恶性肿瘤延诊或误诊因素分析

目的 :分析恶性肿瘤诊断过程中的误诊因素 ,降低临床误诊率。方法 :回顾分析本院 1990年 6月～ 2 0 0 0年 12月收治的 167例恶性肿瘤患者 ,分析其诊疗过程中的误诊因素对正确诊断的影响。结果 :167例患者误诊 5 8例 ,误诊率为 3 4 73 %。误诊率较高的为少见肿瘤达 83 3 3 % ( 10 /12 ) ,其次为妇科肿瘤、胆道系统和甲状腺癌 ,分别为 4/5、3 /4和 3 /5。误诊因素中医生因素为主要因素占 77 5 9% ( 4 5 /5 8)。结论 :提高临床医生 ,特别是非肿瘤专科医生对恶性肿瘤生物学行为的认识 ,重视癌前病变及早期症状 ,以科学严谨的态度分析患者资料是减少误诊的关键     

全视野数字化乳腺摄像与细针穿刺细胞学检查对乳腺肿块的诊断意义

目的评估细针穿刺活检与数字化乳腺摄像在乳腺肿块定性诊断中的准确性。方法102例乳腺肿块患者(年龄17～76岁,中位年龄50岁)均进行细针穿刺活检与数字化乳腺摄像检查,且所有患者均入院手术获得病理诊断,所得结果与最终的病理学诊断结果进行对照分析。结果102例患者中,最终病理确诊为乳腺癌者43例(42.2%),细针穿刺活检对乳腺癌检测的敏感性为90.7%(39/43),特异性为89.8%(53/59),总准确率为90.2%(92/102)。数字化乳腺摄像检查对乳腺癌的敏感性也是88.4%(38/43),而特异性是83.1%(49/59),总的准确率是85.3%(87/102)。细针穿刺活检假阴性的乳腺癌可通过数字化乳腺摄像检查得到正确诊断。结论细针穿刺活检与数字化乳腺摄像都是诊断乳腺疾病的准确有效方法,两者联合应用能够降低乳腺肿块的误诊率。     

扁桃体非何杰金淋巴瘤：（附122例分析）

扁桃体非何杰金淋巴瘤是指原发于魏氏环(Walder’s ring)中扁桃体淋巴组织的恶性肿瘤。淋巴瘤患者多有全身表浅淋巴结肿大,诊断并不困难,但因扁桃体淋巴瘤属结外型淋巴瘤,早期未见表浅淋巴结肿大,故病理诊断前多被误诊为炎症、结核、恶性肉芽肿、扁桃体癌等而延误治疗。延误诊断最短者20天,最长者14个月,平均3个月。活检前误诊率为85.3％、活检后的误诊率仍占9.0％。我院自1975年6月至1989年12月共收治经活检证     

消化道非何杰金淋巴瘤误诊漏诊的教训

本文报道１９８０年１月一１９９３年１２月消化道非何杰金淋巴瘤２９例，均经病理确诊，其临床表现无特异性，由于各种原因，容易误诊和漏诊，本组仅４例首诊时考虑本病，误诊率８６．２％，误诊时间最长１年６月，本组２４例有腹部包块，应予重视进一步检查。如体表无肿大淋巴结供活检，则只能通过内窥镜、Ｂ超、ＣＴ或ＭＲＩ定位引导下针吸活检，必要时剖腹探查才能取得足量的活体组织供确诊之用，以免误诊。消化道非何杰金淋巴瘤，强调病理诊断是主要依据。     

