内镜超声引导下细针穿刺活检对左肾上腺无功能肿块的诊断价值

目的 探讨在内镜超声引导下细针穿刺活检确定左肾上腺肿块的性质，并评价该种方法对肾上腺病变的诊断价值。方法 选择经CT或内镜超声检查发现的左肾上腺无功能肿块患者35例，其中18例患者同时伴有肺部肿块，8例患者同时伴有胃部肿块。对其进行内镜超声检查，以明确病变的大小、形态、位置。在内镜超声导引下对左肾上腺病变行细针穿刺活检。结果 全部35例患者均接受了细针穿刺活检，经组织细胞学检查24例为恶性肿瘤（其中鳞状细胞癌，n=9；小细胞癌，n=8；腺癌，n=7），5例为良性肿瘤（腺瘤，n=5），6例为阴性结果。全部患者经手术及临床随访验证，得出EUSFNA诊断肾上腺肿瘤的敏感性为87．9％，特异性为100％。无1例患者出现不良反应。结论 内镜超声引导下细针穿刺是诊断左肾上腺病变微创、安全、准确的方法。     

超声内镜引导下针吸活检诊断肺部实质性及纵隔病变

目的探讨超声内镜引导下的针吸活检术（EUS-FNA）诊断肺部实质性及纵隔病变的可行性及安全性。方法用上部消化道奥林巴斯超声电子内镜EU-C2000，FNA细针，对10例毗邻食管的肺实质性及纵隔病变患者行EUS-FNA。结果7例患者均一次即获得足够标本，2例患者经再次活检而获得足够标本供病理学检查，1例因拒绝再次活检而失败。病理诊断为结核瘤3例，肺腺癌2例，小细胞癌1例，肺炎性假瘤2例，淋巴结核1例。除了自行停止的少许咯血和自行吸收的气胸外，未出现其他严重的与穿刺相关的并发症。结论EUS-FNA是诊断纵隔及肺部实质性病变的直接、安全、实用的检查方法。     

超声内镜引导下经食管针吸活检术对肺癌诊断价值的探讨

目的探讨超声内镜引导下经食管针吸活检术(EUS-TENA)对肺癌诊断和分期的价值。方法临床疑诊肺癌患者12例,胸部CT示肺部病变临近食管并伴有纵隔淋巴结肿大,使用富士上消化道超声电子内镜系统和COOK 22G超声活检针,经食管对病变实施针吸活检。结果 12例患者均获得足够的标本量,病理诊断:6例为小细胞癌,4例为腺癌,2例为鳞癌,均未发生与活检相关的并发症。结论 EUS-TENA术是一种安全、简便、实用的检查方法,患者耐受性好,是对超声支气管镜引导下经支气管针吸活检术(EBUS-TBNA)和纵隔镜检查的有效补充,对肺癌的诊断和分期具有较高的临床应用价值。     

经皮肺穿刺活检病理诊断肺癌的临床意义

目的探讨经皮肺穿刺活检病理诊断肺癌的临床意义。方法随机选取2017年2月至2018年2月肺部病变患者144例,均行增强CT检查和经皮肺穿刺活检术。以经皮肺穿刺活检结果示肺癌者为阳性,其余诊断结果为阴性,计算经皮肺穿刺活检对肺部恶性病变诊断的准确性、敏感性和特异性。观察患者行经皮肺穿活检术后的不良反应。结果诊断肺癌方面,144例肺部病变患者经皮肺穿刺活检与增强CT比较(41.61%比25.00%),差异有统计意义(P0.05)。增强CT诊断肺癌的准确性、敏感性、特异性分别为83.33%、60.00%、100.00%,误诊率为16.67%。144例肺部病变患者行经皮肺穿活检术后,不良反应发生率为15.28%(22/144),经对症治疗后均恢复正常,随访均未见针道肿瘤转移情况。结论经皮肺穿刺活检对肺癌的诊断结果可靠,是增强CT筛查肺癌的补充依据,可指导肺部病变者后续诊疗方案的制定和分流管理。     

内镜超声引导下细针针吸活组织检查37例分析

目的探讨内镜超声引导下细针穿刺活检在上消化道病变中的诊断价值。方法在超声内镜引导下对37例上消化道隆起性病变进行细针穿刺活检。结果发现在胃和食管隆起性病变中,最多发的为纵隔肿物,胃肠间质瘤。结论内镜超声引导下细针穿刺活检可以判断上消化道黏膜隆起型病变的性质．为黏膜下肿物治疗方式的选择提供依据。     

