肺细针吸取微小组织学与细胞学检查诊断价值的探讨

目的探讨经皮细针肺肿块吸取细胞块和微小碎片组织学(简称微小切片)与涂片细胞学的诊断价值.方法对有组织学对比的187例经皮细针(7号) 肺部肿块吸取资料作微小切片组织学与涂片细胞学比较分析.结果 (1)微小切片组的诊断敏感性88.3%,特异性100%,总准确率89.5%;涂片组分别为87.7%、93.8%和88.8%;涂片结合微小切片则分别为91.6%、93.8%和92.0%.(2)微小切片组对恶性肿瘤的组织分型准确率93.3%(83/89),比涂片组的67.9%(91/134)高(P<0.01).对良性病变分类诊断准确率分别为86.4%(19/22)和 60.0%(18/30) (P<0.05).(3)66.3%的病例获取微小组织切片,其免疫组织化学染色结果与术后病理组织切片的相同.结论微小切片组织学和细胞学的诊断准确性均高,两者结合应用将提高诊断准确性,前者对组织分型、分类诊断接近术后病理诊断,有很高的应用价值.     

假肉瘤性软组织病变的细针吸取细胞学

目的：总结假肉瘤性软组织病变细针吸取细胞学（ＦＮＡＣ）特点,寻求在针吸细胞学基础上与肉瘤鉴别的要点。方法：总结１０例结节性筋膜炎,１例增生性筋膜炎,１例增生性肌炎的针吸细胞学改变及临床经过。结果：假肉瘤性软组织病变的ＦＮＡＣ特点是细胞的种类、大小较多样化及多数会出现节细胞样细胞。细胞核大,核仁明显,但核的恶性特征不明显。有６例结节性筋膜炎及１例增生性肌炎临床自行消退。结论：可凭ＦＮＡＣ特点将假肉瘤     

细针吸取细胞学的进展

自从上世纪80年代开始,细针吸取活检（fine needle aspiration biopsy,FNAB）,又称细针吸取细胞学（fine needle aspiration cytology,FNAC或称FNA）以其具有快捷、损伤少、经济及准确率高的优点,深受临床医生及患者的欢迎,使其应用非常广泛,几乎涉及全身所有的器官。但是,也因其取材较少导致的取材不满意率和假阴性率高,造成对组织结构观察不满意,分型不够细致和确定等缺点而局限了其应用。此方法对操作人员的技术要求也较高。未经细胞病理学专业训练的病理医生,应用FNA的效果并不理想,引发的医疗纠纷较多（美国的医疗纠纷中以FNA引发最多）,使得部分病理科医生对FNA并不十分热衷。相反粗针穿刺活检（core needle biopsy,CNB）取材较多,吸出的组织与手术切除的标本相近,病理科医生容易诊断。影像学的发展使定位准确,     

经皮细针肺穿刺108例细胞学分析

对肺部有肿块,而胸片、痰液以及支气管镜检查未能明确其性质的108例患者,行经皮细针肺穿刺之细胞学诊断分析。108例中,22例仅作单纯细胞学诊断,86例有外科手术切除标本之病理、超微结构或其它化验检查证实。肿块直径为1cm～5cm。细胞学与手术切除标本或活检的病理诊断的符合率为93.0%(80/86),假阴性3例,假阳性3例。文中对各种不同病变的细胞学特征,假阴性和假阳性的原因以及经皮细针肺穿刺的实用价值进行了分析讨论。     

