B超引导下核心针活检术诊断不可触及的乳腺病变

目的 评价B超引导下核心针活检术（CNB）对不可触及的乳腺病变（NPBL）的诊断价值。方法 采用18G Tru-cut针结合活检枪对88例患者的96个NPBL行B超引导下CNB,并与切除活检病理结果比较。结果 NPBL大小4－23mm(平均13．1mm),在CNB中,86个为良性,2个为可疑恶性,6个为恶性,2个取材不良。在切除活检中9个为恶性,87个为良性。CNB可疑恶变的2个NPBL均为恶性,1个恶性NPBL误诊为乳腺腺病,取材不良的2个NPBL均为良性。本组NPBL中恶性病变占9．38％（9／96）,B超引导下CNB对NPBL的良恶性诊断正确率为98．94％（93／94）,诊断乳腺癌的敏感性为88．89％（8／9）,特异性为100％（8／8）,良性病变的病理诊断符合率为97．70％（85／87）,取材不良为2．08％。结论 B超引导下CNB对NPBL的诊断具有较高的敏感性和特异性,结果准确可靠。     

不育睾丸活检病理,免疫组化及组织化学研究

为探讨男性不育原因，对４２例男性不育症患者的睾丸进行活检病理、免疫组化及组织化学研究，结果发现大部分病例睾丸间质及部分曲细精管内有免疫复合物ＩｇＧ、ＩｇＡ、ＩｇＭ沉积，部分曲细精管内有ＰＡＳ阳性物。认为体液免疫是导致男性不育的重要因素。     

乳腺癌哨兵淋巴结活检126例的临床研究

目的 探讨哨兵淋巴结活检（SLND）在临床Ⅰ，Ⅱ期乳腺癌中应用的可行性。方法 使用亚甲蓝对126例临床Ⅰ，Ⅱ期乳腺癌进行SLND，随后行腋窝淋巴结清扫，腋窝阴性患者再行淋巴结的多水平切片和免疫组化（IHC）检查。结果 SLND成功率75．4％，灵敏度91．7％，特异度100％，阳性预测价值100％，阴性预测价值95．2％。术中哨兵淋巴结（SN）冰冻病理学检查的准确率93．4％，淋巴结多水平切片IHC发现35例中1例患者SN有微小转移（2．9％）。结论 SLND可以准确预测乳腺癌患者腋窝淋巴结状态，SN多水平片IHC检测有助于提高SLND的敏感性。     

免疫组织化学方法研究Lumican在结直肠癌中的表达及意义

目的研究Lumican在结直肠癌组织中的表达,探讨其与结直肠癌发生、发展的关系。方法应用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶法(SP法)检测Lumican在114例结直肠癌组织及43例癌旁正常结直肠组织中的表达。结果 Lumican在正常结直肠组织中无阳性表达,在结直肠癌组织中表达阳性率为79.82%(91/114),在结直肠癌组中Lumican表达阳性率明显高于正常结直肠组织,差异有统计学意义(P<0.05)。结直肠癌组织中Lumican表达强度与结直肠癌的分化程度呈负相关(rs=-0.246,P=0.008),在Dukes分期的A+B期中明显低于C+D期,差异有统计学意义(P=0.047);Lumican的表达与结直肠癌患者的年龄及性别差异无统计学意义(P>0.05)。结论 Lumican在癌旁正常结直肠组织中不表达,在结直肠癌组织中有表达,提示其可能与结直肠癌的发生有关;且Lumican的表达可能与结直肠癌细胞的分化及Dukes分期有关,其在细胞内表达状况可作为判断结直肠癌生物学特性的有用指标。     

经支气管针吸活检获取组织学标本的应用技术及意义

目的 探讨在日常气管镜检查中，经支气管针吸活检获取组织学标本的应用技术及对单纯纵隔肿物进行穿刺活检的意义。方法 在气管镜室，对52例CT扫描提示单纯纵隔肿物或肿大淋巴结的患者分别进行细胞学及组织学的穿刺活检。结果 52例患者中，有47例获得可供切片诊断的组织学标本，其中30例为良性肿物，5例未获得组织学标本。结论 在气管镜检查过程中，较好地运用组织学穿刺活检针，可以较好地对良性肿物的诊断提供准确的组织学标本，在相当程度上可避免纵隔镜的使用。     

