细胞DNA定量分析技术用于宫颈癌筛查的应用价值

宫颈癌是女性常见恶性肿瘤,仅次于女性乳腺癌,宫颈癌的发生与持续感染HPV病毒有很大的关系.目前,宫颈癌的发病率、死亡率逐年提高,成为危害女性健康的最大杀手之一.宫颈癌筛查的主要方法是通过细胞学检测,随着细胞学检查技术不断发展,宫颈癌的发病率也有所下降.细胞学技术从原有的宫颈刮片发展为液基薄层细胞学、HPV病毒检测等,近十年又出现细胞DNA定量分析技术,并已在我国一些技术水平高的医院开展.有研究表明,细胞DNA定量分析技术的敏感性远大于传统的细胞学诊断[1],如今细胞DNA定量分析技术在基层病理科逐渐普及.本文拟探讨细胞DNA定量分析-传统细胞学检查联合用于宫颈癌筛查的临床意义.     

乳腺癌筛查模式的探讨

目的 探索适合中国妇女生物学特性的乳腺癌筛查模式.方法 对2000例乳腺触诊阳性与可疑者分别采用以乳腺X线摄影为主、超声检查为辅(模式一)和以超声检查为主、乳腺X线检查为辅(模式二)的两种筛查模式筛查,分析两种筛查方法的乳腺癌检出率、召回率、特异度、敏感度及阳性预测值,并与手术病理诊断结果对照和进行统计学处理.结果 模式一:真阳性6例,真阴性1920例;假阳性74例,假阴性0.乳腺癌检出率为3％,召回率8.5％,阳性预测值12％,特异度96.3％,敏感度100％.模式二:真阳性3例,真阴性1940例;假阳性54例,假阴性3例.乳腺癌检出率为1.5％,召回率9.3％,阳性预测值5.3％,特异度97.3％,敏感度50％.两者比较,模式一敏感度、阳性预测值、肿瘤大小、召回率均优于模式二,敏感度及阳性预测值比较采用卡方检验,P＜ 0.05为差异有统计学意义.结论 以乳腺X线检查为主,超声辅助的筛查模式是乳腺癌筛查的最佳模式.     

急性阑尾炎超声检查方法的再探讨

目的为提高急性阑尾炎超声诊断的准确性,对其超声检查方法予以进一步探讨。方法对278例疑似急性阑尾炎患者术前随机分成两组,分别行方法一、二两种检查,结果与手术病理对照。结果方法一的敏感度65.3%,特异度44.4%,阳性预测值88.7%,阴性预测值16.0%,准确度69.7%,阳性似然比1.5。方法二的敏感度90.4%,特异度84.0%,阳性预测值96.3%、阴性预测值65.6%、准确度89.2%,阳性似然比5.7。结论检查方法二明显提高了急性阑尾炎术前诊断的准确性。     

液基细胞薄片以及阴道镜在宫颈癌及宫颈上皮内瘤变筛查中的应用

目的:探讨液基细胞薄片制备(TCT)联合阴道镜在宫颈上皮内瘤变(CIN)及宫颈癌筛查中的应用价值。方法:以我院2004年6月~2005年1月妇科门诊800例患者为研究对象,行液基细胞薄片制备,采用TBS分级诊断系统,同时进行阴道镜下宫颈多点活检,以组织学检查为金标准,分析TCT与阴道镜检查在宫颈癌前病变诊断中的应用价值。结果:病理组织学检查发现CINⅠ级135例,CINⅡ级26例,CINⅢ级14例,宫颈癌8例,其余均为良性细胞改变。TCT细胞学诊断检测到CINⅠ级以上病变与组织学检查相比,阳性符合率86.89%,查到癌细胞的5例全部相符,细胞学检查阳性而活检结果为炎症者18例,占9.84%。阴道镜检查结果提示CINⅠ级以上病变与组织学检查相比,阳性符合率80.62%。结论:TCT结合阴道镜检查用于宫颈上皮内瘤样病变及宫颈癌筛查,敏感性高,假阴性率低,是一种高效、便捷的方法,有重要的应用价值。     

