腰穿针在骨肿瘤穿刺活检中的应用

骨肿瘤的诊断与治疗须依据临床一病理一X线三结合原则，术前能及时准确地作出病理诊断，对临床选择治疗方案，尤其是保肢手术及其术前综合化疗，均具有重要指导意义。我院自1993年开始应用腰穿针作为骨肿瘤穿刺活检针，为60例患者行术前穿刺活检，其中与最后诊断符合的48例(80％)，现将临床应用情况报告如下；     

骨肿瘤穿刺活检学习班通知

为提高骨肿瘤的诊断水平,普及骨肿瘤穿刺活检的意义,规范和标准化骨肿瘤穿刺活检的设计和操作,提高骨活检的成功率,北京积水潭医院骨肿瘤科拟定于2012年11月2—3日举办“第四届全国骨肿瘤穿刺活检学习班”。本次学习班招收学员20名,通过专家授课、实物操作演练、活检标本即时病理评测等方式,     

全国骨肿瘤穿刺活检学习班

由北京积水潭医院骨肿瘤科主办的国家级医学继续教育项目“全国骨肿瘤穿刺活检学习班”（编号2009-04-07-016）定于2009年10月30-31日在北京积水潭医院举行。主要目的：提高骨肿瘤的诊断治疗水平,普及骨肿瘤穿刺活检的意义,规范和标准化骨肿瘤穿刺活检的设计和操作,提高活检的成功率。     

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。     

骨肿瘤穿刺活检学习班通知

为提高骨肿瘤的诊断水平,普及骨肿瘤穿刺活检的意义,规范和标准化骨肿瘤穿刺活检的设计和操作,提高骨活检的成功率,北京积水潭医院骨肿瘤科拟定于2012年11月2-3日举办“第四届全国骨肿瘤穿刺活检学习班”。本次学习班招收学员20名,通过专家授课、实物操作演练、活检标本即时病理评测等方式,集中讲授与骨肿瘤穿刺活检相关的临床和病理知识,培训演练穿刺活检的设计、操作技巧。欢迎相关医生踊跃参加。本次活动为国家级医学继续教育项目（项目编号：2012—04—07—065）,授予Ⅰ类教育学分。     

全国骨肿瘤穿刺活检学习班通知

由北京积水潭医院骨肿瘤科主办的国家级医学继续教育项目“第二届全国骨肿瘤穿刺活检学习班”[编号2010—04—07—027（国）]定于2010年10月29～30日在北京积水潭医院举办。主要目的：提高骨肿瘤的诊断治疗水平,普及骨肿瘤穿刺活检的意义,规范和标准化骨肿瘤穿刺活检的设计和操作,提高活检的成功率。     

CT导向经皮肺穿刺活检的临床应用

目的 探讨CT导向经皮肺穿刺活检用于肺占位性疾病诊断的意义。方法 采用DLTRA－CUT型16G、18G、20G软组织切割式活检针在PICKER IQ CT机导向下穿刺诊断35例肺占位性疾病。结果 35例经皮肺穿刺活检，经病理检查证实26例为原发性恶性肿瘤，1例转移性癌，3例结核，3例炎性假瘤，2例未能明确诊断，诊断率为94．3％。术后5例出现少量气胸，2例出现血丝痰，均未做特殊处理。结论 CT导向经皮肺穿刺活检是比较安全、实用的技术、可以在有条件的单位广泛应用。     