核心针活检在乳腺病变诊断和乳腺癌新辅助化疗中的应用价值

目的 评价核心针活检(core needle biopsy,CNB)诊断乳腺病变的准确率和浸润性乳腺癌化疗前、后雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和Her2蛋白免疫组织化学(immunohistochemistry,IHC)检测结果的一致性.方法 回顾性分析本院2005年6月至2008年4月间进行的516例CNB结果.结果 本组所有资料均由两位病理医生独立进行病理学诊断.共诊断乳腺恶件肿瘤、原位癌和叶状肿瘤484例,灵敏度为96.7%.经手术活检证实的假阴性为16例(3.3%).CNB诊断准确率不受病灶最大径影响(P=0.423).接受化疗前、后IHC检测的乳腺癌ER、PR和Her2一致率分别为90.3%、76.8%和82.5%.结论 CNB是准确、有效的检查方法.受乳腺癌的组织异质性和治疗的双苇影响,化疗前后的ER、PR和Her2检测的一致性尚难获得满意结果.     

胃肠间叶源性肿瘤210例临床病理及免疫组织化学分析

目的分析胃肠间叶源性肿瘤(GIMT)的临床病理及免疫组织化学(免疫组化)特征,探讨各项诊断指标在鉴别诊断中的价值。方法对北京大学人民医院原病理诊断为GIMT的病例进行回顾性分析,通过连续切片CD117、CD34、Desmin、SMA、PS100五联染色的方法观察免疫组化表型,结合临床、病理资料及苏木精-伊红染色,重新确认诊断。结果210例GIMT经复习后,确诊为胃肠间质瘤(GIST)127例(60.5%),平滑肌(肉)瘤33例(15.7%),神经源性肿瘤27例(12.8%),其他GIMT 23例(11.0%)。GIST与平滑肌肿瘤患者男女性别比例相当,神经源性肿瘤和其他GIMT男性高于女性。GIST的好发部位依次是胃(51.2%)、小肠(19.7%)、食管(11.0%)、结直肠(10.2%);平滑肌(肉)瘤好发部位为食管(15/33,45.5%),神经源性肿瘤好发于腹膜后(20/ 27,74.1%)。GIST常见的临床首发症状依次为消化道出血36例(28.3%)、腹痛27例(21.3%)、腹部包块24例(18.9%),GIST之外的GIMT均无消化道出血的首发症状。79.5%的GIST和72.7%的平滑肌(肉)瘤肿瘤局限;33.3%的神经源性肿瘤侵及邻近器官或组织;GIST之外的GIMT均无远处转移。GIST细胞形态中梭形细胞占72.5%,上皮样细胞占11.8%,多形性细胞占15.7%:平滑肌(肉)瘤的梭形细胞占94.0%。GIST免疫组化CD117染色阳性率93.7%,CD34阳性率69.3%。Desmin阳性率13.4%,SMA阳性率12.6%,PS100阳性率10.2%。平滑肌(肉)瘤Desmin阳性率78.5%、SMA阳性率63.6%,而CD117、CD34和PS100阴性。神经源性肿瘤88.9%为PS100弥漫强阳性表现。结论GIMT以GIST为主,GIST与平滑肌(肉)瘤、神经源性肿瘤在首发症状、好发部位、生物学行为和免疫表型等方面具有一定的差异,免疫组化检测是GIMT鉴别诊断的重要手段。     

超声影像引导的乳腺病灶经皮穿刺组织病理学检查的临床应用

目的评价超声影像引导的乳腺病变经皮空芯针穿刺（CNB）组织病理检查方法的准确性及其影响因素。方法回顾性分析2000年1月至2006年5月收治的2152例乳腺病变患者经皮CNB组织病理检查结果及临床资料。比较穿刺与切除组织病理诊断之间的一致性,并对未进行切除活检的患者进行随访。结果在最终诊断为乳腺癌的1461例患者中,CNB病理结果显示,乳腺癌1339例,假阴性率为3．5％（51／1461）,低估率为4．9％（71／1461）。50．0％（17／34）的导管上皮非典型增生和46．3％（25／54）的乳头状病变在重新活检中诊断为癌。B超引导CNB的假阴性率（2．1％,22／1068）显著低于徒手引导CNB（7．4％,29／393）（P〈0、05）。两名专责医师CNB的假阴性率（1．2％,8／681）显著低于非专责医师（5．5％,43／780）（P〈0、05）。738例经CNB诊断良性病变中,417例进行手术切除活检,50例诊断为乳腺癌,205例良性病变随访2—29个月（中位随访时间10、2个月）,发现1例恶性病变。结论超声影像引导的乳腺病灶经皮病灶穿刺组织病理检查是准确可靠的诊断方法。对于穿刺病理结果为高危病变者应予切除活检。     