宫颈液基薄层细胞学检查在女飞行员宫颈病变筛查中的作用

目的：探讨宫颈液基薄层细胞学检查在女飞行员妇科体检中的作用。方法：回顾性分析2007-01～2008-12间运用宫颈液基薄层细胞学检测（TCT）及传统巴氏涂片方法,均采用TBS分类,对40名女飞行员进行宫颈病变的筛查。不典型鳞状上皮细胞（ASC-US）以上列为阳性病例,比较两种细胞学诊断结果与阴道镜下活检宫颈组织病理学结果间的关系。结果：TCT细胞学阳性病例5例,阳性率为12.5%（5/40）,组织病理学阳性3例,均为人类乳头瘤状病毒感染,阳性60%（3/5）;而传统细胞学的阳性检出率仅为5%（2/40）,组织病理阳性率为0。结论：宫颈TCT检测能明显提高细胞学诊断的阳性率,女飞行员HPV感染现象值得关注。     

HR-HPV、TCT检测结合阴道镜下定位活检在宫颈癌及癌前病变筛查中的应用研究

目的探讨高危型人乳头瘤病毒(HR-HPV)、液基细胞学(TCT)检测结合阴道镜下定位活检对宫颈癌及癌前病变筛查的应用价值。方法收集我院妇科门诊HR-HPV、TCT检测患者1436例,对HR-HPV阳性、TCT≥ASCUS及临床高度怀疑宫颈病变患者共856例在阴道镜检查时行肉眼醋酸(VIA)及卢戈氏碘液(VILI)检查,并行定位活检。结果病理结果证实CINⅡ-619例,CINⅡ+237例,人群HR-HPV总检出率为71.4%,TCT阳性率82.5%,VIA阳性率63.0%,VILI阳性率53.4%。各种筛查方法阳性率在CINⅡ-、CINⅡ+中有统计学差异(P<0.05);HR-HPV对宫颈高度病变的敏感度、特异度、阳性似然比、正确诊断指数和Kappa值分别为89.03%、34.89%、1.37、0.2392和0.1605。TCT以上各指标为92.83%、21.49%、1.18、0.1432和0.0889。VIA以上各指标为86.08%、45.88%、1.59、0.3196和0.2294。VILI以上各指标为86.92%、59.45%、2.14、0.4637和0.3605。结论 TCT检查是一种准确、简便的宫颈病变的细胞学检测方法,结合HR-HPV检测,是宫颈癌前病变的最佳筛查方案;但也有假阴性,必要时要结合VIA、VILI阴道镜下定位活检明确,以免漏诊。     

妇科体检中应用TCT结合高危型HPV检测对宫颈上皮内瘤变的筛查价值

目的探讨妇科体检中应用液基细胞学（TCT）检查结合高危型HPV检测对子宫颈上皮内瘤病变的筛查价值。方法本院2010年1月～2011年12月6973例妇科体检宫颈液基薄层细胞学检查,采用美国新柏氏液基薄层细胞学（TCT）检测系统制片,细胞学诊断采用TBS分级系统。结果6973例液基薄层细胞学检查结果中,细胞学异常者为372例,阳性检出率为5．33％。372例细胞学检查阳性中,ASCUS286例（包含少量非典型鳞状上皮细胞）,占76．88％;LSIL28例,占i7．53％;ASCU—H27例,占7．26％;HSIL22例,占5．91％,非典型腺细胞（AGUS）6例,占1．61％,宫颈鳞癌（SCC）3例,占0．81％;对372例TCT阳性患者行HPV分型检测进行分流,286例ASCUS高危型或低危型HPV阳性者中154例进行阴道镜检查,对细胞学结果ASCUS以上的不论HPV检测是否阳性共计240例均进行阴道镜检查后行宫颈组织学活检,诊断CINI。Ⅲ患者126例,其中CINI36例,CINII36例,CINⅢ54例,宫颈鳞癌6例,慢性宫颈炎伴鳞化38例,HPV亚临床感染33例。宫颈上皮内瘤变的病理诊断符合率分别为ASCUS43．97％,LSIL96．55％,ASC—H100％,HSIL96．65％,SCC100％,AGUC：33．33％。结论液基薄层细胞学（TCT）检测系统是宫颈上皮内瘤变筛查的一种有效方法,宫颈或阴道炎症、HPV病毒感染都会引起宫颈细胞学的异常,有一定的局限性,对于细胞学检查异常的患者进行HPv病毒检测,即便细胞学异常级别较低,一旦合并高危型HPV病毒感染,也有宫颈上皮内瘤变的发生;TCT阳性、HPV阳性者再进行阴道镜检查取组织学,提高了诊断宫颈上皮内瘤变的符合率,对宫颈上皮内瘤变的及时干预和治疗,能有效预防宫颈癌的发生。     