应用细针吸取细胞技术诊断乳腺导管病变的细胞学指标

目的 探讨采用细针吸取细胞学(FNAC)诊断乳腺导管病变的有效和联合的指标,以建立有效的乳腺导管病变FNAC诊断模式.方法 收集澳门镜湖医院6年内400例有随访结果的乳腺FNAC病例作回顾性分析.按组织学诊断结果分为导管上皮非增生性病变(104例)和增生性病变(163例)及癌(133例)三组,对涂片进行60个细胞学指标分析,再根据各指标的程度或量采用半定量分级评估.以组织学诊断结果为金标准对病变分类,研究各指标对诊断导管病变的意义.采用Logistic多重回归模型和分类树模型进行统计学分析.结果 (1)400例良、恶性病变组,上皮细胞团中掺杂肌上皮细胞(P<0.05)、上皮细胞排列成大的细胞团(P<0.05)、上皮细胞排列成小的细胞团(P<0.05)、细胞质内空泡(P<0.05)和细胞套细胞(P<0.1)为有统计学意义的鉴别诊断指标.最重要的鉴别指标为上皮细胞团中有无掺杂有肌上皮细胞.良性病变的诊断指标为上皮细胞团中掺杂有肌上皮细胞,联合大量的上皮细胞排列成大的细胞团,94.4%为良性病变,中等至大量的上皮细胞排列成小的细胞团,倾向为增生性病变;癌的诊断指标为上皮细胞团中无掺杂肌上皮细胞,上皮细胞排列成小的细胞团,细胞质内空泡和细胞套细胞.上皮细胞团中无掺杂肌上皮细胞时,癌占81.3%.(2)267例非增生性和增生性良性导管上皮病变组,上皮细胞团中见不规则的细胞间腔隙(P=0.001)、上皮细胞团成松散排列(P<0.05)和细胞核深染(P<0.1)为诊断增生的有意义指标.两结构指标在涂片中出现的量越多,越提示为增生.单一上皮细胞团中见不规则的细胞间腔隙,增生性病变占70.1%;当中等至大量时增生占82.7%,若同时伴上皮细胞团成松散排列,诊断增生的阳性预测价值为87.5%.(3)伴不典型细胞学改变的35例中,组织学诊断26例增生,多为导管上皮增生性纤维腺瘤,极少数为不典型增生或癌.结论 在乳腺病变FNAC诊断中,结构指标较细胞指标更重要,联合指标和对其量的评估可更有效地鉴别良恶性病变、非增生性和增生性良性病变;对伴不典型细胞学改变的病例应避免误诊为癌,均应组织活检.     

用抽吸空针柄做细针吸取细胞学技术

目前,国外通用一种名为抽吸空针柄的器械,用于吸取细胞,利于细针吸取的操作,可提高诊断正确率。但国内对它很少使用。我们采用抽吸空针柄做了190例细针吸取细胞学检查,取得了满意结果。     

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     

细针穿刺细胞学与小切片对照诊断分析

细针穿刺细胞学与小切片对照诊断分析殷凤泉，刘俊英利用简便、安全的细针吸取术对肿块做生物学诊断是一种直接、快速、准确、经济的方法。我们对体表或接近体表的脏器内肿块行细针穿刺，并制订了＂三步法＂。细胞学诊断为第一步。用斜面刀刃式细针穿刺吸取细胞的同时，切...     

经直肠前列腺细针吸取细胞学诊断的探讨

经直肠前列腺细针吸取细胞学诊断的探讨马博文盛新福刘振疆王福贵一、材料与方法自１９８９年７月至１９９２年３月，我们对７５例前列腺肥大患者行经直肠前列腺细针吸取细胞学（ＦＮＡＣ）检查。年龄最小者５２岁，最大者８８岁，平均６８．７岁。患者分别表现为不同程度...     

Fine needle aspiration cytology of myxoid lesions of soft tissues: a study of 24 cases

OBJECTIVE: To summarize the diagnostic features of fine needle aspiration cytology (FNAC) of myxoid lesions in soft tissue, and to define the cytological criteria for differentiating benign lesions from sarcomas and between various myxoid lesions. METHODS: FNAC data of 24 soft tissue myxoid lesions (14 benign lesions, 10 malignant lesions) from 1993 to 2006 from Kiang Wu Hospital, Macau were reviewed in correlation with the clinical course or the results of biopsy. RESULTS: Ganglion, myxoma, and myxoid nodular fasciitis were the most common benign myxoid lesions of the soft tissues, all of which had low cellularity and lack of marked cellular atypia in smears in common. Ganglion was characterized by the disappearance of or the gradual minimization of the nodule after aspiration and the lack of blood vessel in smears. Myxoid nodular fasciitis was characterized by a pleomorphic pattern of proliferative cells and the presence of ganglion cell-like cells. Myxoid liposarcoma, extraskeletal myxoid chondrosarcoma and myxofibrosarcoma were the most common myxoid sarcomas. Cytologically, they had high cellularity and various degrees of cellular atypia. Myxoid liposarcoma exhibited branching chicken-wire like capillary vessels and/or lipoblasts; myxofibrosarcoma were prominent in both pleomorphic and atypia of the cells. The data revealed that the diagnostic accuracy of FNAC was nearly 100% in differentiating benign and malignant myxoid lesions of the soft tissues. The coordinate rate to the histopathology diagnosis of the common myxoid lesions of the soft tissues was above 75% (benign 71.4% and malignancy 80% respectively). CONCLUSIONS: FNAC is an effective method in diagnosing myxoid lesions of soft tissue, in correlation with the clinical data and the accessory examinations. FNAC can provide an objective basis for the treatment of myxoid lesions and prevention of unnecessary surgical operations.     