细针抽吸、粗针切割和病灶染色切除三种方法诊断非扪及性乳腺疾病的比较

背景与目的:提高乳腺癌疗效、延长患者生存期,关键在于早期诊断。而早期乳腺癌多为隐匿性,临床无法扪及,实验室检查也不能提供有效的检测方法,诊断困难。本研究旨在探寻有效的检查手段,以提高乳腺癌的早期诊断率。方法:选择钼靶照片发现有可疑恶性病变而临床未扪及肿块的患者24例,对每一病例进行计算机辅助钼靶立体定位,并分别行细针抽吸细胞学检查、粗针穿刺活检、病灶染色手术切除冰冻切片活检术,与术后病理对照。结果:本组细针抽吸细胞学检查、粗针穿刺活检和病灶染色手术切除冰冻切片检查的符合率分别为75%、92%和100%(P<0.05)。结论:计算机辅助钼靶立体定位病灶染色手术切除冰冻切片活检术是提高乳腺癌早期诊断率的理想诊断技术。     

模拟机下经皮胸内肿瘤超细针针吸活检——附100例报告

本文报告了1984年10月～1986年3月我们进行的100例模拟机下经皮胸内肿瘤超细针针吸活检的结果。针吸活检的成功率为94.0％(94/100)其中肺癌65例,诊断正确率87.7％,可疑率为6.2％,误诊率为6.2％。没有明显的并发症。作者认为,模拟机定位具有准确、穿刺少受肿瘤部位及大小的限制且成功率高的优点;超细针针吸活检所获取的细胞学标本结果可与小针及粗针针吸活检标本相媲美,但合并症却更少。该技术是一能早期取得细胞学诊断并值得推广应用的方法。对于外周型(钱币样肿块)作此项检查特别合适。     

63例胰腺癌临床诊治分析

目的探讨胰腺癌早期诊断方法,减少误诊误治率。方法回顾分析63例胰腺癌临床诊治资料。结果63例胰腺癌中49例有误诊史,误诊率高达78%,多数误诊为胃炎、胃溃疡、胆囊炎及肝炎,仅14例初诊明确诊断。63例中外科根治性手术14例,剖腹探查、姑息性手术24例,经门诊筛查不能手术的25例内科化疗或介入治疗。3种疗法治疗后平均生存时间为:18个月、9个月、10个月。结论胰腺癌早期诊断率低,手术切除率低,B型超声显像及CT检查是诊断胰腺癌理想的无创伤检查方法,可在术前精确判断肿瘤能否被切除,减少误诊误治率。     

以头痛为首发症状鼻咽癌误诊分析

鼻咽癌是常见恶性肿瘤之一。近30年来,鼻咽癌的早期诊断率始终未见明显提高,尤其是基层医生对该病认识不足,早期病人的误诊率更高。结合我院肿瘤治疗中心及耳鼻喉科近5年来收治的病人,总结鼻咽癌患者60例,误诊35例,其中以头痛为首发症状而误诊为其他疾病的10例,现报道如下。1临床资料从初诊到确诊鼻咽癌时间超出1个月者为延误诊断。本组10例误诊病人中,男6例,女4例。年龄12~54岁,平均40岁。误诊时间1~7个月。被误诊为血管神经性头痛4例,感冒后遗症1例,鼻窦炎2例,诊断不明3例。最后经鼻咽肿物活组织病检确诊为鳞癌9例(高分化1例,中分化3例,低…     

青少年原发性肺癌外科治疗及预后

目的 :探讨青少年肺癌的特点 ,分析原因 ,总结早期诊断方法。方法 :对 4 8例青少年肺癌进行回顾性统计。结果 :青少年肺癌发病率占本院同期原发性支气管肺癌的 0 97% (48/ 4 90 5例 ) ,误诊率约为 81 2 % (39/ 4 8) ,其中 3例病员误诊时间最长超过 9个月。病理分型以腺癌和鳞癌为主。两者相似比分别为 6 0 4 %和 2 7 0 % ;TNM分期 :中晚期肺癌达 93 7% ;术后死亡率为 2 0 % ,术后一年生存率为 6 2 5 % ;三年生存率为 4 5 8% ;五年生存率为 32 6 % ;七年生存率为 2 7 0 %。结论 :(1)青少年肺癌以误诊率高 ,恶性程度高 ,进展快 ,转移率高 ,手术切除率低 ,预后差等为特点。 (2 )普遍误诊原因有 :对青少年肺癌警惕性不高 ,鉴别诊断困难。 (3)应提高对青少年肺癌的认识 ,提倡早期诊断 ,早期治疗     

