采用BioPince^TM活检针在CT引导下肺穿刺活检的诊断价值与安全性

目的：探讨应用BioPince^TM活检针在CT引导下肺穿刺活检的诊断准确性和安全性．方法：对痰细胞学阴性、纤支镜不能确诊的42例肺部外周性病变患者，在胸部CT扫描定位下，应用BioPince^TM 18G活检针经皮肺穿刺活检取材，行病理学诊断．结果：42例患者共行穿刺43次，阳性39例(92．8％)，阴性3例(7．2％)，其恶性病变诊断率96．3％(26／27)，良性病变诊断率86．7％(13／15)．术后少量咯血2例，少量气胸1例．结论：应用BioPince^TM活检针在CT引导下经皮肺活检是一种安全、有效的检查手段，对肺部周围性病变具有较高的诊断价值．     

眼睑皮脂腺癌的穿刺细胞学诊断及鉴别诊断

目的 探讨眼睑皮脂腺癌的穿刺方法、细胞学特点和鉴别诊断。方法 4例眼睑肿物行细针穿刺细胞学(FNAC)检查,穿刺涂片行常规HE染色以及脂肪染色(苏丹Ⅲ染色),光镜观察其细胞学特点;与活检结果对照,并与霰粒肿、眼睑毛母质瘤和基底细胞癌的细胞学特点进行比较。结果 4例肿物穿刺结果考虑为皮脂腺癌。涂片内细胞丰富,特征明显,可见2种肿瘤细胞,一种为胞质丰富呈泡沫样的皮脂腺分化细胞,一种为核大深染、异型明显的低分化癌细胞,脂肪染色显示肿瘤细胞胞质内及背景中可见橘红色脂滴。穿刺诊断与活检结果基本一致。而霰粒肿细胞学表现为肉芽肿性炎症,毛母质瘤内见无异型的基底样细胞、嗜碱性细胞、影细胞及钙化,基底细胞癌表现为核致密深染、排列紧密的细胞团,与皮脂腺癌易于区别。结论 眼睑肿物穿刺细胞学检查是一种安全有效的检查方法,有助于眼睑皮脂腺癌的早期诊断及答别诊断。     

骨肿瘤的针吸细胞学诊断

目的：探讨骨肿瘤针吸细胞学的诊断标准。方法：分析４６例骨肉瘤针吸细胞学涂片,并与２４例骨巨细胞瘤和１２例骨转移性癌进行对照,找出骨肉瘤的细胞学特征,并与组织学对照分析。结果：观察到骨肿瘤中有关１０种细胞学改变：骨肉瘤涂片中,多形性大细胞（９１．３％）,核仁明显（６９．５％）,单核瘤巨细胞（７６％）,多核瘤巨细胞（６５．２％）,核分裂象（３６．９％）,出血、坏死（９３．４％）。骨巨细胞瘤以多核巨细胞     

骨肿瘤穿刺针吸活检针具与技术的改进

传统的骨肿瘤穿刺针吸活检使用１６号粗针头，对骨髓腔破坏而骨皮质尚存的临床早期骨肿瘤、生骨性或皮质外骨膜反应性增生明显的骨肿瘤，由于病灶坚硬很难成功进行穿刺活检。我们为寻找操作简便、适应证宽的骨肿瘤穿刺针吸活检针具和技术进行了探索。一、材料和方法１．临床资料：１９９６年９月至１９９８年９月，应用此套穿刺针具及方法为５６例临床诊断为骨肿瘤的患者进行了穿刺针吸活检术。其中男性３０例，女性２６例，平均年龄３９．７３岁。穿刺部位：上肢１４例，下肢３４例，骨盆７例，腰椎１例。２．针具：（１）Ｂ６５０１型骨…     

微波技术在穿刺细胞学涂片中的应用

微波技术在穿刺细胞学涂片中的应用杨金镇我们应用微波辐射技术于穿刺细胞学涂片的固定、染色等过程中，使涂片中的细胞染色清晰鲜艳，肿胀变形减少，有利于病理诊断，现总结介绍如下。１材料和方法１．１材料本院常规穿刺的肿物、淋巴结等细胞学涂片２３２例。使用虹云牌...     