乳腺癌术前空心针穿刺活检与手术切除标本的免疫组化比较研究

目的评估空心针穿刺活检的标本是否可以准确反映术前化疗的乳腺癌患者手术后的病理组织学状态。方法收集我科于2006年12月-2007年12月35例乳腺癌在术前接受化疗的临床资料。对其中25例的术前空心针穿刺标本（CB）和手术后标本（SS）的雌激素受体（ER）、孕激素受体（PR）、HER2基因表达、Ki67和P53的免疫组织化学检查结果进行比较分析。结果术前空心针穿刺活检与手术切除标本ER和PR的不一致率分别为22．7％和13．6％;HER2的不一致率为22．7％：Ki67和P53的不一致率为30％。结论空心针穿刺标本与手术切除标本的免疫组化状杰有一宗的不致件．因此．在诜择治疗方案时府进行综合考虑状态．     

麦默通旋切系统在乳腺临床触诊阴性病灶活检中的应用

目的:探讨麦默通旋切系统在乳腺临床触诊阴性病灶活检中的应用及意义。方法:通过对我院73例乳腺X线摄影及彩超发现的临床触诊阴性乳腺病灶采用麦默通真空辅助旋切活检及BARD穿刺针活检,分析其病理结果。结果:43例麦默通活检病人及30例BARD穿刺活检病人,其活检成功率分别为100%及83.3%,病理符合率分别为100%及84.6%,两组比较有统计学差异(P<0.05)。早期癌比例麦默通组占16.3%,BARD穿刺针组为6.7%,但尚无统计学差异。结论:麦默通微创活检具有微创、安全的特点,诊断灵敏度及特异度更高,可作为临床触诊阴性乳腺病灶活检的首选方法。     

Clinicopathologic features of papillary lesions on core needle biopsy of the breast predictive of malignancy

BACKGROUND: The necessity for surgical excision of papillary lesions identified on percutaneous breast biopsy remains controversial. We reviewed data from patients with papillary lesions found on core needle biopsies to identify features associated with carcinoma. METHODS: A retrospective chart review was performed on patients with papillary lesions diagnosed from image-guided breast biopsies over a 10-year period. Patients had surgical excision or were followed-up radiographically for a 2-year minimum. RESULTS: Papillary lesions were identified in 154 core needle biopsies. Ninety-five lesions were diagnosed as either benign or atypical. Eighty-nine of these patients had surgical excisions of their lesions. Malignancy was discovered in 22 (25%) of these lesions. Only atypical lesions on biopsy were malignant (P < .005). Forty-six percent of patients age 65 or older were found to have cancer at surgical excision (P < .01). CONCLUSIONS: Papillary lesions found on core needle biopsy frequently harbor malignancy (25%). Atypia and age 65 or older are significant risk factors for malignancy.     

乳腺X线立体定位活检方法的评价及选择

目的对目前乳腺X线立体定位下常用的3种活检方法进行评价。方法自2000年1月起,对361例乳腺病灶进行乳腺X线立体定位活检,其中弹射式空芯针活检（ST—CNB）73例、真空辅助旋切活检（ST-VAB）74例以及手术活检214例。在中位随访时间为18个月（6～66个月）时,比较3种X线立体定位活检方法的准确性以及临床应用特点。结果乳腺X线立体定位手术活检、ST-CNB和ST—VAB诊断乳腺癌的漏诊率分别为0、2．7％和0。微创活检诊断乳腺导管上皮不典型增生的低估率为33％,诊断乳腺导管内癌的低估率为53％。微创活检在操作时间、对乳房外形的影响及并发症等方面明显优于手术活检。微创活检使69％的可疑病灶避免了手术。结论乳腺X线立体定位微创活检,尤其是真空辅助旋切活检是一种准确、安全、简便的诊断方法,因此可作为乳腺X线中度可疑（BIRADS-4）病灶的首选诊断方法,但如果活检结果为不典型增生应进一步行X线立体定位手术活检;而对于高度可疑（BIRADS-5）病灶,宜直接选择手术活检诊断。     

Utilization of minimally invasive breast biopsy for the evaluation of suspicious breast lesions

Background

Percutaneous needle biopsy, also known as minimally invasive breast biopsy (MIBB), has become the gold standard for the initial assessment of suspicious breast lesions. The purpose of this study is to determine modern rates of MIBB and open breast biopsy.

Methods

The Florida Agency for Health Care Administration outpatient surgery and procedure database was queried for patients undergoing open surgical biopsy and MIBB between 2003 and 2008.

Results

Although there was an increase in the use of MIBB, the overall rate of open surgical biopsy remained high (∼30%). A reduction in the open biopsy rate from 30% to 10% could be associated with a charge reduction of >$37.2 million per year.

