超声引导经皮细针穿刺组织学检查

超声引导细针穿刺细胞学检查技术虽已成为临床诊断腹部肿瘤的重要方法,然而,一般难以作出组织学诊断,对某些脏器的肿瘤的分类较为困难。1981年Isler首先报道改进针尖和穿刺技术,用22G细针活检取得成功,肝脏病变的诊断准确率为93%,并能作出具体组织学诊断的标本占71%。由此将细针活检技术突破了细胞学限制,推进到组织学高度。近年来,已广泛用于肝脏,胰腺、腹膜后占位性病变的诊断与鉴别诊断,并且能够报告上述脏器恶性肿瘤的组织学类型和分化程度以及良性病变的组织病理改变,这对指导临床治疗有重要价值。     

超声引导下甲状腺结节细针穿刺的临床应用

目的研究超声引导下甲状腺结节细针穿刺的临床应用价值。方法选择2017年4月-2019年1月来我院治疗甲状腺结节的81例患者进行研究,所有患者均经病理证实,于超声引导下行细针穿刺活检,对比病理结果情况。结果对比甲状腺结节患者手术病理结果与活检结果情况,手术病理结果显示81例患者的阴性与阳性分别为71例、10例,而超声引导下细针穿刺活检的阴性与阳性分别为72例、9例,两组数据差异无统计学意义(P>0.05)。结论超声引导下甲状腺结节细针穿刺所呈现出的诊断准确率高,可被临床推广使用。     

超声引导细针穿刺抽吸细胞学用于甲状腺结节的鉴别诊断

目的评价超声引导下细针穿刺细胞学检查（FNAC）在甲状腺结节鉴别诊断中的作用。方法本组患者76例．共84个结节,在超声引导下,用21G细针穿刺进行负压抽吸行细胞学检查。结果84个结节作出诊断的为77个,其中8个为恶性,69个为良性病变,7个未能作出诊断。结论超声引导下FNAC操作简便快捷且安全,准确性高,是甲状腺结节鉴别诊断可靠的方法之一。     

探讨提高超声引导下甲状腺结节细针穿刺诊断水平的策略

目的:研究提高超声引导下甲状腺结节细针穿刺诊断水平的策略。方法:选取我院于2017年12月至2019年12月期间接治的100例通过病理检查确诊甲状腺结节的患者为本次研究对象,对以上患者进行回顾性分析。总结患者施行超声引导下甲状腺结节细针穿刺诊断效果,包含了特异度、灵敏度、准确度等。结果:100例患者通过改进后的超声引导下甲状腺结节细针穿刺检测后,其中阳性例数为34例,比例为34.00%;阴性例数为66例,比例为66.00%。灵敏度为94.11%(32/34);确诊例数为97例,准确率为97.00%;特异度为96.97%(64/66);假阳性率为3.03%(2/66)。结论:对甲状腺结节患者予以超声引导,能够对穿刺目标的结节进行合理的选择,对甲状腺结节通过超声引导在实施细针穿刺活检中有明显的效果,对细针穿刺过程中每个环节予以质量把控,可有效提升该检测方法的技术水平,该方法值得在临床上推广应用。     

超声引导下甲状腺细针穿刺对甲状腺乳头状癌的诊断价值

目的  探讨超声引导下甲状腺细针穿刺（US-FNAC）对甲状腺乳头状癌的诊断价值。方法  选取2015年1月~2022年3月于我院甲状腺外科行甲状腺结节检查患者235例作为研究对象,根据结节最大径将其分为4组：A组（< 5 mm）、B组（5.1~10 mm）、C组（10.1~20 mm）、D组（≥20 mm）。以病理结果为金标准,统计并记录4组US-FNAC阳性率、无法确诊率、准确率、阳性预测值、阴性预测值、转移性结节分区情况。结果  US-FNAC检查显示,随着结节直径的增加,4组阳性率不断提高（29.41%、39.50%、41.51%、61.82%）,总阳性率为42.45%,各组间阳性病例的差异有统计学意义（χ²=12.180,P=0.007）;4组结节US-FNAC细胞学检查总的无法确诊率为1.80%,随着结节增大波动降低（1.96%、2.52%、1.89%、0.00%）,各组间差异无统计学意义（χ²= 1.370,P=0.713）;US-FNAC细胞学检查结果显示,4组总准确率（符合率）为95.32%,随结节直径的增加有所波动,但差异无统计学意义（χ²=0.40,P=0.941）;4组结节总阳性预测值达到94.92%,总阴性预测值比阳性预测值略高,为95.63%,总敏感度、总特异性分别为94.12%、96.23%。195个转移结节中,超声分区定位检查与病理检查结果符合率分别为95.45%、98.11%、86.21%、97.89%。结论  US-FNAC细胞学检查诊断甲状腺乳头状癌阳性率受到结节尺寸的影响,但对于准确性、阳性预测值、阴性预测值的影响不大。     

