导向器辅助CT引导经皮同轴套管切割活检术在腹膜后淋巴瘤中的应用

目的 探讨导向器辅助CT引导经皮同轴套管切割活检术在腹膜后淋巴瘤中的应用价值及安全性。方法收集2013年6月至2015年5月18例因腹膜后肿块无法行手术取材活检的患者,均在导向器辅助CT引导下行经皮同轴套管切割活检术。每例患者至少切取5条以上活检组织,行病理组织学检查及免疫组化染色。另顺铂10～30 mg通过套管针注射至肿瘤内。结果 18例患者均成功实施了导向器辅助CT引导下穿刺,取材成功率为100％。操作时间为20～40 min,平均30 min,扫描5～9个序列,45～90幅图片。未发生出血、气胸等并发症。10例诊断为淋巴瘤,6例为弥漫大B淋巴瘤,2例为滤泡性淋巴瘤,2例为淋巴母细胞型淋巴瘤;Ann Arbor分期：Ⅱ期2例、Ⅲ期6例、Ⅳ期2例。治疗采用放化疗结合的模式。结论 导向器辅助CT引导经皮同轴套管切割活检术创伤小,并发症少,是一种安全、有效的微创诊疗技术,对腹膜后淋巴组织疾病的诊断具有重要意义,值得临床推广应用。     

超声引导自动活检对肝脏占位性病变的诊断价值

目的探讨超声引导下对肝脏实性占位性病变自动活检的临床应用价值。方法对33例有肝脏实质性占位病变的患者在超声引导下行肝肿块穿刺组织自动活检术,分析其病理结果与超声声像图的关系。结果33例活检均能获得明确的病理结果,组织学诊断率达100%,全组患者未出现明显并发症。结论超声引导下肝肿块穿刺组织自动活检术简便、取材质量好,是一种并发症少、诊断率高的有效方法,值得在临床推广。     

胰腺癌术中组织活检及细胞学诊断的临床意义

目的 探讨胰腺癌术中组织活检和细胞学诊断的临床应用价值.方法 回顾性分析术中行组织活检和穿刺细胞学检查的142例胰腺癌患者的临床资料.142例患者均获得组织病理学诊断,其中80例患者术中行快速冰冻切片病理检查,87例患者术中行穿刺细胞学检查.结果 术中组织活检诊断准确率为83.8%,穿刺细胞学检查诊断准确率为93.1%,差异有统计学意义(P=0.027).术中组织活检和穿刺细胞学检查均无相关并发症发生.结论 胰腺癌组织学诊断困难,术中行组织活检或穿刺细胞学检查安全性和诊断准确率均较高,是提高胰腺癌诊断的有效方法.     

超声引导穿刺活检术在肝内占位性病变诊断中的应用

目的探讨超声引导下穿刺活检术对肝内占位病变的诊断价值。方法对2003年5月-2007年5月间我院肿瘤科在超声引导下穿刺活检的85例肝内占位病变病人的确诊率、并发症及可能影响确诊率的因素进行总结。结果85例中获明确病理诊断者83．5％（71／85），不能确定诊断者16．5％（14／85），无严重并发症发生。结论超声引导下肝肿瘤穿刺活检术是一项微创、安全、方便的检查方法，避免严重并发症的关键为术前掌握手术指征、术中操作仔细熟练，术后严密观察。     

超声引导自动活检对肝脏占位性病变的诊断价值

目的：探讨超声引导下对肝脏实性占位性病变自动活检的临床应用价值。方法：对33例有肝脏实质性占位病变的患者在超声引导下行肝肿块穿刺组织自动活栓术，分析其病理结果与超声声像图的关系。结果：33例活检均能获得明确的病理结果．组织学诊断率达100％，全组患者未出现明显并发症。结论：超声引导下肝肿块穿刺组织自动活检术简便、取材质量好．是一种并发症少、诊断率高的有效方法．值得在临床推广。     

