超声引导针吸活检在术前判断乳腺癌腋窝淋巴结状态中的应用

目的：研究对超声异常的腋窝淋巴结进行针吸活检的临床价值.方法：对47例cT1-2N0M0腋窝超声异常乳腺癌患者的腋窝淋巴结进行超声引导下针吸活检,结果与组织学病理结果进行对照.分析超声引导针吸活检术前判断乳腺癌腋窝淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值和诊断准确率.结果：超声引导针吸活检判断腋窝淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值和诊断准确率分别为82.8%、100.0%、100.0%、78.3%、89.4%.结论：超声引导针吸活检是术前评估腋窝淋巴结状态的有效检查方法,其结果对乳腺癌手术方式的选择具有重要参考价值.     

针吸活检对肺癌伴肺门纵隔淋巴结转移的诊断价值

背景与目的经支气管针吸活检(transbronchial needle aspiration,TBNA)和经支气管超声引导针吸活检(endobronchial ultrasound-guided TBNA,EBUS-TBNA)是用于诊断纵隔淋巴结病变的最新检查方法。本研究旨在评价TBNA和EBUS-TBNA对肺癌伴肺门纵隔淋巴结转移的诊断价值及安全性。方法对CT检查疑似肺癌但管腔内无明显新生物且肺门纵隔淋巴结肿大的250例患者行TBNA后行活检或刷检,15例疑似肺癌患者行EBUS-TBNA。结果180例患者TBNA、刷检和活检确诊为肺癌,阳性率分别为82.86%、51.24%和45.45%。15例EBUS-TBNA的阳性率为91.67%。结论TBNA和EBUS-TBNA检查安全性好,准确率高,对肺癌伴肺门纵隔淋巴结转移的患者有较高的诊断价值。     

超声引导下空芯针活检对于乳腺肿瘤诊断的意义

目的 探讨超声引导下空芯针活检对于乳腺肿瘤诊断的意义.方法 超声引导下空芯针活检乳腺肿瘤97例,对照组为252例乳腺肿瘤的触诊法空芯针活检.以手术后的病理诊断作为诊断的金标准,比较两种方法的符合率和穿刺次数.结果 (1)超声引导下空芯针活检符合率为96.9﹪,高于触诊法的85.7﹪,(P＜0.05);对于乳腺癌的诊断,超声引导下空芯针活检敏感度为96.9﹪,高于触诊法的84.8﹪,(P＜0.05);对于直径≤30 mm肿瘤超声引导下空芯针活检乳腺肿块的符合率为95.7﹪,高于触诊法的75.2﹪,(P＜0.05);(2)触诊法空芯针活检病例平均穿刺6.1次,超声引导下3.8次(P＜0.05).结论 超声引导下空芯针活检对于乳腺癌诊断准确,平均取材次数少,值得临床应用.     

超声支气管镜引导下的经支气管针吸活检对肺癌的诊断价值

背景与目的本研究旨在评价超声支气管镜引导下的经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)对肺癌的诊断价值和安全性。方法于2009年7月-2010年2月,对95例胸部CT检查显示纵隔/肺门淋巴结肿大和/或胸内气管或支气管旁肿块患者进行EBUS-TBNA,并未采取现场细胞学方法进行检测。结果95例患者中,其中经病理学检查和临床随访验证新发肺癌患者60例。60例肺癌患者共穿刺112组淋巴结,肺内肿块11例。60例肺癌患者中通过EBUS-TBNA明确诊断58例,假阴性2例,敏感性为96.67%、特异性100%。EBUS-TBNA过程安全,全部病例无并发症发生。结论EBUS-TBNA是诊断肺癌安全、有效的方法。     

乳腺癌内乳前哨淋巴结活检术的研究进展

乳腺癌内乳淋巴结作为仅次于腋窝淋巴结的重要淋巴转移途径之一,其转移情况在乳腺癌的准确分期及个体化治疗中具有重要意义.内乳前哨淋巴结活检术可以通过微创的方式评估内乳淋巴结的转移情况,本文就乳腺癌内乳前哨淋巴结活检术的研究进展进行综述.     

