淋巴管造影对前列腺癌淋巴结转移的诊断价值

目的　提高前列腺癌盆腔淋巴结转移的诊断水平。　方法　前列腺癌患者 33例 ,行足背淋巴管造影了解有无盆腔淋巴转移 ,造影结果与细针穿剌抽吸或淋巴结活检病理结果比较。　结果　淋巴结癌转移阳性 9例 ,7例经细针穿剌抽吸细胞学检查、6例经病理切片证实 ,无假阳性。 2 4例阴性中病理证实假阴性 4例 (17% )。　结论　淋巴管造影对前列腺癌淋巴结转移有很高的诊断价值 ,对可疑淋巴结细针穿剌抽吸细胞学检查可避免假阳性 ,但仍有假阴性。     

Ultrasound-guided prostate biopsy. Biopty gun superior to aspiration

We used a 7 MHz transrectal ultrasound scanner to perform guided core biopsy and aspiration cytologies on 292 patients with findings suspicious for prostate cancer. One hundred two cancers were identified, 35 of which were not palpable and were detected only by ultrasound. Aspiration needles were guided by ultrasound through the center of the suspicious lesion. Core biopsies were performed using an 18-gauge Tru-Cut type of needle with an automatic, spring-powered needle biopsy device (Biopty). All patients received only local anesthetic and biopsies were done as an outpatient office procedure. The core biopsies gave excellent specimens which detected 89 percent of the cancers, whereas the aspiration method detected 51 percent (P less than 0.001). Aspiration cytology was significantly less sensitive among well-differentiated compared with moderately differentiated cancers. High-resolution transrectal ultrasound and the Biopty device are detecting and documenting prostate cancer with much greater sensitivity than preceding techniques have achieved.     

Transrectal needle aspiration versus transperineal needle biopsy in diagnosis of prostatic carcinoma

Fine-needle aspiration of the prostate was compared to transperineal biopsy in 86 patients with suspected prostatic carcinoma. Aspiration was found to have a sensitivity of 98.6% while no complications were seen. Initial core needle biopsy compared to the final histological diagnosis in this study showed a sensitivity of 84.5%. Fine-needle aspiration of the prostate is a safe, inexpensive and accurate diagnostic method in prostatic carcinoma. Our findings suggest that prostatic aspiration should be used more widely as an initial diagnostic procedure for suspected prostatic cancer.     

Evaluation of prostate aspiration biopsy for cytological detection of prostate cancer

The aspiration biopsy of the prostate for cytological detection was evaluated in 143 patients with clinically suspected prostate cancer and compared with the pathological diagnosis by needle biopsy performed simultaneously. Histopathological evaluation was possible in 136 cases. Sufficient cells for cytological diagnosis were obtained in 92.3% of pathologically diagnosed cases. Only 3 specimens for cytology (4.3%) of the prostate cancer before treatment were insufficient for cytology. Compared with pathological diagnosis by needle biopsy, false positive and negative rates were observed in 4.8% and 25.0% respectively. The accuracy rate of cytological diagnosis was higher the higher the degree of anaplasia in the pathological findings. In 20 clinically well-controlled patients the cytological results were negative in all of the well differentiated adenocarcinomas, whereas positive in poorly differentiated ones without exception. The cytological findings were still positive in all of the 4 cases with progressive cancer in spite of the anticancer therapy. Besides these results, because of no complication in the 182 aspiration biopsies, this may be a useful method for detection of prostate cancer, especially for screening of the cancer and judgment of efficacy during treatment.     

淋巴管造影对前列腺癌盆腔淋巴结转移的诊断价值

目的 评价淋巴管造影在诊断前列腺癌盆腔淋巴结转移的价值。方法 61例前列腺癌患者行足背淋巴管造影，对10例阳性、4例可疑及47例阴性患者行细针穿刺抽吸细胞学检查和淋巴结活检。结果 10例淋巴管造影阳性者，经细针穿刺抽吸细胞学检查和病理证实淋巴结转移9例，假阳性1例。4例可疑患者，经细针穿刺抽吸细胞学检查和前列腺癌根治术后病理证实无淋巴结转移。47例阴性者中，经细针穿刺抽吸细胞学检查和病理证实假阴性4例（8．5％）。结论 淋巴管造影对前列腺癌淋巴结转移有较高的诊断价值，对阳性或可疑淋巴结细针穿刺抽吸细胞学检查可避免假阳性，但有一定的假阴性。     

Comparison of transrectal prostate digital aspiration and ultrasound-guided core biopsies in 99 men