CT引导下经皮穿刺针吸活检术在肺周围肿块诊断中的临床应用研究

目的：探讨在CT引导下经皮穿刺针吸活检术对肺周围肿块病变的早期诊断价值及安全性。方法：选择我院自2000年1月至2006年12月经胸部X线片或胸部CT片示肺周围肿块，靠近胸膜壁层约2cm处的肿块，经其它方法检查亦不能确诊的37例病例，采用CT引导下行经皮穿刺针吸活检术。结果：37例患者中34例获得组织标本，明确定性诊断，成功率91．89％。结论：CT引导下经皮穿刺针吸活检术对难以定性诊断的肺周边部肿块病变，早期诊断率高、痛苦小、并发症少、经济安全。     

ＣＴ引导下经皮肺活检术诊断正确率及并发症的影响因素

目的　探讨ＣＴ引导下经皮肺内病灶穿刺活检术的诊断正确率和并发症及其相关因素。方法　选取２００８年５月至２００８年１０月肺内病变行ＣＴ引导下穿刺活检术的患者２０９例,回顾性研究活检的诊断正确率及并发症与各种影响因素的关系。结果　２０９例患者中,恶性病变１８５例,良性病变２４例。２０９例患者的诊断正确率为８８.５％,其中对恶性肿瘤的诊断敏感性为９５.６％,良性病变的诊断正确率为３８.５％,假阴性为４.４％,无假阳性。病灶的良恶性、病灶大小及病灶中心有无坏死对诊断正确率的影响有统计学意义（Ｐ＜０.０５）。不良反应中气胸的发生率为５.２％,与病灶大小和穿刺针进胸膜次数有关（Ｐ＜０.０５）。结论　ＣＴ引导下经皮肺穿刺的诊断率高、并发症低,值得临床推广应用。     

EBUS-TBNA对纵隔及肺部疾病诊断的意义

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)在纵隔和(或)肺门淋巴结以及肺部病变诊断中的意义.方法 回顾性总结35例接受EBUSTBNA的患者的临床资料.单纯纵隔和(或)肺门淋巴结肿大11例,单纯肺部病变4例,纵隔和(或)肺门淋巴结肿大伴肺部病变20例.结果 通过对35例患者进行EBUS-TBNA检查,获得65份纵隔淋巴结或肺部病变组织.32例患者明确诊断,其中恶性病变27例,良性病变5例.3例患者诊断不清,后经纵隔镜活检2例诊断为淋巴瘤,1例诊断为慢性淋巴结炎.EBUS-TBNA的敏感性、特异性、准确率、阳性预测值及阴性预测值分别为98.3％、100.0％、92.3％、100.0％和83.3％.所有患者检查耐受良好,无任何相关并发症发生.结论 对于纵隔及肺部疾病的诊断,EBUS-TBNA是一种安全有效的微创活检方法.     

CT引导下经骨皮质同轴穿刺活检术在骨肿瘤病变中的应用价值

目的探讨CT引导下经骨皮质同轴穿刺活检技术在骨肿瘤病变诊断中的应用价值。方法入组骨肿瘤患者45例,均行CT引导下经骨皮质同轴穿刺活检术,并经手术病理验证,比较分析穿刺病理结果与手术病理结果。结果所有患者取材成功率100.0%,其中获得明确诊断者43例(95.6%)。45例患者中32例患者结合病史和临床血生化指标证实符合诊断,余13例患者经外科手术获得病理证实。并发症方面,有6例患者出现穿刺点周围少量出血,发生率为13.3%,未发现大量出血、神经损伤等严重并发症。结论CT引导下经骨皮质同轴穿刺活检技术对骨皮质完整的骨肿瘤病变诊断成功率高,且并发症少,值得临床推广应用。     

CT引导下经皮穿刺活检术对胸部肿瘤的诊断价值

目的:探讨CT引导下经皮穿刺活检术对胸部肿瘤的诊断价值.方法:回顾性分析本院在2007年6月-2008年5月收治的40例经胸片及胸部CT加增强扫描检查后诊断为胸部肿瘤的患者资料,入组患者均进行CT引导下经皮穿刺活检术,检出物进行病理检查,通过后续检查治疗和随访,分析该方法对胸部肿瘤诊断的准确率.结果:40例接受穿刺活检术的患者中,38例穿刺活检的病理诊断结果与后续治疗和随访结果吻合,1次穿刺活检的准确率达95%(38/40).其中恶性肿瘤26例,占68.42%;另外12例术前怀疑胸部肿瘤的患者经穿刺活检诊断为良性病变,占31.58%.其余2例患者经穿刺活检诊断为炎性病变,但经动态临床检查及随访证实为恶性肿瘤.CT引导下经皮穿刺活检术的主要并发症为气胸,发生率为20%(8/40),均为少量气胸并可自行吸收.结论:CT引导下经皮胸部肿块穿刺活检术是一种操作简单、微创、安全且准确率较高的诊断技术,对临床诊断和治疗有一定的指导意义,值得临床推广.     