模拟定位机导引下经皮细针吸取活检对肺部肿块的诊断意义

目的　探讨模拟定位机导引下经皮细针吸取活检对肺部肿块的诊断意义。方法　应用模拟定位机导引下经皮细针吸取肺部肿块活检对 175例肺部肿块的诊断价值进行分析。结果　共获得细胞学标本 16 9例 ,活检成功率 96 6 % (16 9/175 ) ,诊断阳性率92 % (16 1/175 ) ,并发症率 6 3 % (11/175 ) ,假阴性率 4 7% (8/16 9)。本组恶性肿瘤占 90 1% (14 5 /175 ) ,可进行病理分类 77 9% (113/14 5 )。良性病变 9 94% (16 /175 )。结论　模拟定位机导引下经皮细针吸取肺部肿块活检对肿块的定位、测量深度及确定进针方向比电透、B超及CT导引下肺穿刺活检有较多的优越性 ,特别对肺内 1 5～ 3cm的小肿块的针吸肺活检更具有诊断价值     

穿刺细胞学与B超相结合在诊断乳腺癌中的意义

目的探讨细针穿刺细胞学与B超相结合对乳腺癌的诊断价值。方法采用B超引导下定位穿刺吸取细胞学及单纯应用针吸细胞学两种方法，与肿物切除后组织学检查相对比进行分析。结果肿物切除后组织学检查诊断乳腺癌98例，假阴性11例，其中36例应用B超引导下定位穿刺吸取细胞学检查，假阴性2例；62例单纯应用针吸细胞学检查，假阴性9例，细胞学诊断准确率分别为94．4％和85．5％，差异有显著性（P〈0．05）。结论细针穿刺细胞学检查具有安全、经济、方便、快速、痛苦小、准确率高的特点，结合B超引导下的定位穿刺更可获取足量的细胞成分，提高细胞学诊断正确率。对乳腺肿块尤其是对乳腺癌的筛选具有重要意义，可达到早期诊断和治疗目的。虽然乳腺的穿刺细胞学检查具有较高的可靠性，但仍存在一定的局限性和误诊率，需要组织学诊断解决。     

Impact of stereotactic large-core needle biopsy on diagnosis and surgical treatment of nonpalpable breast cancer.

INTRODUCTION: Stereotactic large-core needle biopsy is increasingly replacing needle-localized breast biopsy for the diagnosis of nonpalpable breast disease. In this prospective study, the impact of the introduction of this technique on diagnosis and surgical treatment of nonpalpable breast cancer was assessed in two hospitals in The Netherlands. PATIENTS AND METHODS: A total of 84 patients with nonpalpable breast cancer, diagnosed by means of stereotactic large-core needle biopsy (needle biopsy group) were compared with 80 patients diagnosed with nonpalpable breast cancer before the introduction of large-core needle biopsy. These patients were diagnosed by means of needle-localized open breast biopsy (control group). Clinical outcome measures evaluated included: duration of diagnostic and therapeutic intervals and number of surgical procedures required for complete surgical treatment. Subgroup analysis was performed for the category of microcalcifications without tissue distortion. RESULTS: For the needle biopsy group, the median interval between initial referral to the surgeon and the availability of histological diagnosis was 9 days and the interval between initial referral and complete surgical treatment was 31 days. These intervals were significantly longer for the control group (19 days and 44 days respectively); 75% of patients in the needle biopsy group were treated in a single step surgical procedure compared to 16% of the patients in the control group (67 vs 25% respectively for the subgroup). The mean number of surgical procedures required to complete surgical treatment was 1.31 for needle biopsy group vs 1.91 for the open biopsy group (1.46 vs 1.84 for the subgroup). CONCLUSION: Introduction of stereotactic large-core needle biopsy leads to a reduction of the time to diagnosis and the time to complete surgical treatment of nonpalpable breast cancer. It also reduces the number of surgical procedures required for complete surgical treatment of nonpalpable breast cancer. The benefits of large-core needle biopsy may also be anticipated for patients with microcalcifications without tissue distortion.     