宫颈液基细胞学涂片假阴性原因分析

目的回顾宫颈涂片中假阴性病例,分析产生假阴性的原因。方法利用TCT技术检测6850例宫颈涂片,其中细胞学阴性而活检阳性63例,分别记录其细胞量、有无宫颈柱状细胞／化生细胞涂片、是否血涂片、病灶与宫颈管距离及其组织病理结果。结果原细胞学诊断阴性复查为阳性、缺乏宫颈柱状细胞和化生细胞涂片、细胞量〈30％、有血涂片、病灶与宫颈管距离〉1cm者,在假阴性病例中分别占7．93％、19．04％、14．28％、20．6％、46．03％。病灶与颈管距离〉1cm且病变合并尖锐湿疣假阴性者与病灶离颈管距离〈1cm且病变合并扁平湿疣者比较,差异有显著性（P〈0．05）。结论获取满意的宫颈细胞样本、改进标本处理、加强细胞学医师继续教育和提高自身诊断水平是降低宫颈涂片假阴性的有效方法。临床医师对症状体征可疑但细胞学阴性的病例采取阴道镜下多点活检可减少假阴性的发生。     

两种宫颈癌筛查方法对比研究及临床分析

目的:探讨传统巴氏涂片法和液基细胞学法在宫颈癌筛查中的临床意义.方法:分别对12302例和15750例患者分别进行传统巴氏涂片法和液基细胞学检测的宫颈癌筛查.对细胞学阳性者进行阴道镜下活检并分析结果.结果:传统巴氏涂片法和液基细胞学检测的阳性检出率分别为5.45％和6.06％,差异无统计学意义(P＞0.05)；两种方法与活检符合率分别为22.84％和55.57％,差异有统计学意义(P＜0.05)；两种方法的假阳性率分别为77.16％和44.42％,差异有统计学意义(P＜0.05).结论:液基细胞学检测用于宫颈癌的筛查与活检的符合率高,假阳性率低,优于传统巴氏涂片,值得在临床推广应用.     

超声内镜引导下细针穿刺传统涂片细胞学、液基细胞学及组织学结果对比及不一致原因分析

目的探讨超声内镜引导下细针穿刺(endoscopic ultrasound guided fine needle aspiration, EUS-FNA)传统涂片细胞学和液基细胞学的诊断价值,并分析与穿刺组织学结果不一致的原因。方法收集2016年1月～2018年9月武汉大学人民医院存档的193例EUS-FNA标本的传统涂片细胞学、液基细胞学及组织学结果。以组织学结果作为对照标准,分别对传统涂片细胞学与液基细胞学结果进行统计分析,并计算两种细胞学方法的准确性、特异性、敏感性、阳性预测值、阴性预测值、假阳性率及假阴性率。对细胞学与组织学不一致的病例重新阅片,并追踪临床随访情况,分析不一致原因。结果 193例EUS-FNA标本中,97例胰腺实性占位病灶穿刺、43例纵隔病灶及纵隔淋巴结穿刺、36例消化道管壁占位病灶穿刺、17例腹腔病灶及腹腔淋巴结穿刺。传统涂片细胞学与液基细胞学两种细胞学方法的准确性、特异性、敏感性、阳性预测值、阴性预测值、假阳性率及假阴性率差异均无显著性(分别为92.23%vs 88.60%,96.97%vs 96.21%,81.97%vs 72.13%,92.59%vs 89.80%,92.09%vs 88.19%,3.03%vs 3.79%,18.03%vs 27.87%;P均0.05)。传统涂片细胞学/液基细胞学结果与组织学结果不一致的病例共24例。分析不一致原因包括细胞学制片方式及诊断的局限性、穿刺取材所致组织学标本不满意或穿刺部位不准确、细胞病理医师判读有误。结论 EUS-FNA的传统涂片细胞学与液基细胞学两种评估方法的准确性、敏感性、特异性、阳性预测值、阴性预测值、假阳性率及假阴性率差异无显著性,但两种方法互为补充。联合使用EUS-FNA的细胞学和组织学评估,能提高诊断价值。     

CT引导下经皮穿刺活检术在肺癌诊断中的应用

目的 探讨CT引导下穿刺活检术在肺癌诊断中的准确性和并发症发生率。方法 40例使用弹簧芯状活检针经皮穿刺活检，CT扫描确定并引导穿刺途径，达预定位置取材。结果 37例有明确的病理诊断，诊断准确性92．5％。活检后并发气胸3例，咯血2例。结论 CT引导下经皮穿刺活检可以进一步明确肺癌的病理诊断，提高诊断的准确性，并发症发生率低，可为临床提供治疗依据。     

淋巴结常见良性病变的针吸细胞学特点及其诊断

观察良性淋巴结病变的针吸细胞学涂片特点和诊断价值。方法；对有活检对照地７２例针吸涂片进行细胞成分计量观察。结果：上皮样细胞和干酪性坏死物在淋巴结结核涂片上多见，朗罕巨细胞少见，淋巴细胞，转化中心样细胞和浆细胞是淋巴结反应性增生的涂片细胞成分。结论：针吸细胞学检查可以作为淋巴结结核和反应性增五简便快速的筛选诊断方法。     

Scrape cytology of the ovaries: potential role in intraoperative consultation of ovarian lesions