内镜超声检查在肺癌中的应用

目的评价内镜超声（endoscopic ultrasonography，EUS）检查在肺癌的应用价值。方法采用Pentax FG-36UX内镜经食管超声检查肺癌32例。结果对32例肺癌患者EUS检查既了解病变纵隔浸润情况、纵隔病变与周围脏器的关系，又明确纵隔淋巴结转移数目，EUS检查肺癌纵隔浸润的准确率为87％，行内镜超声引导下细针吸取细胞学检查（endosonography—guided fine needle aspiration，EUS FNA）15例，阳性率86％、准确率为100％。结论EUS是一项先进、安全、对肺癌临床诊断有较大帮助的检查手段。     

超声内镜引导后纵隔肿物穿刺活检的临床应用

后纵隔肿物因其部位特殊 ,一般非手术方法很难获得病理学诊断 ,如何采用微创手段获得病理学诊断 ?为此 ,我科于1998年开展了超声内镜 (ＥＵＳ)引导后纵隔肿物细针穿刺活检术 (简称ＥＵＳ ＦＮＡ) ,7例患者有 5例获得了病理诊断。资料与方法一、一般资料7例患者穿刺前均无病理学诊断。 5例患者ＣＴ或ＭＲ检查提示 :后纵隔肿物 ,未见明确的肺部病变 ;胃镜检查 :5例食管粘膜均光滑 ,2例为食管粘膜下肿物 ,2例表现为食管外病变压迫 ,1例未见异常。其余 2例ＣＴ检查提示肺癌并纵隔淋巴结肿大 ,支气管镜检查及痰病理检查均阴性。二、仪器和方法1.…     

经电子支气管镜和经皮肺活检诊断肺外周孤立性肿块

目的：评估综合使用经电子支气管镜肺活检和CT引导下经皮肺穿刺活检经皮肺穿刺活检对疑为周围性肺癌的肺外周孤立性肿块的诊断价值，评估其安全性。方法：对136例经无创检查未能确诊的肺外周孤立性肿块患者，根据病变部位、距胸膜距离及患者病情，对其中62例患者进行了经电子支气管镜肺活检，对另外74例患者使用精细针进行了经皮肺穿刺活检。评估各自诊断准确率、恶性病变诊断敏感度、并发症发生率。结果：经电子支气管镜肺活检和经皮肺穿刺活检均能获取组织标本。病理结果显示经电子支气管镜肺活检组有29例为恶性病变，6例为良性痛变，27例无明确病理诊断结果，诊断准确率为71％；恶性病变诊断敏感度为69．0%；经皮肺穿刺活检组有59例恶性病变．7例为良性病变，8例无明确病理诊断结果，诊断准确率为94．6％；恶性病变诊断敏感度为95．2％（P〈0．01）。两组均未出现严重并发症，经电子支气管镜肺活检并发气胸1例，痰中带血10例。经皮肺穿刺活检组并发气胸11例，痰中带血1例，肺内出血4例。结论：综合使用经电子支气管镜肺活检、经皮肺穿刺活检对疑为周围性肺癌的肺外周孤立性肿块的诊断具有重要价值，安全性高。     

CT引导下经皮肺细针抽吸活检术的探讨

目的:评价CT引导经皮肺细针抽吸活检术在肺内病变的诊断价值。方法:对我院2002年2月至2007年3月期间,45例肺内病变患者行CT引导下经皮肺细针抽吸活检术,将吸取的细胞涂在玻片上,送病理科检查,得到明确的病理和细胞学诊断,统计穿刺成功率和并发症的发生率,并分析可能的原因。结果:44例穿刺成功,穿刺成功率98%。腺癌19例,鳞癌9例,转移癌2例;腺鳞癌、大细胞癌和小细胞癌各1例;炎性假瘤5例;结核瘤3例;错构瘤1例;病理结果为出血和坏死的各1例,这两例其中1例行二次穿刺,病理结果为低分化腺癌,1例有手术指征行手术治疗,病理结果为中分化腺癌。发生并发症5例,其中气胸3例,少量肺出血2例。结论:CT引导经皮肺细针抽吸活检术是一种微创、临床应用准确性较高、并发症较少的有效检查方法,有助于肺部病变的诊断与鉴别诊断,对早期诊断和治疗有重要意义。     

经气道超声内镜引导针吸活检术的护理配合

超声内镜引导下经气管针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)是在超声图像的实时监视下对气管支气管周围病变进行穿刺活检,大大扩展了常规气管镜技术的诊断能力。EBUS-TBNA主要用于纵隔和肺门淋巴结的穿刺活检,其在肺癌纵隔淋巴结分期中的价值已得到     

EUS-guided fine needle biopsy: minimally invasive access to metastatic or recurrent cancer.