颈部淋巴结针吸细胞学580例诊断分析

目的 探讨颈部淋巴结针吸细胞学诊断的准确率及误诊原因.方法 分析580例颈部淋巴结针吸细胞学检查结果.其中161例在原部位取活检,分析针吸细胞学与组织学诊断符合率及误诊原因.结果 580例中淋巴结反应性增生226例,特异性炎202例,恶性淋巴瘤45例,转移癌107例.161例针吸细胞学与组织学诊断符合率为94.4%.107例转移癌中96例经临床及病理检查确定了原发灶.细胞学与组织学对照结果显示,细胞学检查有9例误诊,针吸细胞学误诊主要原因是吸取组织量少,对病变了解不全面;误诊病例结合病史及临床表现均有考虑到其他疾病的可能性.结论 颈部淋巴结针吸细胞学诊断准确率较高,但对可疑病变及原发肿瘤的分型,针吸细胞学仅可给予提示件初步诊断,需经组织学活检,必要时免疫组织化学诊断分型.     

免疫组织化学标记物在乳腺细针吸取细胞学鉴别诊断中的意义

目的探讨免疫标记物对鉴别乳腺细针吸取细胞学（FNAC）良性病变和癌的意义。方法收集135例有随访资料、活检和组织病理学诊断对照的乳腺FNAC资料：良性病变88例,包括非增生性病变43例和增生性病变45例;乳腺癌47例,对其FNAC涂片和相应的石蜡切片作细胞周期蛋白（cyclin）D1、c—erbB-2、Ki-67、p21^CIP1/WAF1（简称p21）和34βE12的免疫组织化学APAAP和ABC法检测。利用SPSS11．5软件进行分析。结果（1）以上各标记物在良性非增生性和增生性病变中的标记差异无统计学意义。（2）以上各标记物在良、恶性病变中的标记差异均有统计学意义（P〈0．001）。多因素的logistic回归分析显示最有意义的组合标记物为cyclinD1（P〈0．001）、34βE12（P〈0．001）和c—erbB-2（P=0．003）．cyclinD1、c—erbB-2阳性和34βE12阴性提示为癌,其组合诊断的敏感性和特异性最高。组合标记物共同判断,cyclinD1和34βE12任一判断为癌,诊断的敏感性和特异性分别为95．7％和94．3％;这三个标记物任一判断为癌,诊断的敏感性进一步上升至97．9％,特异性下降至92．0％;这三个标记物任两个共同判断为癌,诊断的敏感性为72．3％,特异性为100．0％。（3）在癌组中,根据Robinson细胞学分级把癌分为3级,cyclinD1、34βE12和p21在各级癌中的表达差异不大,而c—erbB-2和Ki-67在1级癌的阳性表达率最低,仅为40．0％和33．3％,在3级癌中阳性表达率最高。组合cyclinD1和34βE12,cyclinD1和34βE12,任一判断为癌,1级和2级癌的检出率为93．3％和96．2％。结论所检测的免疫标记物对良、恶性病变的鉴别诊断价值较大,组合cyclinD1、34βE12和c—erbB-2可最有效地提高癌的诊断敏感性和特异性。对鉴别分化好的乳腺癌和乳腺良性病变,最有效的组合为cyclinD1和34βE12。     

乳腺粘液囊肿样病变组织病理学及针吸细胞学改变

目的 分析乳腺粘液囊肿样病变的组织病理学及细针吸取（针吸）细胞学特点,寻求在手术前根据针吸细胞学鉴别ＭＬＬ与乳腺粘液腺癌的依据。方法 重新评估７例ＭＬＬ（良性５例,恶性２例）的组织病理学及针吸细胞学材料,并以同期１４例粘液腺癌作对照,比较两种病变在组织学及针吸细胞学上的差异。     

Extraskeletal myxoid chondrosarcoma: Fine-needle aspiration biopsy findings

Extraskeletal myxoid chondrosarcoma (EMC) is a malignant soft tissue tumor which typically presents as an enlarging mass in an extremity. In this location it is amenable to sampling and diagnosis by fine-needle aspiration biopsy. We present our experience with three cases of EMC and discuss the differential diagnosis of myxoid soft tissue tumors. Diagn Cytopathol 1994; 11:363–366. © 1994 Wiley-Liss, Inc.     