We compared digital transrectal needle aspiration and transrectal core prostate biopsies obtained with ultrasound guidance in 99 men. Both procedures were effective in identifying prostate cancer; complete sensitivity was 94 percent for aspiration and 90 percent for core biopsy. Aspiration confirmed 87 percent of 38 known cancers and 94 percent of 81 cancers overall, compared with 82 percent and 90 percent with core biopsies. The greatest number of cancers was found when both procedures were considered (95% of known and 98% of all cancers). Grading of both specimens was performed but was not equivalent. Unsatisfactory or inconclusive results by either procedure often obtained when cancer was present. We suggest digital transrectal needle aspiration as a first means of identifying most palpable prostate lesions. Transrectal core biopsies guided by ultrasonography should be used when suspicion of cancer cannot be confirmed by aspiration and when there is no palpable lesion (but clinical suspicion of cancer).     

Detection rate of histologically insignificant prostate cancer with systematic sextant biopsies and fine needle aspiration cytology

PURPOSE: We evaluate the detection rate of insignificant prostate cancer and the rate of significant prostate cancer overlooked in the results of systematic sextant biopsy and fine needle aspiration biopsy of the prostate of asymptomatic men with serum prostate specific antigen concentrations less than 4.0 ng./ml. MATERIALS AND METHODS: We analyzed specimens from 133 consecutive patients with a mean age of 60 years undergoing cystoprostatectomy for bladder cancer. Six systematic biopsy specimens and 2 fine needle aspiration cytology samples were taken from the prostate immediately after cystoprostatectomy. The specimens were step sectioned and examined for prostate cancer. Insignificant prostate cancer was defined as any cancer with an aggregate volume 0.5 cm.3 or less. RESULTS: Incidental prostate cancer was found in 58 of the 133 patients (44%). Tumor volume was 0.5 cm.3 or less in 47 cases. Sextant biopsy detected 7 cancers, including 4 of 47 (9%) that were insignificant and 3 of 11 (27%) that were significant. Fine needle aspiration cytology also detected 7 cancers, including 3 (6%) and 4 (36%) that were insignificant and significant, respectively. CONCLUSIONS: Systematic sextant biopsy and fine needle aspiration cytology each diagnose prostate cancer in about 5% of asymptomatic men who have normal digital rectal examination and serum prostate specific antigen less than 4.0 ng./ml. However, many of the cancers thus detected are insignificant and most of the significant cancers are missed. Therefore, routine screening of such patients with sextant biopsy or aspiration cytology does not appear to be justified.     

Comparison of transrectal fine-needle aspiration cytology and core needle biopsy in diagnosis of prostate cancer

One hundred sixty-nine transrectal fine-needle aspirations of the prostate gland were performed in 166 patients over a two-year period. The results were compared with simultaneous core needle biopsy performed in all but 4 patients. Forty-seven (28%) aspirations were either unsatisfactory or inconclusive. Of the remaining 122 (72%) patients in whom a cytologic diagnosis could be made, core biopsy was available in 120. Aspiration cytology was 87 percent sensitive and 96 percent specific with an overall agreement of 93 percent with core biopsy. No major complications occurred. We conclude that fine-needle aspiration of the prostate is accurate, safe, and cost-effective, and greater application of this technique is encouraged.     

Core biopsy instrument in the diagnosis of prostate cancer: superior accuracy to fine needle aspiration

The recent availability of an automated core biopsy gun has made the performance of core biopsies of the prostate easier and better tolerated. A prospective study was conducted to compare the efficacy of fine needle aspiration to core biopsy with the gun. Among 94 patients subjected to both biopsy techniques at the same visit 30 (32%) had a positive diagnosis of prostate cancer. Core biopsy was positive in these 30 patients (100%), while fine needle aspiration was positive in 21 (70%). This study suggests that core biopsy with the gun is superior to fine needle aspiration in the diagnosis of prostate cancer.     

Transrectal ultrasonography in the diagnosis and staging of carcinoma of the prostate

Transrectal prostatic ultrasonography is a potentially valuable means to evaluate the prostate of men with suspected carcinoma. We studied 118 patients with this modality before histological evaluation of the prostate (20 underwent radical prostatectomy, 75 core needle biopsy and aspiration cytology, and 23 transurethral resection of the prostate). Transrectal ultrasonography was more efficient than digital rectal examination in the staging of carcinoma of the prostate before radical prostatectomy. The value of transrectal ultrasonography in the diagnosis of prostatic cancer in men with an abnormal-feeling prostate on digital rectal examination is less certain, since 10 of 75 patients (13 per cent) in this group had a falsely positive scan. The predictive value of a scan positive for malignancy was 37 per cent. Further refinements in the technique of transrectal prostatic ultrasonography are needed to realize fully the diagnostic potential of this imaging modality.     