经气管镜超声引导针吸活检术（EBUS-TBNA）诊断纵膈淋巴结的初步应用

背景与目的:经气管镜超声引导针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)是用于诊断纵隔淋巴结等病变的最新微创检查方法.本研究旨在评价EBUS-TBNA用于纵隔淋巴结定性诊断的价值.方法:2009年4月1日-2009年7月16日之间,共计20例纵隔淋巴结肿大患者接受EBUS-TBNA检查.总结穿刺结果,评价该方法的应用价值.结果:20例患者共穿刺淋巴结37组,穿刺成功率100%,未发生并发症.EBUS-TBNA检查总体准确率90.00%(其中上皮性癌诊断准确率100%),灵敏度84.62%,特异度100%,阳性预测值100%,阴性预测值77.78%.每组淋巴结平均操作时间为11.9 min.20例患者术后住院1～17 d,中位住院1 d.前3例患者各组平均操作时间为36.25 min,后17例患者各组平均操作时间为7.76 min,两者差异具有显著性(z-=3.247,P=0.001).结论:EBUS-TBNA检查安全性好,准确率高,是用于纵隔淋巴结定性诊断的较好方法.     

超声造影引导下细针穿刺活检在乳腺癌前哨淋巴结转移中的诊断价值

目的 探讨超声造影引导下细针穿刺活检在乳腺癌前哨淋巴结转移中的诊断价值.方法 选取110例乳腺癌患者,均行超声造影引导下细针穿刺活检,以前哨淋巴结活检术结果为金标准,评估超声造影引导下细针穿刺活检对乳腺癌前哨淋巴结转移的诊断价值.结果 前哨淋巴结活检结果显示,110例乳腺癌患者中,存在前哨淋巴结转移60例,无转移50例.超声造影引导下细针穿刺活检诊断乳腺癌前哨淋巴结转移的曲线下面积(AUC)为0.876(95％CI:0.721～0.912),灵敏度为83.33％、特异度为60.00％、阳性预测值为71.43％、阴性预测值为75.00％、准确度为72.73％.结论 超声造影引导下细针穿刺活检在乳腺癌前哨淋巴结转移中有较高的诊断价值.     

经纤维支气管镜针吸活检对纵隔肿大淋巴结的诊断价值

目前 ,经纤维支气管镜针吸活检 (ＴＢＮＡ )在临床上应用越来越广泛 ,纤维支气管镜的检查范围也从单纯的评价气道内病变扩展到纵隔腔内。我们在 1999年 11月至 2 0 0 1年 12月期间 ,对经ＣＴ扫描发现纵隔隆突附近淋巴结 (前隆突淋巴结 ,后隆突肿大淋巴结 ,隆突下淋巴结 ,右气管     

临床腋窝淋巴结阳性乳腺癌患者内乳区前哨淋巴结活检术研究*

目的：评估临床腋窝淋巴结阳性乳腺癌患者行内乳区前哨淋巴结活检术（IM-SLNB）的临床意义。方法：2013年6 月至2014年10月对山东省肿瘤医院乳腺病中心就诊的64例临床腋窝淋巴结阳性的原发性乳腺癌患者行前瞻性单臂入组研究,采取腋窝淋巴结清扫术,同时均应用新的核素注射技术进行IM-SLNB。结果：64例患者中内乳区前哨淋巴结（IM-SLN）显像为38例,显像率为59.4%（38/ 64）。 38例IM-SLN 显像患者中IM-SLNB 成功率为100%（38/ 38）,并发症发生率为7.9%（3/ 38）,IM-SLN 转移率为21.1%（8/ 38）。 肿瘤位于内上象限和腋窝淋巴结转移数目较多的患者,其IM-SLN 转移率较高（P < 0.001 和P = 0.017）。 患者临床获益率为59.4%（38/ 64）,其中12.5%（8/ 64）另接受了内乳区放疗、46.9%（30/ 64）避免了不必要的内乳区放疗。结论：临床腋窝淋巴结阳性的乳腺癌应进行IM-SLNB,尤其对于肿瘤位于内上象限及怀疑存在较多腋窝淋巴结转移数目的患者,以获得内乳区淋巴结的转移状态,指导乳腺癌患者内乳区放疗。     

超声引导经皮针吸活检诊断膀胱癌2例报告

膀胱肿瘤术前病理学确诊主要依靠膀胱镜的组织活检,但当膀胱镜检查失败时,超声引导穿刺针吸细胞学检查可作为1种补充手段作出病理诊断,现报告2例如下。1　方法采用ＡｌｏｋａＳＳＤ620型线阵扫描仪,频率为3.5ＭＨｚ,配附加导向器。病人取仰卧位,膀胱适度充盈,消毒下腹皮肤(必要     

Ultrasound and ultrasound-guided fine needle aspiration biopsy of supraclavicular lymph nodes in patients with esophageal carcinoma

The use of ultrasound combined with ultrasound-guided fine-needle aspiration biopsy (UGFAB) of supraclavicular lymph nodes in the pretreatment staging of 37 patients with squamous cell carcinoma of the esophagus is described. All patients underwent computed tomography (CT) scans of the chest and the abdomen and ultrasound of the abdomen and supraclavicular regions. Supraclavicular lymph node metastases (Stage IV disease according to the tumor nodes metastasis [TNM] classification) were cytologically diagnosed in seven (18.9%) of the 37 patients. In two of these patients, no other metastases were found. In the other five patients, UGFAB replaced more invasive diagnostic procedures. Due to their superficial location, ultrasound and UGFAB of the supraclavicular lymph nodes was relatively simple to perform, and contributed to an improved staging of squamous cell carcinoma of the esophagus.     