Intraoperative diagnosis of ovarian lesions can be achieved by gross examination with the help of frozen sections and/or cytologic examination. Various cytologic techniques, including imprint, fine-needle aspiration, and scrape, may be used. In this study, we evaluated the application of scrape cytology in the diagnosis of ovarian lesions occurring during a 16-mo period at one institution. The cytologic diagnosis was primarily based on findings in air-dried, Diff-Quik-stained smears in correlation with clinical and intraoperative findings. In total, 131 histologically proven ovarian lesions, including 13 nonneoplastic lesions, 47 benign tumors, 17 epithelial tumors of low malignant potential (LMP), and 54 malignant tumors (35 primary, 1 leukemia, and 18 metastases), were cytologically examined. The accuracy of scrape cytology was 95% in the benign, 47% in the LMP, and 98% in the malignant group. In the LMP group, the false-negative rate was 12%, while the deferred rate and false-positive rate were 24% and 18%, respectively. There was no misdiagnosis between the benign and malignant categories. The histologic subtypes were correctly predicted in 78% of cases. There were limitations of scrape cytology in the diagnosis of LMP and mucinous tumors, which require histologic architectural evaluation and adequate histologic sampling. Scrape cytology is a simple, rapid, and inexpensive adjunctive technique that should be used in intraoperative consultation for ovarian lesions.     

Aspiration and brush cytology of the liver

In this study, 1,650 liver aspirates and laparoscopic brushings, representing a wide range of neoplastic and nonneoplastic conditions were examined cytologically. Of the 470 cytologic malignancies, only one was a false-positive. The most frequently diagnosed malignant neoplasms were carcinomas of the colon, breast, pancreas, lung, and liver. The overall accuracy rate of cytologic examination was 96%, with a sensitivity of 94%, and a specificity of 100%. Predictive values for both positive and negative results, were high: 100% and 95%, respectively. Reviewing the literature on aspiration cytology of the liver, we found that our results confirmed the findings of others: that cytologic examination of liver aspirates and brushings is a safe, useful, and accurate technique and may obviate tissue biopsy in cases of tumors metastatic to the liver.     

Transcatheter bronchial brush and forceps biopsies. Histologic evaluation.

The histologic findings in transcatheter brush and forceps biopsies from 472 cases over a six-year period are evaluated. Diagnostic accuracy based on histologic findings was 38% and based on cytologic findings was 70%. When the two methods of examination were used, however, the overall accuracy was improved to 76%. In Hodgkin's disease and some inflammatory processes histologic examination is essential for the diagnosis. The transcatheter biopsies under fluoroscopic control are especially useful for securing tissues from the peripherally located lesions. When possible, examination of tissue obtained by transcatheter as well as forceps biopsies is encouraged.     

Prospective study of concurrent ploidy analysis and routine cytopathology in body cavity fluids

A total of 390 body cavity fluids were analyzed by both cytopathologic examination and flow cytometric DNA analysis. The two methods gave compatible results in analyses of 304 fluids (78%). In 24 patients, cytopathologic studies found the specimens to contain malignant cells, but the DNA content was diploid. This illustrates an area where flow cytometric studies do not extend tumor detection. In 56 fluids from 48 patients, cytologic methods revealed no malignant cells but flow cytometry distinguished aneuploid cell populations; additional clinical information allowed the identification of malignant tumors in 24 (50%) of these patients. Because flow cytometry was able to detect aneuploidy in cases where conventional cytologic examination could not detect malignant cells, the number of patients with tumors detected was increased by 39% beyond those detected by cytologic methods alone in this series.     

Intraoperative surgical specimen evaluation: frozen section analysis, cytologic examination, or both? A comparative study of 206 cases

Having recently become aware of the merits of cytologic preparations, histopathologists are focusing their attention on cytologic examination as a means of intraoperatively evaluating surgical specimens. This study compares the diagnostic accuracy and quality of frozen-section (FS) and cytologic preparations from 206 surgical specimens. The quality of cytologic preparations was significantly superior to that of FSs (P = 0.0001). With the use of a three-level accuracy scale suited to the practical demands of intraoperative evaluation, there was no significant difference between the accuracy of diagnosis by FS analysis compared with that achieved by cytologic examination (P = 0.35). More importantly--except in one case--whenever one technique did not correctly distinguish benign from malignant disease, the other technique yielded an essentially correct diagnosis. With the use of both techniques, 99.5% of cases were interpreted correctly, at least in regard to benign versus malignant diagnoses. Because significant additional time, equipment, stains, laboratory space, or personnel are not needed to implement intraoperative cytologic studies in a routine anatomic pathology laboratory, the authors advocate the simultaneous use of FS and cytologic studies in the specified context.     