Diagnostic accuracy of stereotactic large-core needle biopsy for nonpalpable breast disease: results of a multicenter prospective study with 95% surgical confirmation

Stereotactic large-core needle biopsy is increasingly applied for the diagnosis of nonpalpable breast disease. Our study examines whether this minimally invasive technique is sufficiently accurate to replace surgical breast biopsy. In a prospective multicenter study, 973 consecutive women with 1,029 nonpalpable breast lesions were offered stereotactic 14-gauge needle biopsy. If the needle biopsy yielded breast cancer, the patient was offered therapeutic surgery. Surgical biopsy was proposed in cases of needle biopsies without malignancy. An expert panel reviewed all discrepancies in histologic diagnosis between the needle biopsy and open biopsy. Forty-five patients withdrew from participation and 113 (11%) planned needle biopsy procedures were cancelled. Of the 871 successful biopsy procedures, 95% were confirmed surgically. In 13 cases (1.5%), insufficient material was obtained for histologic assessment. Fifty-five percent of the needle biopsies were diagnosed as malignant (290 invasive cancers, 190 ductal carcinoma in situ). Thirteen of the 322 lesions (4%, 95% CI 2-7%) with a benign needle biopsy diagnosis contained malignancy after surgery. Six of the 26 (23%, 95% CI 9-44%) lesions with a high-risk diagnosis (atypical ductal or lobular hyperplasia or lobular carcinoma in situ) were diagnosed as malignant after surgery. Five of the 30 lesions containing normal breast tissue held malignancy (17%, 95% CI 6-35%). Guidelines for the management of different categories of needle biopsy diagnoses were made. Application of these guidelines to the present findings resulted in sensitivity and specificity rates of 97% (95% CI 95-98%) and 99% (95% CI 97-100%), respectively. Stereotactic large-core needle biopsy is an accurate diagnostic instrument for nonpalpable breast disease. It may safely replace needle localised open-breast biopsy provided that high-risk and normal breast tissue diagnoses are followed by needle or open-breast biopsy.     

X线摄片计算机辅助定位穿刺活检对早期乳腺癌的诊断价值

为了探讨乳腺钼靶X线摄片在计算机辅助下立体定位核心穿刺活检对临床上不能扪及肿块的早期乳腺癌的诊断价值,对48例临床上不能扪及明确肿块、乳腺X线摄片发现可疑病变患者,采用计算机辅助立体定位核心穿刺,取得活组织行病理检查。结果示,48例患者中共发现早期乳腺癌7例,占14.6%。初步研究结果提示,X线摄片计算机辅助立体定位核心穿刺活检技术具有定位精确、可靠程度高、创伤小、操作简单等优点,对早期乳腺癌的诊断有重要价值。     

The detection of local recurrence after definitive irradiation for early stage carcinoma of the breast. An analysis of the results of breast biopsies performed in previously irradiated breasts

One hundred forty-five breast biopsies were performed in 139 treated breasts to evaluate for potential recurrent carcinoma of the breast in women previously treated with definitive breast irradiation for early stage carcinoma of the breast. One hundred thirty-four patients had undergone one breast biopsy, four patients had undergone two breast biopsies, and one patient had undergone three breast biopsies. The median interval from completion of definitive irradiation to breast biopsy was 28 months (range, 2 to 117 months). Of the 145 breast biopsies, 52% (76 of 145) were positive, and 48% (69 of 145) were negative. The positive biopsy rate was related to the type of biopsy, the location of the biopsy, and the findings on physical examination and mammography. In patients with a negative physical examination but mammographic findings of a mass, microcalcifications, or both, the positive biopsy rate was 66% (25 of 38). For patients with a mass on physical examination but a negative mammogram, the positive biopsy rate was 28% (nine of 32). For patients with a mass on physical examination and a positive mammogram, the positive biopsy rate was 72% (13 of 18). For patients undergoing an incisional or Tru-Cut (Travenol Laboratories, Deerfield, IL) needle biopsy, the positive biopsy rates were 94% (15 of 16) and 75% (three of four), respectively, whereas the positive biopsy rate for an aspiration cytology was 25% (five of 20). Of the 76 positive biopsies, 64% (49 of 76) were from an in field or marginal location. The rate of detection of a subsequent local recurrence after an initial negative biopsy was 5% (three of 66). Of the evaluable patients, the complication rate was 9% (seven of 81). This study has documented the results of breast biopsies after definitive irradiation for early stage carcinoma of the breast.     