超声引导下甲状腺结节细针穿刺细胞学检查与超声评估的临床价值

目的 探讨甲状腺结节超声评估与超声引导下细针穿刺细胞学检查(US-FNAC)的临床应用价值.方法 分析169例甲状腺结节的超声表现、超声引导下甲状腺结节细针穿刺细胞学结果 、随访及手术病理.结果 24例未能获得细胞学诊断(14.2%),145例获得细胞学诊断(85.8%),其中32例手术,与手术病理诊断对照,FNAC的符合率为84.4%,FNAC诊断甲状腺癌的敏感性为82.6% (19/23),特异性为88.90% (8/9).与FNAC对照和手术病理对照,超声符合率分别为89.0% (129/145)和78.1% (25/32),超声诊断甲状腺癌的敏感性分别为94.7% (18/19)和93.3% (14/15),特异性分别为88.1% (111/126)和64.7% (11/17).结论超声评估结合超声引导下细针穿刺细胞学检查对甲状腺结节的正确处理具有重要的临床价值.     

超声引导下细针穿刺在胰腺癌ras基因诊断中的应用

胰腺癌是临床常见消化系统的恶性肿瘤之一 ,确诊较晚是其预后差的主要因素之一 ,尤其是对一些与炎症难以鉴别的胰腺癌 ,更缺乏有效的诊断方法。近年来随着医学技术的不断发展 ,国内外学者在胰腺癌早期诊断方法上进行了比较深入的研究 ,使得胰腺癌的诊断手段日益增多 ,特别是介入超声学的迅猛发展 ,使得胰腺癌的诊断方法更加丰富。同时 ,分子生物学的引入 ,尤其是高度敏感的ｒａｓ基因的引入弥补了超声引导下细针穿刺活检法的不足使该方法更加完善。应用此方法 ,不仅可以对有症状的病人及早诊断 ,缩短确诊时间 ,尽早得到诊治 ,也为胰腺癌的鉴…     

甲状腺结节超声引导下细针穿刺细胞学与粗针穿刺组织学检查的临床研究

目的:探讨甲状腺结节超声引导下细针穿刺细胞学与粗针穿刺组织学检查的临床应用价值。方法:筛选出2017年1月至2019年10月期间接受治疗的甲状腺结节患者240例,应用数字随机表将患者随机划分为参照组与观察组。参照组应用超声引导下细针穿刺细胞学检测方式,观察组应用超声引导下粗针穿刺组织学检测方式。结果:两组甲状腺良性结节的检测精准度对照,无明显差异(P>0.05),相较于参照组,观察组甲状腺恶性结节的检测精准度明显提高(P<0.05)。结论:超声引导下细针穿刺细胞学与粗针穿刺组织学检测均可有效鉴别甲状腺良性结节,但粗针穿刺组织学检测对甲状腺恶性结节的检测价值更高。     

超声引导细针穿刺细胞学检查在甲状腺疾病诊断中的应用

本研究旨在探讨超声引导细针穿刺活检细胞学检查用于诊断甲状腺疾病的可靠性。资料与方法选择 2 0 0 0年 7月至 2 0 0 0年 11月间 ,我院 5 0例甲状腺疾病住院患者 ,包括实质性肿物和囊实混合性肿物。男性 11例 ,女性 39例 ,年龄 16～ 73岁。采用ＳｉｅｍｅｎｓＳｏｎｏｌｉｎｅＥｌｅｇｒａ型彩超仪 ,探头频率 5ＭＨｚ。在超声引导下定位 ,采用 2 1ＧＰＴＣ针连接 2 0ｍｌ注射器抽吸取材。载玻片按常规方法涂片 ,巴氏染色。将细胞学穿刺结果与术后病理学对照。结　　果5 0例患者行超声引导下甲状腺细针穿刺细胞学检查结果见表 1。 5 0例均获…     