Electron microscopy of fine-needle aspiration biopsies of the mediastinum.

Twenty cases of fine-needle aspiration (FNA) biopsy of mediastinal tumors with ultrastructural studies of the aspirated material were reviewed. The cases were classified according to the cytologic and ultrastructural diagnosis. A specimen insufficient for ultrastructural study was obtained in five cases (25%). Refinement of the cytologic diagnosis was made in three cases (15%) and good correlation between the initial cytologic impression and the ultrastructural studies was seen in the remaining cases (60%). Comparison of different sites of FNA biopsy revealed a higher rate of ultrastructural examination in the cases involving the mediastinum. Illustrative cases of the use of electron microscopy in FNA biopsies of mediastinal tumors are presented.     

Accuracy of cytologic diagnosis of central nervous system tumours in crush preparation

The aim of this study was to assess the usefulness and accuracy of cytologic smears by making crush preparation as a diagnostic method, in central nervous system tumors. 278 patients with central nervous system tumors were investigated. In 98 cases, material was obtained intraoperatively during craniotomy and in 180 cases stereotactic biopsies were done. In all the cases crush preparations were made, and cytologic diagnosis was correlated with final histologic diagnosis. 244 out of 278 patients showed correlation with histopathological diagnosis. So, in present study diagnostic accuracy was 87.76%. In 18 cases no definite diagnosis was made due to inadequate material. Majority of the patients were in age group 31 to 40 years (72 cases). The youngest patient was three years old and the eldest was 87 years old. The most common tumor in intracranial cavity was astrocytoma (56.68%), followed by meningioma (6.88%), medulloblastoma (5.66%) and ependymoma (5.56%). The most common tumor in intraspinal cavity was ependymoma (38.46%), followed by meningioma (23.07%) and schwannoma (23.07%). In conclusion, crush preparation is an effective, simple, rapid, relatively safe and reliable technique for the diagnosis of central nervous system tumors. Diagnostic accuracy of cytology with final histopathological report is established with accuracy rate of 87.76%.     

薄层液基细胞学制片联合阴道镜检查对宫颈病变的诊断价值

目的评价薄层液基细胞学制片联合阴道镜检查对宫颈病变的诊断价值。方法对2006年1月～2008年12月在哈尔滨医科大学附属第四医院妇科门诊检查的1220例患者行宫颈薄层液基细胞学制片(TCT)检查,对其中186例细胞学提示阳性或临床高度可疑的患者行阴道镜下活组织病理检查,以病理诊断为金标准,对结果进行分析。结果宫颈薄层液基细胞学制片检查1220例中,异常涂片157例(12.59%),临床高度可疑的患者45例行阴道镜检查下活检。病理结果显示:CINⅠ39例,CINⅡ9例,CINⅢ3例,子宫颈鳞癌3例。TCT检查诊断宫颈病变符合率为84.0%,阴道镜检查对宫颈病变的诊断符合率为88.0%,两者比较差异具有显著性(P0.05),二者联合病变检出率为98.0%。结论采用薄层液基细胞学制片检查配合阴道镜下病理检查可明显提高对宫颈病变诊断的准确率,能满足早期发现癌前病变的需要。     

Improving the diagnostic accuracy of cytologic cerebrospinal fluid examinations in acute lymphoblastic leukemia using high-power microscopy and terminal deoxynucleotidyl transferase determinations

In patients with acute lymphoblastic leukemia (ALL), cytologic examination of cerebrospinal fluid (CSF) is becoming increasingly important for clinical management. In order to enhance the diagnostic accuracy of CSF cytology results, the value of using terminal deoxynucleotidyl transferase (Tdt) and high-power (1,000×) light microscopy, together with conventional cytologic examination was assessed. In 33 CSF samples from ten multiply examined Tdt-positive ALL patients, original cytologic interpretations were compared to Tdt results. Cytology samples were reviewed by two pathologists (one with hematopathologic expertise). The cases in which cytologic interpretation did not correlate with Tdt result were first reviewed via 1,000× microscopy without knowledge of Tdt result, then re-reviewed with knowledge of Tdt result. Conventional cytology alone diagnosed 64% of cases accurately (Tdt representing the comparative standard). High-power microscopy increased the correlation to 82%. Use of high-power microscopy and knowledge of Tdt result together produced a total of 85% of cases with correlation of results. High-power microscopic examination therefore contributes significantly to the accurate diagnosis of ALL, and knowledge of the Tdt result at the time of cytologic examination produces an additional advantage in providing an objective measure for CSF involvement by leukemia. Using all three methods in conjunction is recommended in order to increase the overall accuracy of CSF examination for the detection of leukemic involvement in ALL patients. Diagn. Cytopathol. 16: 413–419, 1997. © 1997 Wiley-Liss, Inc.