Provider case volume and outcome in the evaluation and treatment of patients with mammogram-detected breast carcinoma

BACKGROUND: Practice volume may affect the outcome of patients with breast carcinoma. Defining factors that influence the relation of volume and outcome for the diagnosis and treatment of breast carcinoma is important, because breast carcinoma is common, and care is decentralized. METHODS: Community-wide diagnosis and treatment of mammogram-detected breast carcinoma was examined using claims data from a single insurer representing 25% of the regional population. Among 1001 mammogram-directed breast biopsies, the rate of breast carcinoma diagnosed by stereotactic core needle biopsy (SCNB) or excisional biopsy with needle localization (EBNL) and the rate at which breast-conserving surgery (BCS) was used were analyzed. Outcome and practice volume were examined for surgeons, radiologists, and medical centers. RESULTS: Two hundred twenty-four tumors were diagnosed by EBNL (604 diagnoses) and SCNB (397 tumors), for a 22.4% positive biopsy rate. The median number of procedures per physician was one. Positive biopsy rates for radiologists, surgeons, and medical centers did not correlate with practice volume. Positive biopsy rates for high-volume physician providers and medical centers ranged from 9% to 46%. The BCS rate was 45% and 64% for surgeons treating one or more than one claim, respectively. Tumor stage and surgeon case volume were the only independent predictors of BCS (P < 0.05). CONCLUSIONS: There is wide variation in diagnosis and treatment outcomes for patients with mammogram-detected breast carcinoma. Overall, practice volume was correlated with the use of BCS but not with the rate of positive biopsy. A wide variation in the positive biopsy rate among high-volume providers and medical centers suggests that volume of practice is not a surrogate for quality in the diagnosis of breast carcinoma.     

Diagnosis and Treatment Experience of 14 Cases of Breast Cancer Associated with Pregnancy or Lactation

Objective： To explore the diagnosis and treatment experience of breast cancer associated with pregnancy or lactation. Methods： From January 1990 to December 2005, 14 cases with breast cancer associated with pregnancy or lactation were analyzed retrospectively （TNM stage Ⅱ, 2 cases; stage Ⅲ, 11 cases; stage Ⅳ, 1 case）. Diagnosis was established by fine needle aspiration biopsy primarily or routine pathological method if necessary. Abortion was used for discontinuation of pregnancy in 1 case with early pregnancy and 1 case with meddle pregnancy. 2 patients with late pregnancy received cesarean section, 10patients of breast cancer associated with lactation received multidisciplinary and-tumor treatment after discontinuation of lactation. Results： Diagnosis was confirmed by fine noodle aspiration biopsy in 9 cases and by secondary routine pathological method in the other 5 cases, 12 cases were followed up, 1 case of stage Ⅳ died of metastasis 5 months after diagnosis. 3-, 5-year survival rates in 10 cases of stage Ⅲ were 66% and 30% respectively. One case remained alive without recurrence for 8 years up to now. Conclusion： A thorough breast examination is necessary at the first antenatal visit physicians should aggressively pursue work-up in women with a palpable breast tass. In the patients during the second and third trimness, the various modalities available for treatment inholding abortion and their risks and beneath modalities available for treatment including abortion and their risks and benefits must be discussed openly with patients and their families.     