超声引导下甲状腺结节细针穿刺细胞学检查与超声评估的应用分析

目的探讨超声引导下甲状腺结节细针穿刺细胞学检查与超声评估的应用。方法选取2016年5月～2019年2月我院手术治疗的甲状腺结节患者167例,分别应用超声评估和超声引导下甲状腺结节细针穿刺细胞学检查,以手术病理学结果为对照,评价两种方法诊断结果差异。结果 167例甲状腺结节患者经病理检查恶性结节41例,良性结节患者126例;超声引导下细针穿刺细胞学检查准确度为94.01%,灵敏度为90.24%,均高于超声检查,假阴性率为9.76%,显著低于超声检查,差异均有统计学意义(P0.05)。结论超声引导下细针穿刺细胞学检查同普通超声检查比较具有更高的准确度、灵敏度,为临床诊断和治疗提供重要依据,值得推广应用。     

甲状腺结节超声引导细针穿刺初学者质量控制方法探讨

目的通过分析超声科6名医师甲状腺结节超声引导下细针穿刺活组织检查（US-FNAB）的学习曲线,探讨US-FNAB初学者达到平均水平且相对稳定时所需的训练量,从而指导科室有效管控初学者甲状腺结节US-FNAB的穿刺质量。 方法选取2011年3月至2014年11月四川大学华西医院超声科6名穿刺医师（Dr1~Dr6）行US-FNAB的甲状腺结节6147例（其中Dr1和Dr6为有经验穿刺医师;Dr2~Dr5为穿刺初学者）,收集其细胞病理学结果。并按结节的穿刺时间排序,从第1例结节开始,每100例为一组,依次进行分组。根据Bethesda分类标准将结节细胞病理学结果分为穿刺无效和穿刺有效2类,统计每一位医师每一组的穿刺无效率,绘制学习曲线。统计6名医师6147例甲状腺结节穿刺无效率的平均值。按照甲状腺结节的穿刺时间排序,统计Dr2~Dr5每名初学者第一个100例（F100）和第二个100例（S100）的穿刺无效率。采用四格表的χ²检验,将Dr2~Dr5每名初学者的F100和S100的穿刺无效率分别与6147例甲状腺结节穿刺无效率的平均值进行比较。 结果Dr1~Dr6每名医师每组穿刺无效率分别为：Dr1（17组）：25%、23%、17%、17%、14%、15%、24%、14%、12%、7%、8%、9%、6%、10%、11%、16%、8%;Dr2（5组）：40%、27%、24%、21%、13%;Dr3（10组）：22%、9%、20%、23%、13%、17%、14%、11%、10%、15%;Dr4（15组）：21%、22%、28%、26%、22%、29%、24%、19%、14%、20%、8%、11%、11%、9%、4%;Dr5（8组）：39%、24%、13%、21%、12%、13%、8%、9%;Dr6（4组）：13%、15%、5%、9%。由此绘制学习曲线。6名医师6147例甲状腺结节穿刺无效率的平均值为16.04%。Dr2~Dr5每名初学者F100和S100的穿刺无效率分别为：Dr2：40%,27%;Dr3：22%,9%;Dr4：21%,22%;Dr5：39%,24%。Dr2~Dr5每名初学者F100穿刺无效率和平均值的比较,差异有统计学意义的为Dr2（χ²=14.286,P<0.001）和Dr5（χ²=13.266,P<0.001）,S100穿刺无效率和平均值的比较中,差异均无统计学意义（P均>0.05）。 结论绘制甲状腺结节US-FNAB初学者学习曲线,探讨其学习曲线规律,分析其达到平均穿刺水平且相对稳定时的训练量,从而准确判断初学者能够独立操作的时机,是初学者甲状腺结节US-FNAB质量控制的有效方法。     

Ultrasound guided fine-needle aspiration biopsy of abdominal masses

Twenty-six cases of ultrasonically guided percutaneous fine-needle aspiration biopsies of abdominal masses are reported. Included are masses in the pancreas, retroperitoneum, liver, kidney, and pelvis. Aspiration biopsies accurately diagnosed or excluded malignancy in 21 patients (81%). The procedure, performed under local anesthesia, is rapid, simple and almost painless. No complications occurred; specifically, there was no hemorrhage, peritonitis, or spread of tumor along the needle tract.     