���١�Vater������Χ������ȷ�﷽��224���ٴ�����

目的 探讨胰腺、Vater壶腹周围癌术中确诊方法。方法 对224例胰腺、Vater壶腹周围癌术中确诊方法进行回顾性分析。结果 行穿刺细胞学,穿刺组织学活检166例,阳性134例（80.7%);切取肿瘤组织活检65例,阳性60%（92.3%);切取肝转移灶活检26例,全部阳性;淋巴结活检32例,阳性18例（56.2%);胆汁细胞学检查10例,阳性4例（40%）;刮取胆总管肿瘤组织活检8例,阳性5例（62.5%);术中胆道镜活检7例,阳性5例（71.4%)。结论 穿刺细胞学,组织学活检是胰腺、Vater壶腹周围癌术中确诊首选方法,根据肿瘤部位、生长方式等采取相应方法可达确诊目的。     

Aspiration biopsy of prostate

Needle biopsy of the prostate has been widely practiced for more than twenty-five years, whereas transrectal aspiration biopsy, first described fifty years ago, has not. We describe our experience using the transrectal aspiration biopsy and correlate the results with histologic studies of the prostate obtained by conventional needle biopsy and surgical specimens. Aspiration needle biopsy of the prostate has a high degree of diagnostic accuracy, it causes minimal inconvenience and discomfort, the results are rapidly available, the ease of entering the suspected area in the prostate is more precise than with conventional needle biopsy, and sampling of prostate can be greater. The disadvantages of aspiration biopsy are that the technique, being unfamiliar to most urologists, must be learned and requires an experienced cytologist for interpretation. Cytologic evaluation by aspiration biopsy and the histologic diagnosis by conventional needle biopsy are complementary.     

The complementary role of fine needle aspiration cytology and Tru-cut needle biopsy in the management of breast masses

Fine needle aspiration cytology (FNA) and Tru-cut needle biopsy (TNB) have been used for the pre-operative diagnosis of cancer in breast masses as alternatives to open breast biopsy. The accuracy of clinical examination, fine needle aspiration biopsy and Tru-cut needle biopsy was assessed in 230 patients with palpable breast masses and the value of using both biopsy methods in the management was prospectively evaluated. Clinical diagnosis had a sensitivity of 89.2% and specificity of 78.4% (32.7% false positive, 6.5% false negative). Aspiration cytology was diagnostic in 78.4% of cancers and 71.6% of benign lesions [excluding non-diagnostic samples (27.4%), sensitivity was 96.6% and specificity was 100%]. Tru-cut needle biopsy identified 82.9% of cancers and 61.7% of benign lesions [excluding non-diagnostic samples (33.3%), sensitivity was 96.7% and specificity was 100%]. There were no false positive errors with either aspiration cytology or needle biopsy. Statistical comparison showed that there was no significant difference between aspiration cytology and needle biopsy. The combined result of both biopsies was superior to clinical examination when non-diagnostic samples were excluded. With the routine use of both biopsy techniques, frozen section was avoided in 73% of all cancers and unnecessary operations were avoided in 33.5% of patients which included breast cysts, benign mammary dysplasia and inflammatory lesions.     

A comparison of fine needle aspiration and core biopsy in diagnosis and preoperative grading of prostate cancer

Fine needle aspiration biopsy has been documented to be safe and accurate for the diagnosis of prostate cancer. A study was done based on 3 objectives to determine 1) whether performing core biopsies and fine needle aspiration in each patient with a prostate nodule increases the detection rate of prostate cancer, 2) the accuracy of preoperative grading by fine needle aspiration in predicting the final pathological grade in radical prostatectomy specimens and 3) the usefulness of fine needle aspiration in screening for unsuspected stage A prostate cancer. Of 203 consecutive patients undergoing prostate biopsies core and fine needle aspiration biopsies were performed in 121. An additional 58 patients underwent prostate biopsies just before transurethral resection of the prostate and 24 underwent radical prostatectomy. The diagnostic accuracy of fine needle aspiration was superior to that of core biopsy (82 versus 74 per cent). Performance of both biopsies yielded a higher percentage of positive diagnoses than either biopsy alone (32.2 per cent versus 24 and 28 per cent). Except in poorly differentiated cancers, fine needle aspiration is a poor predictor of final pathological grade. Fine needle aspiration is not useful in detecting stage A1 prostate cancer. Although fine needle aspiration has several distinct advantages over core biopsies, there is a definite learning curve before its use can be fully exploited. It is important to have an experienced pathologist and to perform both biopsies at each center until sufficient experience is accumulated.     