Combined modality treatment of local regionally advanced breast cancer patients. 5 to 10 year follow-up

Local regionally advanced breast cancer carries a poor prognosis overall. There is little published information regarding the long-term follow-up of such patients prospectively treated with surgery, radiation therapy, and early systemic therapy. This communication reports 5-10 year follow-up results on 32 women with local regionally advanced breast cancer prospectively treated with initial surgery followed by systemic chemotherapy and irradiation therapy. Median relapse-free and overall survivals in these women were 37.6 and 62 months, respectively. Nine patients (28%) are currently alive and disease-free 5 to 10 years after diagnosis. Women with inflammatory breast cancer fared as well as other patients with local regionally advanced breast cancer in this small trial. None of 10 patients with gross disease after an initial mastectomy is disease-free as opposed to 9 of 22 women with initially resectable disease (41%). Thus, an appreciable minority of women with resectable local regionally advanced breast cancer may have prolonged disease-free survivals following combined modality therapy.     

A decade of breast cancer screening in The Netherlands: trends in the preoperative diagnosis of breast cancer

Purpose In a prospective, multi-institutional follow-up study we describe the trends in the preoperative pathologic confirmation of breast cancer of women who underwent breast cancer screening between 1995 and 2005. Methods We included all women aged 50–75 years who underwent biennial screening mammography in the southern breast cancer screening region of the Netherlands between February 13, 1995 and December 22, 2004. Clinical data, breast imaging reports, biopsy results and breast surgery reports were collected of all women with a positive screening result. Follow-up lasted through the next biennial screening examination and was approximately two years for all referred women. Results Of 258,900 mammographic screening examinations, 3,064 (1.2%) were positive screens. The majority of women (92%) were analyzed in four regional hospitals and workup yielded breast cancer in 1,332 women. From 1995 to 2005, the percentage of breast cancer cases that underwent percutaneous biopsy prior to surgery, increased from 42.4 to 100%. The proportion of cancers with a preoperative diagnosis of malignancy by percutaneous biopsy, increased from 27.1% in 1995 to 92.7% in 2004. Preoperative breast cancer confirmation by fine needle aspiration cytology (FNAC) gradually decreased from 91.3% to 14.5%, whereas preoperative confirmation by ultrasound guided core biopsy (USCB) or stereotactic core needle biopsy (SCNB) increased from 8.7% to 69.1% and from 0 to 17.4% respectively. Conclusions A preoperative diagnosis of breast cancer is currently obtained in more than 90% of breast cancer patients. The increase in preoperative breast cancer diagnosis through 1995–2004 is correlated with the introduction of SNCB and increased use of USCB at the expense of FNAC.     

乳腺放射状瘢痕31例临床分析

目的分析乳腺放射状瘢痕（radial scar,RS）的临床病理特点和处理方法。方法回顾性分析Z003年7月至2008年6月天津医科大学附属肿瘤医院收治的31例乳腺RS患者的临床病理资料。结果RS患者的中位年龄为48岁（23～75岁）,其中12例因乳腺肿物就诊。31例患者中6．5％（2／31）为单纯乳腺RS,45．2％（14／31）伴有乳腺良性病变,48．4％（15／31）伴有乳腺癌。16例单纯或伴良性病变的乳腺RS患者中,行超声检查者11例,行X线检查者14例;临床初诊误诊率为10／16,超声诊断误诊率为5／11,X线诊断误诊率为9／14,冰冻病理诊断符合率为16／16。15例RS伴乳腺癌患者的各种辅助检查均诊断为乳腺癌。所有RS患者均接受手术治疗,术后随访6～66个月（中位随访34个月）,患者均健在,无局部复发,亦无继发乳腺恶性肿瘤。结论乳腺RS多伴其他乳腺病变,与乳腺癌的关系不明确,术前辅助检查易与乳腺癌混淆。手术局部切除是安全有效的诊治措施。