Ultrasonographic characteristics predictive of nondiagnostic results for fine-needle aspiration biopsies of thyroid nodules

The objective of this study was to identify clinical and ultrasonographic (US) characteristics predictive of nondiagnostic results. An experienced radiologist performed an US-guided fine-needle aspiration biopsy (US-FNA) for 1493 thyroid nodules in 1419 patients. Cytological results were classified as nondiagnostic (<6 groups of cells containing more than 10 cells) or diagnostic. The clinical characteristics of patients and the US features of thyroid nodules were compared according to nondiagnostic or diagnostic results. Age and sex were not associated with nondiagnostic results. A cystic portion >50% and hypoechogenicity were independent factors for predicting nondiagnostic results in all nodules (odds ratios [OR] = 2.82 and 1.88, respectively). In 534 nodules with more than 50% of cystic portion, the size of more than 10 mm and in 813 solid nodules, the size of 5 mm or smaller increased the likelihood of nondiagnostic results (ORs = 3.61 and 1.88, respectively). (E-mail: ekkim@yuhs.ac)     

Lytic bone lesions suspected for metastasis: Ultrasonically guided fine-needle aspiration biopsy

Ultrasonically guided fine-needle aspiration biopsy (US-FNAB) was performed in 30 patients with a lytic bone lesion suspected for metastasis detected by conventional radiological examinations. The patients were selected for US-FNAB on the basis of the ability of the ultrasound examination to clearly visualize the lesion. The cytological diagnosis was confirmed at surgery in 3 cases, and at clinical and radiological follow-up after more than 6 months in the remaining cases. The lesions were located mostly in the thoracic skeleton (ribs and sternum) and pelvic bone. We diagnosed malignancy in 26 cases and benign lesions in 2 cases. An inadequate sample was obtained in 1 case, and 1 case yielded a false-negative result. According to these results, we obtained a sensitivity of 93%. We conclude that ultrasonically guided fine-needle aspiration biopsy is a useful technique to obtain a pathological diagnosis in cases of lytic bone lesions that can be visualized with this imaging technique. © 1994 John Wiley & Sons, Inc.     

Disseminated mycobacterial infection in AIDS patients: abdominal US features and value of fine-needle aspiration biopsy of lymph nodes and spleen

Background: We evaluated the efficacy of abdominal ultrasound (US) and fine-needle aspiration biopsy (FNAB) in the diagnosis of disseminated mycobacteriosis (DM) in acquired immunodeficiency syndrome (AIDS).Methods: Twelve AIDS patients (nine male, three female; age range, 22–43 years) with DM underwent abdominal US within 2 days after admission with 3.5- to 5-MHz convex probes and a 7.5-MHz linear probe. All patients underwent FNAB of one or two enlarged abdominal lymph nodes. Eight patients underwent FNAB of the spleen. The aspirated specimens were stained with acid fast for quick examination and cultured for isolation of mycobacteria.Results: Abdominal US showed enlarged, hypoechoic, round or oval, abdominal lymph nodes (diameter, 10–35 mm; mean, 18 mm) in all patients; splenomegaly (spleen diameter, 14–22 cm; mean, 16.8 mm) in all patients; numerous splenic abscesses (diameter, 3–20 mm) in nine patients; hepatomegaly (right hepatic lobe thickness, 14.5–17 cm) in all patients; small intestinal wall thickening in five patients (maximum bowel wall thickness, 7–15 mm); mild to moderate ascites in six patients; pleural effusion in four patients; bilateral enlargement of the kidneys with hyperechogenicity of the cortex in three patients; and a retroperitoneal tubercular abscess in one patient. No complication occurred after FNAB of lymph nodes and spleens. Fast-acid stain of spleen and/or lymph node FNAB specimens allowed early diagnosis of mycobacteriosis in 12 of 12 cases (100%). Cultures of lymph node aspirates grew mycobacteria in six of 12 patients (50%). Spleen aspirates grew mycobacteria in nine of nine patients (100%). Blood cultures were positive in four of 12 patients (33%). Mycobacterium tuberculosis was diagnosed in six patients and M. avium in five.Conclusion: Abdominal US features can suggest DM in AIDS patients. Spleen and/or lymph node FNAB indicated the specific diagnosis in 100% of patients.     