细胞DNA倍体与TCT在健康人群宫颈癌筛查中的临床意义

目的 宫颈癌是一种妇科最常见的恶性肿瘤,故早期筛查和早期干预是预防宫颈癌的重要措施.方法 通过对体检中心的2510例妇科体检人员,进行了DNA倍体分析、TCT检测及"TCT+DNA倍体分析".结果 3种检查结果比对,并进一步对阳性病例进行阴道镜下取活检,对比3种方法对宫颈癌及癌前病变早期筛查的临床意义.结论 宫颈液基细胞学TBS检查联合宫颈细胞DNA定量分析检测能明显提高宫颈癌筛查阳性检出率,有较好的临床应用价值[3]提高宫颈病变诊断的准确性,减少误诊和漏诊,从而弥补了单独DNA倍体分析因其高敏感性可能造成的部分患者过度诊断[2],同时也防止了单独TCT因敏感性低且受制片及读片人员经验的限制而造成的漏诊.     

宫颈液基细胞学检查对宫颈病变的诊断价值分析

目的 探讨宫颈液基细胞学检查(TCT)对宫颈病变的诊断价值.方法 对2006年8月～2010年5月来我院就诊并体检的798例妇女,采用贝赛斯达(TBS)诊断系统经宫颈液基薄层细胞学检查(TCT),选择TCT报告ASC-US以上患者55例(阳性率6.89%),进行活检,同时部分病例经组织学对比印证.结果 55例TCT报告ASC-US以上的患者,与组织病理学的符合率为86.38%.其中非典型鳞状细胞(ASCUS)以上异常28例(3.51%),低度上皮内瘤变(L-SIL)19例(2.38%),高度上皮内瘤变(H-SIL)5例(0.62%),鳞癌(SCC)2(0.25%),不典型腺细胞(AGUS)2例(0.25%).其中30例细胞异常者进行病理活检,CIN2以上病变TCT与组织病理检查方法的符合率为85.72%(6/7).结论 宫颈液基细胞学检查是一种简便、准确的早期宫颈病变筛查方法,对宫颈癌前病变的早期诊断有重要价值,可以作为妇女宫颈癌防治的有效工具.     

MRI对锥切术后残余宫颈的评估价值

目的 探讨MRI表观扩散系数（ADC）和时间-信号强度曲线（TIC）对锥切术后残余宫颈的评估价值。方法 回顾性收集因宫颈病变行宫颈锥切术及子宫切除术的50例病人的影像和病理资料,病人均行T1WI、T2WI、扩散加权成像（DWI）和动态增强MRI检查。将病灶根据病理结果分为残留癌灶和阴性切缘,测量残留癌灶和阴性切缘的ADC值并分析TIC类型。以手术病理结果为金标准,计算MRI对残余宫颈癌灶的诊断敏感度、特异度、准确度、阳性预测值和阴性预测值。采用t检验和Fisher确切概率检验比较残留癌灶和阴性切缘间ADC值和TIC类型的差异。结果 残留癌灶MRI表现为稍低T1、稍高T2信号,DWI上表现为高信号,扩散受限,动态增强扫描早期强化明显,延迟期强化程度低于正常宫颈,TIC均呈快进快出型（Ⅲ型）。阴性切缘MRI表现为等T1、等或稍高T2信号,DWI上表现为等或稍高信号,扩散不受限,动态增强扫描表现为持续性明显强化,TIC主要呈流入型（Ⅰ型）。21例病人宫颈切缘残留癌灶,29例呈阴性切缘。MRI对残留癌灶诊断敏感度较低（19.0%）,特异度较高（93.1%）,准确度62.0%,阳性预测值66.7...     