肺原位腺癌与微浸润腺癌的病理分化情况及超高分辨率CT对疾病的鉴别诊断价值

目的 研究肺原位腺癌与微浸润腺癌的病理分化情况及超高分辨率CT对疾病的鉴别诊断价值.方法 回顾性分析80例肺腺癌患者的临床资料,所有患者均经病理组织学证实,肺原位腺癌46例、微浸润腺癌34例.观察比较肺原位腺癌与微浸润腺癌的超高分辨率CT图像,包括形状、边缘、密度,病灶直径和CT值,病灶内肺静脉异常、空气支气管征、胸膜...     

骨与软组织肿瘤穿刺活检技术

目的探讨穿刺活检的技术及方法。方法自1994年1月至2004年12月共有1304例骨与软组织肿瘤患者在我院接受治疗,通过分析术前穿刺活检病理与术后病理的相关性,研究穿刺活检的技术特点及影响穿刺活检准确性的因素及改进方法。结果将术前穿刺病理及术后病理的相关性分为三种:正确、支持、阴性。1304例穿刺活检,正确918例(69.4%),支持346例(26.2%),阴性57例(4.4%)。结论穿刺活检是损伤小、操作简便的获取病理诊断的方法,在影像学检查的指导下可完成复杂部位的活检,具有很高的准确率。     

Accurate diagnosis of musculoskeletal lesions by core needle biopsy

BACKGROUND: Percutaneous needle biopsy has many advantages over open biopsy in the treatment of neoplasms. However, the accuracy of needle biopsy in the diagnosis of musculoskeletal lesions has not yet been established. Here, we evaluate the accuracy and limitations of the procedure for musculoskeletal lesions. METHODS: The diagnoses of 163 needle biopsies (bone, 91; soft tissue, 72) performed on 157 consecutive patients using a Jamshidi needle or an Ostycut needle for bone lesions, or a Tru-cut needle for soft tissue lesions were compared with the final diagnoses made by open biopsy and/or a definitive operation. RESULTS: One hundred forty-three specimens (88%) were determined to be adequate for histological examination. Obtaining undamaged cores from very hard bony lesions or sclerotic cyst walls proved difficult. A pathologist with experience in musculoskeletal lesions was able to differentiate malignant tumors from benign lesions in 97% of the cases (bone, 100%; soft tissue, 94%) and arrive at a specific diagnosis in 88% (bone, 96%; soft tissue, 78%) when adequate cores were obtained. Differentiating a well-differentiated liposarcoma from a benign lipoma and inflammatory lesions from benign tumorous conditions, was difficult. The overall accuracy was 77% (bone, 85%; soft tissue, 68%). There was no morbidity related to the procedure. CONCLUSION: The results indicate that needle biopsy is safe and accurate for diagnosing musculoskeletal lesions.     