Conclusions

The current rate of open surgical breast biopsy remains high. Interventions and quality initiatives are warranted, which could lead to a reduction in unnecessary operations for women, improved patient care, and a reduction in breast health care costs.     

乳腺X线立体定位穿刺活检术对早期乳腺癌的诊断价值

目的探讨乳腺X线立体定位穿刺活检术（SMCNB）对早期乳腺癌诊断的应用。方法对21例钼钯X线摄片诊断为可疑早期乳腺癌患者应用SMCNB。将手术病理结果与穿刺取材病理结果相比较。结果与手术病理结果比较，SMCNB诊断阳性率为85．71％，无假阳性。结论SMCNB对早期乳腺癌活检定位准确，操作简单，安全可靠。     

Stereotactic core needle biopsy of mammographic breast lesions as a viable alternative to surgical biopsy

Background: Stereotactic needle biopsy technique has received considerable attention as a possible alternative to surgical biopsy of nonpalpable breast lesions. The exact role of this procedure in the management of mammographic breast lesions has not yet been accurately defined. Methods: Data have been collected prospectively on 416 patients over an 8-month period (January 1992 through August 1992). Of 416, 356 patients underwent only stereotactic breast biopsy with a 14-gauge needle. Sixty patients underwent stereotactic breast biopsy followed by surgical biopsy. Based on mammographic findings before biopsy, lesions were classified as benign (24%), likely benign (49%), malignant (2%), likely malignant (6%), and indeterminate (19%). The number of core biopsy specimens obtained from each patient ranged from one to six. Results: The specimen was considered adequate in 98% of cases. Complications were minimal. The tissue diagnosis was benign in 92% and malignant in 8% of patients. In those patients undergoing surgical and stereotactic biopsy, 57 of 60 had matching histopathological results, representing an agreement rate of 95% (p<0.001). The three patients whose histopathological results did not match had malignant diagnoses on stereotactic biopsy that were subsequently not identified in the modified radical mastectomy specimen because the entire focus of malignancy was removed by the several passes made by the core needle during biopsy. No patient had a negative stereotactic biopsy result in whom malignancy was later detected by surgical biopsy. Conclusions: This study indicates excellent agreement between surgical and stereotactic needle biopsy findings. Stereotactic biopsy with a 14-gauge needle could obviate the need for surgical biopsy in certain women with radiologically benign, likely benign, and indeterminate lesions. The results of this study were presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

A minimally invasive breast biopsy clinic: an innovative way to teach breast fellows how to perform breast ultrasound and ultrasound-guided breast procedures

BACKGROUND: The ability to perform breast ultrasound and ultrasound-guided breast procedures are increasingly important skills for breast surgeons. Breast fellowship programs must develop programs to ensure adequate ultrasound training for breast fellows. METHODS: A Minimally Invasive Breast Biopsy Clinic was established at the Los Angeles County + University of Southern California Medical Center to provide breast fellows with comprehensive, hands-on, "live-patient" breast ultrasound training. RESULTS: From December 2004 though February 2005, 5 breast fellows received training in the Minimally Invasive Breast Biopsy Clinic. Each fellow received a minimum of 18 weeks of "live-patient" experience. Although the learning curve varied among the fellows, all showed proficiency in performing breast ultrasound and ultrasound-guided core biopsies by the 12th week. A total of 39 patients with fibroadenomas underwent 62 ultrasound-guided procedures, including 30 vacuum-assisted percutaneous excisions, 16 cryoablations, and 16 core biopsies. CONCLUSION: The Minimally Invasive Breast Clinic model provided breast fellows with sufficient "live-patient" experience to enable confident performance of breast ultrasound and ultrasound-guided breast procedures. The selection of patients with fibroadenomas facilitated safe and efficient training without interfering with the management of cancer patients.     

临床触诊阴性的乳腺多发病灶麦默通微创旋切的应用价值

目的：探讨超声引导下麦默通系统在临床触诊阴性的乳腺病灶中的应用价值。方法：对超声检查发现的163例患者的575个乳腺肿块在超声引导下行麦默通微创旋切术,切除标本送常规病理检查。结果：575个病灶均被准确定位切除,引导成功切除率达100%,术后2例出现局部血肿,5例出现皮下淤血,术后病理显示所有肿块中：乳腺纤维瘤316个,乳腺囊肿174个,导管乳头状瘤35个,腺病41个,乳腺癌9个。结论：超声引导下麦默通装置具有定位准确、微创切除或活检乳腺肿块的功能,尤其适合于临床触诊阴性的乳腺病灶。