OBJECTIVE: Endoscopic ultrasound (EUS) is a sensitive technique for preoperative staging of gastrointestinal tumors. However, the value of this technique in the diagnosis of metastatic or recurrent disease is limited by the inability to differentiate malignant and benign lesions. We have prospectively investigated the role of EUS-guided biopsy in the evaluation of peri-intestinal tumors. METHODS: EUS-guided biopsy was performed in 167 patients with thoracic, intra-abdominal or pelvic lesions. The upper gastrointestinal tract was examined with a flexible echoendoscope equipped with a 7.5 MHz curved array transducer. For transrectal EUS a rigid endoprobe with a bifocal multiplane transducer (10 MHz) was used. Both instruments allowed to observe the biopsy procedure exactly in the longitudinal scan plane. RESULTS: Real time ultrasonography guidance of the biopsy needle enabled precise tissue sampling even of small lesions with a diameter of 1 cm. Overall EUS-guided fine needle biopsy yielded tissue samples for histopathologic or cytologic analysis in of 151 of 167 patients. Histology demonstrated benign lesions in 71 of 74 patients and malignant tumors in 68 of 93 patients. EUS-guided fine needle biopsy failed to provide the correct diagnosis in 28 cases. The overall sensitivity and specificity of EUS-guided biopsy in the diagnosis of malignancy were 73 and 96%, respectively. The histopathological results changed the clinical and endosonographic diagnosis in 49 patients. No complications were observed related to the biopsy. CONCLUSIONS: EUS-guided needle biopsy is a safe and efficient method for tissue sampling of peri-intestinal lesions. This minimally invasive technique provides adequate biopsies and improves the diagnostic value of endoscopic ultrasonography considerably.     

Sonographically guided renal mass biopsy: indications and efficacy.

PURPOSE: To review the clinical indications, pathologic results, and success rate of all our sonographically guided solid renal mass biopsies over a 5-year period. METHODS: Between 1993 and 1998, 44 consecutive patients underwent sonographically guided percutaneous biopsy of a solid renal mass. Indications included prior history of nonrenal malignancy, metastatic disease of unknown primary origin, previous contralateral nephrectomy for a renal cell neoplasm, a renal transplant mass, suspected renal lymphoma, history of tuberous sclerosis, and poor surgical candidacy. Aspiration biopsies were initially performed with 22- to 18-gauge spinal needles. If the initial cytologic evaluation findings were nondiagnostic, core biopsies were then performed with 20- to 18-gauge core biopsy guns. Dictated sonographic reports of the biopsies were reviewed to determine the following: indication for biopsy, location and size of the renal mass, needle gauge and type, number of needle passes, and complications. Final cytologic and surgical pathologic records were reviewed. RESULTS: Thirty-six (82%) of the 44 biopsy specimens were diagnostic. Aspirated smears were diagnostic in 24 (67%) of these cases, with the diagnosis made on the basis of cell block alone in an additional 2 (6%). A definitive diagnosis came from core biopsy alone in 10 cases (28%). The 18-gauge core needle yielded diagnostic results more reliably than the 20-gauge core needle, and a significant correlation was seen between core biopsy needle size and the rate of diagnostic core samples (P = .017). Pathologic diagnoses included renal cell carcinoma (n = 18), lymphoma (n = 4), oncocytic neoplasm (n = 4), transitional cell carcinoma (n = 2), angiomyolipoma (n = 1), papillary cortical neoplasm (n = 1), and metastatic carcinoma (n = 6). Complications were seen in 4 (9%) of 44 cases; all were treated conservatively. CONCLUSIONS: For specific clinical indications, sonographically guided fine-needle aspiration and core biopsy of a solid renal mass can be performed safely. In many cases, a definitive diagnosis can be made on the basis of fine-needle aspiration alone. However, diagnosis may ultimately require core biopsy, for which 18-gauge core needles would be more reliably diagnostic than 20-gauge needles.     

CT引导下经皮肺穿刺活检的临床应用(附117例分析)

目的 探讨CT引导下经皮肺穿刺活检的临床应用价值。方法 对117例肺部病变（肿块66例，结节42例，实变9例）行CT引导下经皮肺穿刺活检。采用18G穿刺针，选择最佳层面进针点多点取材，活检后行组织学和细胞学检查。结果 穿刺的成功率为94．1％。117例中，肺癌84例，其中穿刺确诊77例，穿刺敏感性为91．7％，特异性为82．5％，假阴性7例，假阴性率为17．5％，无假阳性。良性病变33例，经手术和随访证实。共7例发生气胸，占14．5％，仅2例经插管处理。结论 CT引导下经皮肺穿刺准确性高，并发症少，安全可靠，可为临床提供诊断依据，值得推广。     

Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses.