超声引导下对老龄肺肿块组织学活检的诊断优势

目的:分析老年人周围性肺肿块的超声图像特征以及超声引导下组织学活检的取材过程,探讨超声引导定位的安全性及风险预防,以提高超声引导下肺周围性肿块穿刺活检的成功率。方法:我院门诊及住院患者57例,其中男性43例,女性14例,年龄60-79岁,平均73.5岁。57例老年患者中合并慢性阻塞性肺病31例（占54%）,合并心脑血管病49例（占86%）,合并糖尿病等27例（占47%）。孤立性病灶48例,多发病灶9例。病灶＞5cm 7例,3-5cm 21例,＜3cm 29例。全程在超声实时监测引导下完成肺周围性肿块穿刺组织学活检。结果:全部病例取材过程顺利,标本满意,成功率100%。未出现并发症。病理分型鳞癌28例,腺癌19例,小细胞癌6例,鳞腺混合癌3例,未定型1例。结论:肺癌是常见的老年恶性肿瘤之一,随着社会人口的老龄化,老年肺癌发病率逐年增加。在超声引导下以微创的方式对老年患者肺部周围性肿块获取病理组织学诊断,是一种安全可靠的方法。老年患者本身基础疾病多,耐受性较差,存在器官老化基础功能减退等生理、病理方面的因素,本研究结果显示超声引导下定位准确,严格控制穿刺深度,组织切割精准无误,因而避免损伤周围组织结构,在超声引导下进行周围性肺肿块的穿刺活检,最显著的优势在于穿刺全过程均可直观的动态显示,术中可以在直视下准确把握进针角度、进针深度,确保对靶目标取材准确无误。克服了盲目性,避免了针下结构不清、并发症难以控制的缺点。提高了超声引导下肺周围性病变穿刺活检的成功率。为老年人平稳安全的完成肺肿块组织学穿刺活检及时进行诊断与治疗提供了重要依据。     

Upright stereotactic vacuum-assisted needle biopsy of suspicious breast microcalcifications

Stereotactic core needle biopsy is a useful technique for evaluation of suspicious breast microcalcifications. The development of the 11-G vacuum-assisted biopsy system offers another method of minimally invasive biopsy carried out on a conventional mammography unit. We evaluate its usefulness, efficacy and safety in Asian women. Vacuum-assisted biopsy was carried out through the lateral approach using an add-on stereotactic device attached to a mammography unit. One hundred and five lesions were sampled in 97 patients. Excisional biopsy was subsequently Carried out for diagnosis of atypical ductal hyperplasia or carcinoma in high-risk patients. Patients with benign diagnosis underwent mammographic follow up. The technical success rate was 97%. An average of 13.5 tissue cores were retrieved for each lesion. The histopathological result obtained from mammotome was benign in 84.8% and malignant in 15.2%. The benign microcalcifications were predominantly fibrocystic change (n = 42) whereas the malignant microcalcifications included ductal carcinoma in situ (n = 15) and invasive carcinoma (n = 1). Twenty-two patients underwent subsequent open surgical biopsy but no underestimation of disease was seen. Only two patients had vasovagal syncope and three others felt unwell during the biopsy. Nine patients had small haematomas, which resolved spontaneously. Vacuum-assisted biopsy carried out on an upright stereotactic mammography unit is a safe and effective method for evaluation of suspicious microcalcifications.     

CT导引下经皮纵隔肿块穿刺活检的临床应用

目的：探讨应用软组织切割针在CT导引下对纵隔肿块性病变穿刺活检技术及其临床的应用价值。方法：回顾性分析85例纵隔肿块性病变在CT导引下应用18G和20G软组织切割针进行穿刺活检的临床资料。结果：纵隔肿块穿刺技术成功率100%（85/85）。病理明确诊断75例（88.2%）,不能明确诊断10例;18G针活检39例、20G针活检46例,阳性率分别为92.3%、84.8%;≤3cm病灶18例,〉3cm病灶67例,活检阳性率分别为83.3%、89.6%;胸腺类肿瘤、转移性肿瘤、恶性淋巴瘤、神经源性肿瘤活检阳性率分别为92.3%、93.8%、87.5%、63.6%,P〈0.05有统计学意义。穿刺并发症发生率为11.8%。结论：CT导引下经皮穿刺活检对纵隔肿块性病变是一种安全有效的诊断方法,值得临床推广应用。     

CT导引下经皮纵隔肿块穿刺活检的临床应用

目的:探讨应用软组织切割针在CT导引下对纵隔肿块性病变穿刺活检技术及其临床的应用价值.方法:回顾性分析85例纵隔肿块性病变在CT导引下应用18G和20G软组织切割针进行穿刺活检的临床资料.结果:纵隔肿块穿刺技术成功率100%(85/85).病理明确诊断75例(88.2%),不能明确诊断10例;18G针活检39例、20G针活检46例,阳性率分别为92.3%、84.8%;≤3cm病灶18例,>3cm病灶67例,活检阳性率分别为83.3%、89.6%;胸腺类肿瘤、转移性肿瘤、恶性淋巴瘤、神经源性肿瘤活检阳性率分别为92.3%、93.8%、87.5%、63.6%,P<0.05有统计学意义.穿刺并发症发生率为11.8%.结论:CT导引下经皮穿刺活检对纵隔肿块性病变是一种安全有效的诊断方法,值得临床推广应用.     