醋酸肉眼观察用于宫颈病变筛查的价值

目的研究醋酸肉眼观察用于宫颈病变筛查的价值。方法600名妇女依次接受液基细胞学检测（TCT）,醋酸肉眼观察,阴道镜检查并取活检,将醋酸肉眼观察结果与宫颈细胞学检查结果进行比较。结果醋酸肉眼观察的灵敏度为82.8%（77/93）,高于TCT（72.0%）,尤其是对于CIN2级以上的病变灵敏度可达91.4%（32/35）,阳性预测值67.8%,阴性预测值97.9%。醋酸肉眼观察特异性为92.7%（470/507）,与TCT（92.5%）相近。结论醋酸肉眼观察法是检查宫颈阴道部病变的一种非常灵敏的肉眼检查方法,便宜且操作简单,灵敏度高且迅速出结果,尤其适用于贫困地区、一些基层卫生院及进行宫颈癌的普查,对于那些拒绝TCT等检查者,也可用此方法进行初筛。     

液基薄层细胞学检测法和传统涂片法在宫颈癌前病变筛查中的应用

目的探讨液基薄层细胞学检测（TCT）技术在宫颈癌前病变中的诊断价值。方法收集4185例体检及门诊病例,分为2组,分别应用TCT（2150例）检查及传统巴氏涂片（2035例）检查,细胞学异常者,行阴道镜下组织病理活检。结果TCT检查标本的满意率、对宫颈癌前病变筛查的阳性率及与组织病理活检的阳性符合率均明显高于巴氏涂片组,差异均有显著性（P〈0.01）。结论TCT技术应用于宫颈癌前病变筛查,明显提高了标本的满意率及宫颈异常细胞检出率,并与组织病理活检有较高的阳性符合率。此技术敏感性高于巴氏涂片,适于临床推广应用。     

Clinical assessment of three common tests for superior labral anterior-posterior lesions

BACKGROUND: Three tests (active compression, anterior slide, and compression rotation) are commonly used to diagnose superior labral anterior-posterior lesions. HYPOTHESIS: We hypothesized that the accuracy, sensitivity, and specificity for these tests was less than that previously reported and that a click in the shoulder during manipulation was not specific for the study lesion. STUDY DESIGN: Case-control study. METHODS: The three tests were performed on 426 patients who subsequently underwent shoulder arthroscopy. The results of physical examination were compared with the arthroscopic findings and analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. RESULTS: At arthroscopy, 39 patients had type II to IV lesions (study group); the remaining 387 patients had type I lesion or no lesion (control group). The incidences of positive results were not statistically different between the groups (P > 0.05). Our findings were as follows: most sensitive test, active compression (47%); most specific test, anterior slide (84%); highest positive predictive value, active compression (10%); highest overall accuracy, anterior slide test (77%); lowest overall accuracy, active compression test (54%). The presence of a click and the location of the pain were not reliable diagnostic indicators. CONCLUSIONS: The results of such tests should be interpreted with caution when considering surgery for a possible superior labral anterior-posterior lesion.     

彩色多普勒超声联合D-二聚体对周围型下肢深静脉血栓筛查的价值

目的探讨彩色多普勒超声(CDUL)联合D-二聚体检测对周围型下肢深静脉血栓的筛查价值。方法对1821例下肢深静脉血栓的高危患者行下肢深静脉CDUL检查及D-二聚体的检测。分别计算CDUL、血浆D-二聚体浓度水平检测以及二者联合对高危人群中周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值以及Kappa值。结果CDUL诊断周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值、Kappa值为95.8%、94.5%、88.2%、98.1%、0.881。血浆D-二聚体浓度检测诊断周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值、Kappa值为85.2%、95.6%、89.3%、93.8%、0.818。二者联合诊断周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值、Kappa值为98.0%、100.0%、100.0%、99.1%、0.986。CDUL联合D-二聚体检测与单独行D-二聚体检测及CDUL检查的差异均有统计学意义(均P<0.05)。结论CDUL检查联合血清D-二聚体检测对筛查周围型下肢深静脉血栓有较高的诊断准确率,具有较高的临床价值。     