硬化性上皮样纤维肉瘤的临床病理学观察

目的探讨硬化性上皮样纤维肉瘤的临床病理学特征、免疫表型及鉴别诊断.方法应用光镜和免疫组织化学LSAB法对8例硬化性上皮样纤维肉瘤进行临床病理学分析和免疫表型检测.结果患者均为成年人,男性5例,女性3例,年龄35～54岁(平均45岁).临床上表现为深部软组织内缓慢性生长的肿块,其中大腿/臀部3例,右上臂/肩部2例,胸壁和背部2例,小腿1例.大体上,肿块呈结节状,境界相对清楚,直径2.0～10.5 cm(平均6 em),切面呈灰白色,质地坚韧或有弹性.组织学上,肿瘤由形态一致、小至中等大的圆形或多边形上皮样细胞组成,多呈单个或狭窄的条索状排列,夹杂于大量嗜伊红色、玻璃样变的胶原纤维之间.部分区域中也可排列成巢状、片状或腺泡状.高倍镜下,瘤细胞的胞质透亮或嗜伊红色,核异型性不明显,核分裂象也少见(＜1/10HPF).另在2例肿瘤的局部区域,细胞密度明显增加,核有显著的异型性,核分裂象也易见,类似经典的纤维肉瘤.免疫组织化学标记显示,瘤细胞弥漫强阳性表达波形蛋白,灶性或弱阳性表达上皮膜抗原,不表达细胞角蛋白、S-100蛋白、HMB45、肌动蛋白、结蛋白、CD34、bcl-2、CD30和白细胞共同抗原(LCA)等标记.随访6例,3例复发,1例发生肺部转移.结论硬化性上皮样纤维肉瘤是纤维肉瘤的一种少见亚型,尽管瘤细胞异型性不明显,核分裂象也少见,但肿瘤可发生局部复发及远处转移,临床上应视为一种低至中度恶性的软组织肉瘤处理,组织学上则应注意与一些具有上皮样形态和硬化性间质的肿瘤相鉴别.     

Fine-needle aspiration cytopathology of soft tissue: Chondromyxoid and myxoid lesions

Soft-tissue lesions pose an intimidating challenge to diagnostic interpretation by fine-needle aspiration cytology. to better characterize such aspirates, we investigated a subgroup of lesions which yielded a large amount of chondromyxoid and myxoid stroma (CMS). Thirty-three cases (22 malignant lesions, 11 benign lesions) in which CMS was a prominent feature of the smears were studied. the most common malignant neoplasms were extraskeletal chondrosarcoma (6 cases), myxoid liposarcoma (6), and malignant fibrous histiocytoma (5). the benign entities consisted of ganglion cyst (4), myxoma (3), and neurofibroma (2). of the aspirates from 22 malignant neoplasms, 15 (68%) contained opaque stroma, and in 18 (81%) the stroma was distributed as discrete clumps or fragments; all extraskeletal chondrosarcomas and chordomas contained these features. Additionally, in five of six chondrosarcomas the matrix exhibited cells within lacunae. Except for a tracheal chondroma which extended into the adjacent soft tissue, no benign aspirates had all three of these cytologic features. Twenty-three aspirates (70%) were moderately or highly cellular; all but two of these were malignant. Moderate to marked nuclear atypia occurred in 13/22 (59%) malignant and 1/11 (9.0%) benign aspirates. With a few exceptions, aspiration smears of benign lesions with abundant CMS were characterized by low cellularity, semitransparent amorphous stroma, and lack of nuclear irregularity. Recognition of variations in the character of the background material in addition to traditional cytologic criteria can aid in the diagnosis of benign and malignant chondromyxoid and myxoid aspirates of soft tissue. © 1995 Wiley- Liss, Inc.     

Fine-needle aspiration cytology of soft tissue lesions: diagnostic challenges

Clinical and radiographic data provide important information in the evaluation of soft tissue lesions/neoplasms. Morphologic tissue and cytologic examination is considered to be a necessary part of the diagnostic work-up. The standard procedure for obtaining tumor tissue for morphologic evaluation has been incisional (open) or core needle biopsy. An increasing use of minimally invasive diagnostic procedures has resulted in better acceptance of fine-needle aspiration cytology (FNAC) in the diagnosis of soft tissue lesions. This article discusses challenges in FNAC of soft tissue lesions based on the experience at a multidisciplinary referral sarcoma center. Obtaining sufficient specimens from deeply seated small and necrotic/cystic lesions is technically a potential pitfall and misdiagnosis of cells from reactive zones surrounding the tumor as well as the correct evaluation of spindle cell lesions, rare soft tissue neoplasms, and "new entities" lacking reproducible cytological criteria are other important challenges in FNAC of soft tissues. The successful cytological evaluation of soft tissue lesions requires the application of strict, reproducible morphological criteria in the context of the clinical findings as well as ancillary techniques. The minimal criteria for diagnostic intervention in various clinical settings and the relative advantages and disadvantages of FNAC must be understood. FNAC of soft tissue lesions is facilitated when limited to specialized orthopedic-oncologic centers with a well-integrated multidisciplinary team and experience in the evaluation and therapy of soft tissue lesions.