麦默通系统微创切除及活检87例乳腺病例分析

为探讨使用麦默通（Mammotome）系统对乳腺病灶进行微创切除及活检的临床应用价值,我们在超声图像或钼靶指引下,利用Mammotome系统对87例患者216个乳腺病灶进行切除或活检,记录术后病理结果及其随访情况。结果示87例患者216个乳腺病灶被准确完全切除或进行活检,切除组织足够用于病理诊断。初步研究结果提示,Mammotome技术是一项切除准确、有效、安全的乳腺微创技术,可对乳腺病灶进行选择切除或术前活检。     

The value of needle biopsy in the diagnosis of musculoskeletal tumors

Background Percutaneous needle biopsy has many advantages over open biopsy in the treatment of neoplasms. However, the accuracy of the needle biopsy in the diagnosis of musculoskeletal tumors has not been established. It is essential to evaluate the accuracy and limitations of the procedure in musculoskeletal tumors. Methods The diagnoses from 66 needle biopsies (bone, 37; soft tissue, 29) performed on 64 consecutive patients using a jamshidi needle (bone tumors) or a Tru-cut needle (soft tissue tumors) were compared with the final diagnoses made by open biopsy and/or a definitive operation. Results Fifty-eight specimens (87.9%) were judged to be adequate for histological examination. It was technically difficult to obtain undamaged cores from very hard bony lesions or sclerotic cyst walls. A pathologist with experience in musculoskeletal tumors was able to differentiate malignant tumors from benign lesions in 98.3% of the cases (bone, 100%; soft tissue, 96.4%) and arrive at a specific diagnosis in 91.4% (bone, 100%; soft tissue, 82.1%) when adequate cores were obtained. It was troublesome to distinguish a well-differentiated liposarcoma from a benign lipoma, or inflammatory lesions from benign tumorous conditions. The overall accuracy for needle biopsy was 80.3% (bone, 81.1%; soft tissue, 79.3%). There was no morbidity related to the procedure. Conclusion The results indicate that meedle biopsy is a safe and accurate technique for diagnosing musculoskeletal tumors.     

Unsuspected bone and soft tissue lesions identified at cancer screening using positron emission tomography

BACKGROUND: [F-18]-fluorodeoxy-D-glucose (18FDG) positron emission tomography (PET) is a sensitive modality for detecting malignant lesions. The purpose of the present study was to describe unknown bone and soft tissue lesions in adults identified at cancer screening using PET. METHODS: A total of 4283 individuals of more than or equal to 40 years of age were enrolled. All individuals underwent scans from the base of the skull to proximal thigh. The images were reviewed and a consensus was reached by two board-certified radiologists and a nuclear medicine specialist for the diagnoses. Diagnoses of the lesions were confirmed by histological examination, typical radiologic findings, obvious progression in number and/or size of the lesion on follow-up examinations, and medical examination of interview. RESULTS: Unsuspected focal abnormality in the bone and soft tissue were found in 62 individuals (1.4%). The mean size of the lesion was 26 mm (range, 6-155 mm). There were 29 bone lesions (47%) and 33 soft tissue lesions (53%). A malignant lesion was found in one case (1.6%) and histologic diagnosis was primary non-Hodgkin lymphoma of the vertebra. Other major diagnoses were healing bone (n = 11, 18%) and benign cystic lesions of bone and soft tissue (n = 9, 15%), and brown fat of soft tissue (n = 4, 6%). CONCLUSION: Unsuspected bone and soft tissue lesions of a wide variation of pathologic and clinical diagnoses were encountered at cancer screening using PET. Correlation with clinical history and other imaging findings is essential in the differential diagnosis.