经手术或穿刺活检后骨盆恶性骨肿瘤患者病理分析及病灶特点分析

目的 分析经手术或穿刺活检后病理确诊为骨盆恶性骨肿瘤患者的病理类型以及病灶特点.方法 收集136例经病理确诊为骨盆恶性骨肿瘤患者的临床资料.根据WHO 2013版骨肿瘤分型标准以及骨盆分区对136例患者的病灶特点以及病理类型进行分类分析总结.结果 本组患者浆细胞瘤发病率最高(30.1%),其次为非霍奇金淋巴瘤(21.3%)、软骨肉瘤(16.2%)、骨肉瘤(9.6%);骨肉瘤好发于青少年以及儿童,平均年龄为(24.6±14.9)岁,好发年龄段位为2~28岁,男性发病率高于女性(男女发病比例为2.25:1);尤文肉瘤也是青少年好发的骨盆恶性骨肿瘤之一,年龄为2~39岁,相比骨肉瘤年龄跨度更大.136例患者中41例患者单区发病,Ⅲ区发病例数最多为20例,发病率最高(48.8%),其次为Ⅰ区、Ⅳ区、Ⅱ区,单区发病中软骨肉瘤病例数为16例,发病率最高(39.0%);53例患者为多区发病,Ⅰ+Ⅱ+Ⅳ区发病例数17例,发病率最高(32.1%),其次为Ⅰ+Ⅳ、Ⅰ+Ⅱ、Ⅱ+Ⅲ、Ⅰ+Ⅱ+Ⅲ+Ⅳ区,非霍奇金淋巴瘤发病例数为15例,发病率最高(28.3%).结论 根据经手术或穿刺病理活检分析得出骨盆恶性骨肿瘤中浆细胞瘤发病率最高,其次为非霍奇金淋巴瘤、软骨肉瘤、骨肉瘤;各个年龄段都有发病,总体男性发病率高于女性,其中骨肉瘤以及尤文肉瘤好发于青少年;骨盆恶性骨肿瘤患者单发病灶中以Ⅲ区相对好发,且软骨肉瘤在单区病灶中发病率最高;多区病灶中Ⅰ+Ⅱ+Ⅳ区相对好发,非霍奇金淋巴瘤发病率最高.     

模拟定位机导向经皮肺活检34例临床分析

经皮肺活检对肺内周围性病变的定性诊断有重要作用,尤其是对肺内小的结节性病变,已成为明确病理诊断的首要检查方法。我们对本院近年来经CT扫描疑诊为周围型肺癌的34例患者,以模拟定位机导引自动弹力切割枪经皮肺穿刺活检,现报告如下。     

超声介导下BI-RADS 4级乳腺肿物行空心针穿刺活检的诊断意义

目的:探讨超声介导下BI-RADS 4级乳腺肿物患者行空心针穿刺活检对肿物性质的诊断价值。方法:随机抽取我科于2014年1月-2014年12月共500例已行手术治疗的乳腺肿块患者,收集其穿刺病理与切检病理（包括术中快速冰冻切片或术后病理）结果,应用SPSS 17.0对其空心针穿刺活检与切除活检结果一致性作比较分析,并将超声下BI-RADS 4级的病例单独列出,检验组间一致性。结果:超声介导下空心针穿刺活检（US-CNB）与切除活检的病理诊断结果符合率为96.23%,BI-RADS 4级病例诊断结果符合率为94.57%,与整体准确率相差不大,与切除活检具有良好的一致性。结论:US-CNB作为对乳腺肿瘤的术前诊断手段之一,对超声下良恶性难以鉴别的BI-RADS 4级乳腺肿物具有较好的诊断价值。     

螺旋刃活检针在骨肿瘤诊断中的应用价值

目的:探讨螺旋刃活检针在骨肿瘤诊断中的应用价值.方法:应用螺旋刃活检针进行四肢、脊柱及骨盆骨肿瘤穿刺活检共94例(恶性肿瘤59例、非恶性肿瘤35例),其中B超引导下穿刺45例,CT引导下穿刺2例.结果:组织获取率达98.9%;88例可做出病理诊断,阳性率93.6%.诊断恶性骨肿瘤的敏感性为93%,特异性100%,阳性预测值100%,阴性预测值89.7%.结论:该活检针结构设计独特合理,标本挤压损伤小,在单一针道内可完成不同深度或多点取材,值得推广应用.     

Evaluation and indications of ultrasound-guided vacuum-assisted core needle breast biopsy

BACKGROUND: The Mammotome is a diagnostic tool used under stereotactic or with ultrasound guidance. A clear indication for Mammotome use under stereotactic guidance is when a non-palpable microcalcification is a target. However, the indications for the use of the Mammotome under ultrasound guidance vary among institutions, and it is difficult to find a place for the Mammotome among conventional biopsy techniques. The Mammotome biopsy has been available in our hospital since July 1999. We assessed the effectiveness and indications of ultrasound-guided Mammotome biopsy. METHODS: We performed Mammotome biopsies in 433 cases requiring histological diagnosis from July 1999 to September 2006, using an 11-gauge articulated arm-type Mammotome under ultrasound guidance. There were 377 mass lesions including 83 non-palpable cases and 56 hypoechoic lesions. RESULTS: The indications for Mammotome biopsy were 162 cases with inconsistent fine needle aspiration (FNA) and imaging findings, 114 cases indeterminate by FNA, 68 cases of an identified pathological type before neoadjuvant chemotherapy and confirmation of hormone receptor status, 36 inadequate cases by FNA, 20 cases of confirmation of fibroadenoma and other benign tumors, 8 removal cases of fibroadenoma, 8 microcalcification cases, and 17 others. The target lesion was obtained in 99.5% of the cases. CONCLUSIONS: Ultrasound-guided Mammotome biopsy is an accurate and useful diagnostic method that enables sufficient amounts of tissue to be obtained with minimal invasion and few complications. The Mammotome is the first choice for obtaining a definitive pathological diagnosis in breast lesions.     