The role of ultrasound and ultrasound-guided fine needle aspiration biopsy of lymph nodes in patients with skin tumours

Background

The primary aim of this study was to evaluate the diagnostic accuracy of ultrasound (US) in the study of superficial lymph nodes during the follow-up of patients surgically treated for skin tumours. The secondary objective was to compare positive cytological results with histological reports.

Patients and methods

From 2004 to 2011, 480 patients (male/female: 285/195; median age 57 years; prevalent skin tumour: melanoma) underwent US-guided fine-needle aspiration biopsy (FNAB) of suspicious recurrent lymph nodes. An expert radiologist first performed US testing of the lymph nodes, expressing either a negative or positive outcome of the test. Subsequently, US-guided FNAB was performed. FNAB positive patients were subjected to lymphadenectomy; the patients who tested negative underwent the follow-up.

Results

The size of lymph nodes was ≤ 2 cm in 90% of cases. Out of the 336 (70%) US “positive” patients, 231 (68.8%) were FNAB positives. Out of the 144 (30%) US “negatives”, 132 (91.7%) were FNAB negatives. The sensitivity and specificity of the US were 95% and 55.7%, respectively; the negative predictive value was 91.7% and the positive predictive value was 68.8%. Definitive histological results confirmed FNAB positivity in 97.5% of lymphadenectomies.

Conclusions

US is a sensitive method in the evaluation of superficial lymph nodes during the follow-up of patients with skin tumours. High positive predictive value of cytology was confirmed.     

The value of ultrasound-guided fine needle aspiration in the assessment of solid breast lumps

To assess the value of routine ultrasound-guided fine needle aspiration (US-FNA) of solid mass lesions of the breast, all such patients presenting to the breast clinic over a 5 month period were offered US-FNA in addition to standard imaging. One thousand, three hundred and eighty-six consecutive patients were assessed and 77 solid mass lesions identified. US-FNA was performed in 49 of these. Sixteen demonstrated cytological features of malignancy that was confirmed at surgery. US-FNA did not diagnose malignancy in cases with typical benign imaging features. It did alter diagnosis from an equivocal suspicious mass lesion to a definite diagnosis of malignancy in four cases (25%). It also altered diagnosis from an equivocal, probably benign, diagnosis to a more confident diagnosis of benign disease in 18 (58%) of benign cases. US-FNA confirmed the diagnosis of malignancy in four cases where a suspicious mass could only be imaged by ultrasound. US-FNA is simple, rapid and, unlike large Tru-Cut biopsies, is not associated with complications. It causes only minimal discomfort to both patient and operator. We recommend that US-FNA becomes a routine component of the imaging workup of breast mass lesions both to exclude malignancy in equivocal cases and to confirm malignancy when this is expected.     

Unsuccessful preoperative biopsies, fine needle aspiration cytology or core needle biopsy, lead to increased costs in the diagnostic workup in breast cancer

Correct preoperative diagnosis of a breast lesion is essential for optimal treatment planning. Our aim was to compare feasibility of fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) in diagnosis of breast lesions. The special aim was to evaluate the extra costs and delay in surgical treatment due to unsuccessful preoperative biopsies. Diagnostic work-ups in 572 patients with 580 breast lesions were retrospectively evaluated. FNAC was the first biopsy method for 339 lesions, CNB for 241 lesions. The postoperative diagnosis was malignant for 503 lesions. The preoperative rate of definitely malignant diagnosis was 67% (194/289) for FNAC and 96% (206/214) for CNB (p < 0.0001), and 95% and 99%, respectively (p = 0.0173), when also suspicious findings were included. In patients with FNAC, an additional needle biopsy was performed for 93 and a surgical biopsy for 62 lesions. In the CNB group, a subsequent CNB was performed for 2 and a surgical biopsy for 33. The frequent need for additional biopsies raised the total expenses of FNAC over those of CNB. Multiple biopsies may also delay cancer surgery. It is therefore recommended to use CNB as the initial needle biopsy method.     