The indications for scrotal ultrasound

Scrotal ultrasound scanning is now a routine and mandatory investigation of the patient presenting with scrotal symptoms. The need for scrotal ultrasound scanning when the physical examination reveals no significant abnormality has not been previously assessed. We conducted a retrospective study of 160 patients attending for scrotal ultrasound over a period of 1 year. The accuracy of clinical examination was compared with the gold standard of ultrasound for identifying clinically significant lesions. The sensitivity, specificity and positive and negative predictive values were calculated. Four clinically relevant groups were used for analysis purposes: Group I, acutely painful scrotum with or without swelling; Group II, chronic testicular pain without swelling; Group III, chronic scrotal swelling with or without pain; and Group IV, the asymptomatic testis. In Group I, sensitivity was 100%, specificity was 81.3%, the positive predictive value was 92.1% and the negative predictive value was 100%. In Group II, sensitivity was 71.4%, specificity was 90.9%, the positive predictive value was 76.9% and the negative predictive value was 88.2%. In Group III, sensitivity was 88.9%, specificity was 66.7%, the positive predictive value was 92.3% and the negative predictive value was 57.1%. In Group IV, sensitivity was 33.3%, specificity was 100%, the positive predictive value was 100% and the negative predictive value was 93.9%. All clinically significant abnormalities were identified on clinical examination. Clinically insignificant lesions identified by ultrasound alone did not affect the clinical management. It is recommended that scrotal ultrasound is used in the acutely painful scrotum where a confident diagnosis cannot be made or there is failure to respond to treatment, and in the chronic swelling where a confident clinical diagnosis cannot be made.     

Use of virtual endoscopy with computerized tomography in the identification of colorectal neoplasms. Prospective study with symptomatic patients

INTRODUCTION: Aim of this study was to evaluate the sensitivity of virtual colonoscopy (CT colonography) in the identification of colorectal cancer and to define the limitations and the advantages of this imaging modality, as well as indications to the examination. MATERIAL AND METHODS: We examined prospectively 62 symptomatic patients aged 36 to 82 years (28 women and 34 men). All patients underwent both conventional and virtual colonoscopy on the same day; the conventional examination allowed exploration of the entire colon. RESULTS: Conventional colonoscopy identified 89 lesions 3-50 mm in diameter, namely 84 benign and 5 malignant lesions. No lesions were identified in 12 patients. CT colonography identified 52 of the 89 lesions, with 57.1% diagnostic accuracy. There were 11 false positives (82.5% positive predictive value and 52.2% specificity) and 37 false negatives (24.5% negative predictive value and 58.4% sensitivity). Sensitivity was significantly higher (85.7%) for polyps > or = 1 cm. CONCLUSIONS: Virtual colonoscopy is an imaging modality with good diagnostic yield, well tolerated by patients and with great potentials for further development. We suggest that the examination be performed in symptomatic patients who cannot undergo total colonoscopy or refuse the other imaging modalities. Further studies are warranted in larger series of patients, possibly introducing it in screening programs.     

The incremental contribution of clinical breast examination to invasive cancer detection in a mammography screening program