彩超引导下空芯针穿刺在乳腺肿块诊断中的意义

目的:评价彩超引导下空芯针穿刺活检（US-CNB）在乳腺肿块诊断中的临床意义。方法:回顾性分析宿州市立医院肿瘤外科2011年1月至2014年6月行空芯针穿刺活检病人120例,对空芯针穿刺活检和切除活检标本的病理组织学诊断进行比较和分析。结果:120例乳腺疾病病人经空芯针穿刺活检组织学诊断乳腺癌为90例,7例假阴性,假阴性率为5.8%。US-CNB 与切除活检的病理诊断符合率为94.2%,无显著性差异（P＞0.05）,空芯针穿刺结果与肿瘤性质、部位、患者年龄、钙化等因素,无显著性差异（P＞0.05）,与肿瘤大小有显著性差异（P＜0.05）。结论:彩超引导下空芯针穿刺活检是一种敏感性高、特异性强、安全性较高的乳腺病变诊断方法。     

Pathological aspects of core needle biopsy for non-palpable breast lesions

Recently, the incidence of non-palpable or noninvasive breast cancer has increased. Consequently, criteria for choosing procedures to obtain pathological materials had changed. Fine needle aspiration biopsy cytology (FNA) and core needle biopsy (CNB) are both reliable procedures for detecting breast cancer. However, for non-palpable lesions, the diagnostic accuracy of CNB is higher. The main limits of FNA are the high rate of insufficient sampling and inability to determine invasiveness. CNB is an established alternative to surgical biopsy, and CNB can avoid excess surgical biopsies in a large number of patients. In addition to accurate histological diagnosis, there is interest in obtaining prognostic information from CNB, especially for patients being considered for preoperative (neoadjuvant) therapy. CNB provides useful information about histologic type and grade. However, an unavoidable problem of CNB is underestimation of invasion. On the other hand, there is good concordance in particular for estrogen receptor (ER) and progesterone receptor (PR) between CNB and surgical excision. Several aspects of CNB remains controversial, such as diagnosing papillary lesions by CNB, problems regarding tumor cell displacement after CNB, and management of lobular neoplasia (LN) on CNB.     

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.     

B超引导空芯针穿刺活检对于乳腺肿块诊断作用的分析

目的:评价B超引导空芯针穿刺活检(core needle biopsy,CNB)在可触及的乳腺肿块中的临床应用价值,同时讲述操作中的技术事项.方法: 回顾分析可触及肿块的乳腺疾病住院患者的临床和病理资料,总结B超引导CNB的适应证、优缺点、注意点.结果:CNB的敏感性为94.85%,假阴性为5.15%;病理低估为5.83%; 诊断符合率为89.32%.14Gauge穿刺针的标本数应该是3根以上的合格标本;行ER、PR、neu检测的患者,需取合格穿刺标本4根以上.结论: 对于临床可触及的乳腺肿块,该检测方法有较高的临床应用价值.B超引导CNB适用于超声发现的乳腺病灶.B超引导的CNB的优点是明显缩短手术时间和避免了手术切除肿块时可能带来的肿瘤播散.从术中冰冻病理到术前明确诊断是一种治疗模式的转变.     

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。     

Present state of and problems with core needle biopsy for non-palpable breast lesions

The widespread use of screening mammography has resulted in increased detection of nonpalpable breast lesions here in Japan. For the histopathologic work-up of these lesions, stereotactic core biopsy is essential as a minimally invasive diagnostic procedure. However, the number of facilities that provide this procedure cannot keep up with the increasing demand from patients.Another issue is interpreting the results of the biopsy. With a histological diagnosis using needle samples, there is always a risk of underestimation or a false-negative result. To avoid missing cancers after stereotactic biopsy, it is important to check for sampling errors and for discrepancies between the radiologic and pathologic findings.We are pushing for the rapid spread of an ideal form of stereotactic breast core biopsy (using prone-type units, digital methods, and vacuum-assisted breast biopsy devices) throughout Japan so that every patient can undergo this examination.