细针穿刺肿瘤组织端粒酶活性检测在乳腺癌诊断中的意义

目的 :探讨细针穿刺乳腺肿瘤组织端粒酶活性检测在乳腺癌诊断中的意义。方法 :用PCR ELISA法检测79例术前乳腺肿瘤穿刺活检标本和大体标本的端粒酶活性并与病理诊断进行对照。结果 :乳腺癌 65例 ,穿刺组织端粒酶阳性 5 7例 ,阳性率为 87 7% ;大体组织端粒酶阳性 5 4例 ,阳性率83 1% ;淋巴结有转移者端粒酶活性高于无淋巴结转移者 ;乳腺良性疾病 14例 ,端粒酶阳性 2例 ,阳性率 14 3 %。结论 :术前乳腺肿瘤穿刺组织端粒酶活性检测有利于乳腺肿瘤的早期诊断及鉴别诊断 ,可以间接了解乳腺癌的进展程度     

乳腺癌细针穿刺活检的临床应用价值

背景与目的：随着乳腺癌术前诊疗手段的发展,细针穿刺似乎不再受临床医生的青睐。细针穿刺作为乳腺癌的术前诊断方法之一,其安全及有效性存在争议。本研究探讨30年来我院乳腺癌细针穿刺与复发、转移的关系。方法：统计我院1975—2006年1 260例乳腺癌患者的临床资料,根据是否术前细针穿刺分组,比较2组间临床基本特点、复发转移率、无瘤生存率。结果：细针穿刺阳性率为61.4%,其中Ⅳ期患者阳性率最高,达100%;细针穿刺组中以Ⅱ期和Ⅲ期患者居多,均为45.2%;细针穿刺组和非细针穿刺组的局部复发率(7.0% vs 6.4%)、复发转移率(13.2% vs 14.0%)、5年无瘤生存率(82.0% vs 81.0%)及10年无瘤生存率(51.0%vs 64.0%)差异均无统计学意义。结论：细针穿刺具有易操作、阳性率高、对复发及生存无影响等优点,因此对乳腺癌患者的术前诊断仍有较高的临床应用价值。     

乳腺癌细针穿刺的细胞形态学观察

目的 总结乳腺癌细针穿刺的细胞形态学特点及鉴别诊断.方法 观察175例乳腺癌细针穿刺的细胞学涂片与76例乳腺增生症、93例乳腺纤维腺瘤对照分析;同时观察20例细胞学漏诊和低诊乳腺癌细胞学涂片与13例细胞学过诊病例对照分析.结果 175例乳腺癌:细胞排列杂乱无极性96.6%(169/175),核间疏松排列71.4%(12...     

超声引导下经皮空心针穿刺组织病理学检查对乳腺病灶的诊断效果评价

目的 探讨超声引导下经皮空心针穿刺(CNB)组织病理学检查诊断乳腺病灶的临床价值.方法 回顾性分析177例乳腺病灶的超声引导下CNB病理学检查结果 ,并与术后组织病理学诊断结果 进行比较,评价CNB诊断的效果.结果 177例乳腺病灶组织中,CNB病理诊断乳腺痛129例,术后病理组织学诊断乳腺癌136例,CNB病理诊断假阴性7例.CNB病理诊断乳腺癌的灵敏度为94.9%,特异度为100%,准确率为96.0%,阳性预测值为100%,阴性预测值为85.4%,约登指数为0.949,Kappa值为0.895(P<0.01).结论 CNB组织病理诊断乳腺病灶具有较高的准确性,与术后病理组织学诊断结果 一致性较高,是一种可靠的乳腺病灶活检方法 .     

超声引导下经皮空心针穿刺组织病理学检查对乳腺病灶的诊断效果评价

目的 探讨超声引导下经皮空心针穿刺(CNB)组织病理学检查诊断乳腺病灶的临床价值.方法 回顾性分析177例乳腺病灶的超声引导下CNB病理学检查结果 ,并与术后组织病理学诊断结果 进行比较,评价CNB诊断的效果.结果 177例乳腺病灶组织中,CNB病理诊断乳腺痛129例,术后病理组织学诊断乳腺癌136例,CNB病理诊断假阴性7例.CNB病理诊断乳腺癌的灵敏度为94.9%,特异度为100%,准确率为96.0%,阳性预测值为100%,阴性预测值为85.4%,约登指数为0.949,Kappa值为0.895(P<0.01).结论 CNB组织病理诊断乳腺病灶具有较高的准确性,与术后病理组织学诊断结果 一致性较高,是一种可靠的乳腺病灶活检方法 .