesions are generally considered to be benign and managed by repeated aspiration and/or biopsy. We report characteristic sonographic signs in eight cases of cystic papillary carcinomas of the thyroid gland. In all eight cases, ultrasonography (US) revealed mostly cystic lesions with solid excrescences protruding into the cyst. These nodules contained multiple punctate echogenic foci suggesting calcification. In three of these cases the initial fine needle aspiration biopsy was negative. The 'calcified nodule in cyst' sign was found to be very specific for cystic thyroid carcinoma in a review of the ultrasound findings in 115 patients with nodular thyroid lesions. Careful evaluation and/or surgery should be recommended in patients who have such characteristic sonographic findings even if the fine needle aspiration result is negative.     

Radioiodine (131I) accumulation in bronchogenic cyst in the setting of thyroid carcinoma remission

A 76-year-old woman had (131)I accumulation within the mediastinum in the setting of thyroid carcinoma remission. Extensive diagnostic imaging including computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound, bronchoscopy, and subsequently a needle aspiration biopsy revealed that the mass was a bronchogenic cyst. Five-year clinical and laboratory follow-up showed that the patient was free from thyroid carcinoma recurrence.     

Value of ultrasound-guided cytopuncture in the diagnosis of hepatocellular carcinoma

Ultrasonically guided fine needle aspiration biopsy cytologies (external diameter inferior to 1 mm) were carried out in 28 patients with proved hepatocellular carcinoma. In all cases, the diagnosis of malignant involvement of the liver was firmly established by cytological examination. A correct diagnosis of hepatocellular carcinoma was made in 26 of 28 patients (sensitivity = 93%). The specificity of the procedure was 100%. No complications were observed. The present study shows that fine needle aspiration biopsy under ultrasound guidance is a safe and accurate diagnostic procedure in hepatocellular carcinoma even associated with cirrhosis.     

Percutaneous needle evaluation of intradural extramedullary lesions of the lumbar spine

Summary A total of eight patients in whom five intradural extramedullary lesions and three epidural lesions were present were evaluated by percutaneous needle biopsy. In four patients the level of aspiration biopsy was determined using the initial myelogram and in those patients fluoroscopic guided percutaneous needle biopsies were performed. Three of these patients had large intradural extramedullary masses (above 1 cm); one patient had an epidural lesion. Diagnostic material was obtained in all cases (medulloblastoma, astrocytoma, small cell carcinoma, adenocarcinoma). Immediate post procedure CT and clinical followup showed no complications. In three patients with small lesions (below 1 cm), post myelographic CT was used to determine the level of aspiration. Post myelographic CT showed an intradural extramedullary mass in one patient and epidural lesions in two cases. Plain CT showed a high attenuation lesion in one patient. CT guided percutaneous needle biopsies in these four patients yielded diagnostic specimens (neurofibroma, uroepithelial carcinoma, hematoma, Thorotrast deposit). Clinical follow up showed no complications. Our experience indicates that percutaneous needle biopsy of intradural extramedullary and epidural lesions of the lumbar spine is safe and efficacious. Depending upon the size of the lesions, myelography or CT can be utilized to determine the level of aspiration.     

甲状腺乳头状癌淋巴结转移诊疗现状研究

甲状腺乳头状癌（PTC）是甲状腺癌最常见的组织病理学类型,其淋巴结转移影响患者的预后。目前PTC的淋巴结转移机制尚不明确,其诊断方法包括超声、细针穿刺活检、CT、MRI、SPECT/CT、PET/CT等,但特异度及灵敏度均不高,联合使用可以提高检出率。PTC淋巴结转移首选的治疗方式是手术。目前PTC淋巴结转移早期综合诊断及有效治疗是改善和提高PTC患者生活质量的难点。笔者就PTC淋巴结转移的诊疗现状及研究进展进行综述。     

The development of ultrasonically guided fine needle aspiration biopsy in the diagnosis of nonpalpable minimal thyroid tumors

We have developed two practical adapters for the ultrasonically guided fine needle aspiration biopsy of the thyroid tumors. The aspiration needle was easily identified on the real-time ultrasonograms. We succeeded in obtaining sufficient materials for cytologic diagnoses in 64 out of 67 minimal thyroid lesions of 10 mm or less diameter. Eight patients with nonpalpable minimal thyroid cancer were discovered by this modality. The diameter of these lesions were 7, 6, 5, 5, 4, 4, 3 and 3 mm, respectively. None of the 20 patients with cystic fluid in the tumor showed the posterior echo enhancement known to be characteristic of the cystic tumor on ultrasonograms, and all of them were proved to have benign tumors on cytologic examinations. In conclusion, the ultrasonically guided fine needle aspiration biopsy using these adapters was confirmed to be a highly valuable diagnostic tool.     