OBJECTIVE: The objective of this study was to determine the potential added contribution of clinical breast examination (CBE) to invasive breast cancer detection in a mammography screening program, by categories of age and breast density. SUBJECTS AND METHODS: We prospectively followed 61,688 women aged 40 years or older who had undergone at least one screening examination with mammography and CBE between January 1, 1996, and December 31, 2000, for 1 year after their mammogram for invasive cancer. We computed the incremental sensitivity, specificity, and positive predictive value of CBE over mammography alone for combinations of age and breast density (predominantly fatty or dense). RESULTS: Mammography sensitivity was 78% and combined mammography-CBE sensitivity was 82%, thus CBE detected an additional 4% of invasive cancers. CBE detected a minority of invasive cancers compared with mammography for all age groups and all breast densities. Sensitivity increased from adding CBE to screening mammography for all ages, from 6.8% in women ages 50-59 with dense breasts to 1.8% in women ages 60-69 years with fatty breasts. CBE generally added incrementally more to sensitivity among women with dense breasts. Specificity and positive predictive value declined when CBE was used in conjunction with mammography, and this decrement was more pronounced in women with dense breasts. CONCLUSION: CBE had modest incremental benefit to invasive cancer detection over mammography alone in a screening program, but also led to greater risk of false-positive results. These risks and benefits were greater in women with dense breasts. The balance of risks and benefits must be weighed carefully when evaluating the inclusion of CBE in a screening examination.     

Sensitivity and specificity of first screen mammography in 15 NBSS centres

We report the sensitivity and specificity of first screen mammography in a 15-centre randomized screening trial. Of 44,718 women who received mammography and physical examination at first screening, 238 were diagnosed with breast cancer at first screen, 34 in the 12-month interval after the first screen, and 98 at the second screen. Seventeen of the interval cases and 47 of the second-year cancers were defined as potentially detectable at first screening. Interpretations of first screen mammograms by radiologists at the screening centres were matched to known histological outcomes. Simultaneous blind review of 2908 cases, which included all cancers detected at first and second screenings as well as interval cancers, was done by a single reference radiologist. The sensitivity of the technique as carried out at all NBSS centres was 0.75, the specificity 0.94, the positive predictive value 0.07, and the negative predictive value 0.998.     

The role of transvaginal ultrasound and sonohysterography in the diagnosis and staging of endometrial adenocarcinoma]

PURPOSE: The aim of this study is to evaluate the accuracy of sonohysterography in early diagnosis of endometrial tumor lesions and in the detection of myometrial infiltration for staging. MATERIAL AND METHODS: We performed sonohysterography as a preoperative test in 24 patients with an hystologic diagnosis of endometrial adenocarcinoma obtained by hysteroscopy and biopsy. The mean age of the patient was between 50 and 82 years. The sonohysterographic examination was performed by using 5.0 and 6.0 MHz transvaginal probes and a 5 or 7 French hysteroinjectors with inflating balloon. 19 of the 24 patients were enrolled in the study: in 2 cases the examination was not technically performable, 2 patients refused surgical treatment and 1 patient had a cervical adenocarcinoma with extension to the myometrium. In each patient we evaluated the number and the size of the lesions and the degree and the depth of myometrial infiltration. Each parameter was compared with the final histopathologic examination. RESULTS: Sonohysterography showed a single lesion in 15 patients, whereas in 4 patients it showed multiple lesions; in 1 of these patients it showed 3 lesions which were, in reality, a single lesion that infiltrated the first half of the myometrium. Myometrial infiltration was correctly evaluated by the examination in 17 of the 19 women (89.4%): 16 positive and 1 negative case. The sensitivity was 88%, the specificity 100%, the positive predictive value 100% and the negative predictive value 33%. The sonohysterography allowed to evaluate exactly the depth of myometrial invasion in 15 of the 16 cases (93.7%), in which a myometrial infiltration was suspected. With regard to this parameter the sensitivity was 85.7%, the specificity was 100%, the positive predictive value 100% and the negative predictive value 90.9%. CONCLUSIONS: Although the introduction of transvaginal ultrasonography in clinical practice allows to obtain an early diagnosis of endometrial adenocarcinoma, about half patients seems to present already at the diagnosis myometrial invasion. Moreover 50% of these patients seems to have pelvic lymphonodes and about 29% positive paraaortic lymphonodes. Currently myometrial invasion is evaluated by the extemporary frozen test and confirmed by the definitive hystologic examination. It would be helpful to have a technique able to detect and evaluate infiltration before surgery. The results of this study suggest that sonohysterography could have a role in preoperative staging. However these data need to be confirmed by further studies.