Simultaneous multiple primary malignancies diagnosed by endoscopic ultrasound-guided fine-needle aspiration: A case report

BACKGROUNDMultiple primary malignancies (MPMs) refer to more than one primary malignancy in the same or separate organs of the same patient, and MPMs are considered when different histological characteristics are detected in epidemiological studies. Herein, we report a case presumed to be primary pancreatic cancer with multiple liver metastases by positron-emission tomography/computed tomography (PET/CT) and confirmed to be synchronous liver and pancreatic MPMs by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).CASE SUMMARYA 50-year-old man was referred to our hospital due to abdominal discomfort for 2 mo. Abdominal CT at a local hospital revealed a pancreatic mass with multiple liver nodules. After being transferred to our hospital, PET/CT confirmed all these lesions to have elevated metabolic activity, and therefore primary pancreatic cancer with multiple liver metastases was considered. EUS-guided liver aspiration unexpectedly found signet-ring cells with a high Ki-67 positive rate (20%), while EUS-guided pancreatic aspiration detected pancreatic neuroendocrine cells with a relatively low Ki-67 positive rate (1%). The final diagnosis from the multidisciplinary team was simultaneous liver and pancreatic MPMs. The patient returned to his local hospital for neoadjuvant chemotherapy and surgery, and he is still alive during the 6-mo postoperative follow-up.CONCLUSIONAlthough rare, MPMs should be considered when treating pancreatic mass with suspected metastatic lesions, and EUS-FNA has proved minimally invasive and accurate.     

Ultrasound guided fine-needle biopsies in pancreatic and hepatic neoplasms

Two hundred patients underwent ultrasound-guided percutaneous fine-needle aspiration biopsies of hepatic and pancreatic space-occupying lesions. In addition to the cytologic smear preparations (100%), tissue fragments and cores suitable for histological evaluation were obtained from aspirated samples in 84% of specimens from hepatic targets (n=130) and in 61 % of specimens from pancreatic lesions (n=70). The prevalence of malignant disease was 78.5% in the liver study group and 74.3% in the patients undergoing pancreatic biopsies. The overall accuracy rate of cytohistologic readings for malignancy was 94.6% in liver biopsies and 92.9% in pancreatic biopsies with a high predictive value of positive results of 98% and 100%, respectively, and a less satisfying predictive value of negative results of 83.9% and 77.3%, respectively. Two false-positive diagnoses were encountered in the evaluation of cytologic smear preparations of hepatic aspirations. No serious complications occurred with the biopsy procedure. Ultrasound-guided fine-needle biopsy is recommended as a safe and reliable method for cytohistological confirmation of suspected hepatic and pancreatic malignancy.     

超声引导下细针抽吸活检对甲状腺小结节的诊断价值

目的探讨超声引导下细针抽吸活检对最大径≤10 mm甲状腺结节的诊断价值。方法回顾性分析2012年1至12月上海交通大学医学院附属瑞金医院632例患者654个最大径≤10 mm甲状腺结节的超声引导下细针抽吸活检细胞学结果。以手术病理及临床随访结果作为金标准,评价超声引导下细针抽吸活检诊断最大径≤10 mm甲状腺结节的敏感度、特异度、准确性、阳性预测值、阴性预测值。结果 654个甲状腺结节中,36个细胞学结果不满意或无诊断,361个良性,2个不典型滤泡性病变,30个可疑恶性,225个恶性。排除不满意与未手术的不典型滤泡性结节,余616个结节经手术或临床随访1年以上,最终诊断为恶性259个,良性357个。超声引导下细针抽吸活检诊断最大径≤10 mm甲状腺结节的敏感度为96.5%,特异度为98.6%,准确性为97.7%,阳性预测值为98.0%,阴性预测值为97.5%。所有患者均未见明显穿刺后并发症。结论超声引导下细针抽吸活检安全准确,是鉴别最大径≤10 mm甲状腺结节良恶性的重要方法。     

Endoscopic ultrasound-guided fine-needle aspiration biopsy - Recent topics and technical tips

Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is a useful procedure that enables reliable pathological diagnoses of pancreatobiliary diseases, subepithelial lesions, and swollen lymph nodes. In recent years, a pathological diagnosis based on EUS-FNA has made it possible to provide accurate treatment methods not only in these fields, but also in respiratory organs and otorhinolaryngology. This review discusses the latest topics pertaining to EUS-FNA as well as procedural tips.