Evaluating the Degree of Conformity of Papillary Carcinoma and Follicular Carcinoma to the Reported Ultrasonographic Findings of Malignant Thyroid Tumor

Objective

We wanted to evaluate the degree of conformity of papillary carcinoma and follicular carcinoma to the reported ultrasonographic findings of malignant thyroid tumor.

Materials and Methods

Between January 2003 and December 2004, fine needle aspiration biopsy was performed in 1,036 patients with palpable and nonpalpable thyroid lesions. We retrospectively reviewed the ultrasonographic findings of patients with papillary carcinomas (n = 127) and follicular carcinomas (n = 23) that were proven by operation or fine needle aspiration biopsy. We analyzed the ultrasonographic findings of these nodules based on the reported ultrasonographic findings of malignant thyroid tumor: hypoechogenicity, a taller than wide orientation, a microlobulated or irregular margin, a thick hypoechoic rim (halo sign), microcalcification and cystic change.

Results

The echogenicity was hypoechoic in 72.4% (92/127) of the papillary carcinomas, but it was isoechoic in 65.2% (15/23) of the follicular carcinomas (p < 0.001). The nodule shape was tall or round in 74.1% of the papillary carcinomas, but it was flat in 72.7% of the follicular carcinomas (p < 0.001). The tumor margin was microlobulated or irregular in 92.9% of the papillary carcinomas and in 60.9% of the follicular carcinomas (p < 0.001). A hypoechoic rim was seen in 26% of the papillary carcinomas (thin rim: 13.4%, thick rim: 12.6%) and in 86.6% of the follicular carcinomas (thin rim: 39.1%, thick rim: 47.8%, p < 0.001). Microcalcifications were demonstrated in 33.9% of the papillary carcinomas and in none of the cases of follicular carcinoma (p < 0.001). A solid mass without cystic change were seen in 98.4% of the papillary carcinomas and in 82.6% of the follicular carcinomas (p < 0.001).

Conclusion

The previously reported ultrasonography findings of malignant thyroid tumor are in conformity with most of the papillary carcinomas, but not with follicular carcinomas. The current ultrasonographic features for thyroid malignancy should be cautiously applied as the indication for needle aspiration biopsy so that follicular carcinomas are not missed by too narrow and strict biopsy criteria.     

CT导向下经皮针刺活检前纵隔肿瘤

目的　探讨经皮针刺活检前纵隔肿瘤的影响穿刺准确性的因素。资料与方法　回顾性分析 80例前纵隔肿瘤CT导向下经皮针刺活检术。结果　 (1)病理学明确诊断 6 7例 ,不能确定诊断 13例 ;(2 )细针抽吸、切割针活检穿刺敏感性分别为 75 %、90 .5 % ;(3) 16例小病灶穿刺敏感性为 6 8.8% ,6 4例大病灶穿刺敏感性为 87.5 % ;(4)胸腺类肿瘤、淋巴结转移性癌活检准确性均为 92 % ,淋巴瘤活检准确性仅为 6 5 % ,与前两组比较有统计学意义(P <0 .0 5 ) ;(5 )穿刺并发症发生率为 7.5 %。结论　切割针活检阳性率高于细针活检 ,活检阳性率大病灶高于小病灶 ,胸腺类肿瘤、淋巴结转移性癌活检阳性率显著高于淋巴瘤 ;CT导向下经皮针刺活检术是前纵隔肿瘤安全、有价值的诊断方法。     

超声检查和PET/CT检查诊断甲状腺乳头状癌中央区淋巴结转移的对比研究

目的比较超声检查和18F-FDG PET/CT检查对甲状腺乳头状癌中央区淋巴结转移的诊断价值。方法回顾性分析93例经病理证实的甲状腺乳头状癌患者中央区淋巴结转移情况,与术前超声检查和PET/CT检查对比,评价其诊断甲状腺乳头状癌中央区淋巴结转移的价值。结果超声检查诊断中央区淋巴结转移的敏感度、特异度、准确度、阳性预测值、阴性预测值分别是78.8%、61.0%、71.0%、71.9%、69.4%(χ^2=4.742,P=0.029);PET/CT检查诊断中央区淋巴结转移的敏感度、特异度、准确性、阳性预测值、阴性预测值分别是53.8%、78.0%、64.5%、75.7%、57.1%(χ^2=3.882,P=0.049)。超声检查和PET/CT检查诊断中央区淋巴结转移的ROC曲线下面积(AUC)分别为0.699、0.659。结论超声检查诊断甲状腺乳头状癌中央区淋巴结转移具有较高敏感度和准确性,且因其简便、分辨率高、无辐射等优势,较18F-FDG PET/CT检查更具有显著意义。