OBJECTIVE: Large-core needle biopsy of the breast can be performed with stereotactic or ultrasonographic guidance. However, ultrasonographically guided large-core needle biopsy has notable advantages, including the absence of ionizing radiation, increased patient comfort, and greater cost-effectiveness. The purpose of this study was to evaluate the accuracy of ultrasonographically guided large-core needle biopsy for the diagnosis of breast cancer in palpable and nonpalpable breast masses. METHODS: The study was a retrospective review of consecutive ultrasonographically guided large-core needle biopsies for indeterminate breast masses. A total 424 ultrasonographically guided core biopsies were performed in 367 patients with 1 or more breast masses. Ultrasonographically guided core biopsy was performed with a 14-gauge spring-loaded needle and a freehand technique. Correlation of ultrasonographically guided core biopsy pathologic findings with subsequent surgical pathologic findings or long-term imaging follow-up was performed. RESULTS: Of 424 indeterminate breast lesions for which histopathologic findings were obtained by ultrasonographically guided core biopsy, 234 cancers were diagnosed. Twenty-eight additional lesions had either questionable but not definitively malignant pathologic features (n = 11) or radiologic-pathologic discordance (n = 17) and were surgically excised. Of these, 8 additional cancers were diagnosed. Patients or surgeons chose excision of 41 additional lesions that were benign on ultrasonographically guided core biopsy No cancer was found in these surgical specimens. One additional cancer was diagnosed at a 6-month imaging follow-up because of interval growth. On the basis of surgical and long-term imaging follow-up, the sensitivity of ultrasonographically guided core biopsy for the diagnosis of breast carcinoma was 99.2% (95% confidence interval, 95.6%-99.9%) in 173 palpable breast masses and 93.2% (95% confidence interval, 87.1%-97%) in 251 nonpalpable masses. In cancers diagnosed on the basis of immediate surgical excision as a result of ultrasonographically guided core biopsy that showed either questionable pathologic features or radiologic-pathologic discordance, the sensitivity of ultrasonographically guided core biopsy for the diagnosis of breast cancer was 99.2%. CONCLUSIONS: Ultrasonographically guided large-core needle biopsy is a sensitive percutaneous biopsy method for the diagnosis of breast cancer in palpable and nonpalpable breast masses.     

Sonographically guided fine needle aspiration biopsy of abdominal lymph nodes: experience in 102 patients.

We present our experience with sonographically guided fine needle aspiration biopsy of abdominal and retroperitoneal lymph nodes in 102 patients. The biopsied lymph nodes measured 1 to 6 cm (mean, 2.3 cm) and were located at the porta hepatis (n = 23), in the peripancreatic (n = 31), paraaortic (n = 22), aortocaval (n = 1), common iliac (n = 3), or external iliac (n = 6) regions, or in the mesentery (n = 16). Material sufficient for cytologic analysis was obtained in 87 (85.2%) of the 102 patients. The cytologic diagnosis in these patients included malignancy in 47 patients, tuberculosis in 28 patients, reactive lymphoid hyperplasia in 10 patients, and aspergillosis in two patients. In the other 15 patients, fine needle aspiration biopsy could not provide a definitive diagnosis. No major or minor complications occurred in our study. Thus, sonographic guidance is an effective alternative to computed tomography for biopsy of abdominal and retroperitoneal lymph nodes.     

超声引导下经皮肺和胸膜穿刺活检的应用

目的探讨超声引导下经皮肺、胸膜穿刺活检的组织学诊断准确性和并发症。方法对120例外周型肺占位和胸膜病变进行超声引导下的穿刺活检。结果120例患者均成功取材。病理结果示腺癌34例,鳞癌40例,低分化癌14例,小细胞癌4例,恶性间皮瘤4例,间皮瘤6例,结核病变4例,炎性病变12例,隔离肺2例。其中3例假阴性,活检结果为炎性病变,手术后病理结果示鳞癌。气胸7例,未经治疗自愈,咯血1例,其它112例均未出现明显并发症。结论超声引导下对外周肺、胸膜病变活检,具有准确性高、并发症少的特点,对临床诊疗具有重要的价值。     

内镜超声引导下细针穿刺活检对上消化道及毗邻脏器疾病的诊断价值

目的探讨纵轴内镜超声引导下细针穿刺活检(EUS-FNA)在上消化道及其毗邻脏器疾病诊断中的价值。方法31例上消化道及其毗邻脏器疑难疾病患者行纵轴EUS-FNA，进行细胞学及组织学检查初步诊断。所有患者均随访6个月或经手术病理作出最终诊断。评价纵轴EUS-FNA诊断准确性。结果25例患者获得足够的细胞或组织学资料，穿刺成功率80．6％。在所有穿刺病例中，EUS-FNA敏感性81．5％，特异性100％；而在穿刺成功的病例中，敏感性达到90．5％，特异性100％。所有患者未出现严重并发症。结论纵轴EUS-FNA对上消化道及其毗邻脏器疾病的诊断特异性高，尤其对常规方法诊断困难的部分疾病价值较大。提高穿刺成功率和小病变穿刺准确性是增进其临床价值的关键。     

The utility of ultrasonographically guided large-core needle biopsy: results from 500 consecutive breast biopsies.

Five hundred ultrasonographically guided large-core needle breast biopsies of solid masses were performed in 446 women. Histopathologic results were correlated with imaging findings. Ultrasonographically guided large-core needle biopsy resulted in diagnosis of malignancy (n = 124) or severe atypical ductal hyperplasia (n = 4) in 128 lesions (26%). In the remaining 372 lesions (74%), ultrasonographically guided large-core needle biopsy yielded benign pathologic results. Follow-up of more than 1 year (n = 225), results of surgical excision (n = 50), or both were obtainable in 275 (74%) of the benign lesions. No malignancies were discovered at surgical excision or during follow-up of this group of benign lesions. There were no complications related to large-core needle biopsy that required additional treatment. Ultrasonographically guided large-core needle biopsy is a safe and accurate method for evaluating breast lesions that require tissue sampling.     

超声内镜对结直肠黏膜下病变的诊断价值

目的探讨超声内镜(EUS)在结直肠黏膜下病变诊断和治疗中的作用。方法对结直肠黏膜下病变进行EUS检查。根据黏膜下病灶的起源层次,部分患者接受深挖活检、超声内镜引导下细针穿刺吸取活检术(EUS-FNA)、内镜下治疗或外科手术。回顾性分析EUS诊断结果与临床病理的相关性。结果 EUS检查的74例患者中,诊断神经内分泌肿瘤28例(均位于直肠);脂肪瘤15例(其中位于回盲部4例、横结肠1例、升结肠8例、乙状结肠2例);直肠间质瘤2例(固有肌层和黏膜肌层各1例);外压性改变14例(卵巢肿瘤9例,淋巴结2例,盆腔肿瘤3例);囊肿5例(横结肠4例、升结肠1例);气囊肿1例;乙状结肠子宫内膜异位3例;直肠周边恶性肿瘤侵犯4例;肠道淋巴瘤2例。所有病灶均接受深挖活检、EUS-FNA、内镜下治疗或外科手术。最终病理和EUS诊断符合率为68/74(91.9%),其中2例EUS考虑直肠类癌最后病理确诊为黏膜肌层来源的平滑肌瘤。1例考虑脂肪瘤最终确诊为肠道淋巴瘤。2例考虑直肠周边恶性肿瘤最终为炎性包块,1例考虑子宫内膜异位症最终诊断为直肠癌。结论 EUS能清晰地显示消化道各层结构,能清楚显示结直肠黏膜下病变的大小、起源及其与相邻结构的关系,并且能较精确地判断各种病变的性质,进而指导结直肠黏膜下病变的治疗。     

肝脏实性占位病变超声诊断的临床研究

目的 :探讨肝脏实性占位病变尤其是≤ 3cm的小肝癌应用二维超声和彩色多普勒的诊断价值。方法 :采用 Medison- 880 0及 Toshiba- 35 0彩色多普勒超声诊断仪 ,探头频率为 3.5 MHz,对 16 8个肝脏实性占位病变进行检查 ,并与超声引导下细针穿刺活检所得病理结果对照。结果 :16 8个肝脏实性占位病变中 ,肝细胞肝癌和肝转移癌占 72 % (12 1/ 16 8) ;32个≤ 3cm肝脏占位病变中 ,肝细胞肝癌和肝转移癌占 5 3% (17/ 32 )。结论 :彩色多普勒超声检查可提高肝脏占位病变的诊断 ,对病灶性质存有异议时可行超声引导下穿刺活检