经直肠超声引导穿刺活检诊断早期前列腺癌漏诊原因的分析

目的:分析经直肠超声(TRUS)引导下穿刺活检诊断前列腺癌的漏诊原因,减少漏诊率,提高诊断率。方法:80例疑似前列腺癌的良性前列腺增生(BPH)患者行TRUS引导下穿刺活检,结果均为阴性,均行前列腺电切术(TURP),术后标本行病理检查。结果:25例术后病理报告为前列腺癌,漏诊率31.25%(25/80)。其中10例行经会阴前列腺癌根治术、8例行手术去势、7例行药物去势。结论:TRUS引导穿刺活检诊断前列腺癌存在一定的漏诊,多次或多点穿刺活检可以减少漏诊率。     

Aspiration cytology is superior to Tru-Cut needle biopsy in establishing the diagnosis of clinically suspicious breast masses.

Eighty-one consecutive patients with breast masses clinically suspicious for malignancy were evaluated prospectively. There were 31 benign lesions and 50 malignancies. Clinical diagnosis was correct in 85% (2.5% false negative, 12.5% false positive). Mammography was diagnostic in 52.8% (31.5% false negative, 15.7% false positive). Needle biopsy was accurate in 78.9% (21.1% false negative, 0% false positive). Aspiration cytology was diagnostic in 96.2% (3.8% false negative, 0% false positive). Statistical comparison of all four tests revealed that aspiration cytology was slightly more accurate than physical examination for all lesions (p = 0.07), but significantly more accurate for benign lesions (p = 0.005). Overall, aspiration cytology was significantly more accurate than mammography (p = 0.000001) and needle biopsy (p = 0.008). Only one minor complication, a superficial infection, occurred with aspiration cytology and needle biopsy. Thin-needle aspiration cytology is a benign procedure that appears to be superior to physical examination, mammography, and needle biopsy in establishing the diagnosis of clinically suspicious breast masses.     

Usefulness of fine needle aspiration cytology in the diagnosis of prostatic carcinoma

Eighty-six cases of cytological diagnosis of the prostate by fine needle aspiration performed between January, 1986 and December, 1987 were reviewed. Twenty patients were diagnosed as positive cytology in prostate (malignant: class V, suspicious: class IV or atypical: class III) and were admitted and further evaluated with conventional needle biopsy followed by histological diagnosis. Then, 18 of them were diagnosed with prostatic carcinoma. False positive rate and false negative rate of this aspiration cytology were 10% and 3.0%, respectively. There was only one minor complication (fever onset) (1.2%) following this procedure. These results indicate that fine needle aspiration cytology of the prostate gland is an easily performed, diagnostically reliable outpatient procedure with minimal complications.     

Replace fine needle aspiration cytology with automated core biopsy in the triple assessment of breast cancer

All patients presenting with a symptomatic breast lump are assessed by means of triple assessment (clinical examination, radiology in the form of mammography and cytology by means of a fine needle aspiration) performed by the clinician in the rapid access breast clinic at the Royal Gwent Hospital, Newport, UK. In our initial experience, it was found that a significant number of patients were returning to clinic for the results of the triple assessment to find that the cytology was not conclusive and hence needed a core biopsy, thus delaying diagnosis and definitive treatment. Therefore, a prospective study was carried out over a 6-month period, where all patients presenting with a symptomatic lump with a clinical or radiological suspicion of breast cancer had, in addition to the standard triple assessment, an automated core biopsy, thus giving rise to the quadruple assessment of the breast lump. A total of 52 patients with a clinical or radiological suspicion of breast cancer were included over this 6-month period. Of these 52 patients, 31 had a definitive diagnosis of breast cancer on fine needle aspiration (sensitivity 60%) compared with 50 of the 52 patients on core biopsy (sensitivity 96%). When radiology was diagnostic of breast cancer (R 5), the sensitivity of cytology was 61% compared with 97% with core biopsy. However, when radiology was not diagnostic of cancer (R 1-4), the sensitivity of cytology fell to 53% while the sensitivity of core biopsy remained high at 95%. The overall cellularity rate for cytology was 96%, which exceeds the BASO requirement for fine needle aspiration cytology. From these results, we conclude that automated core biopsy has a superior diagnostic power when compared with fine needle aspiration cytology and hence should replace fine needle aspiration cytology in the assessment of symptomatic breast lumps.     

Transrectal needle aspiration versus transperineal needle biopsy in diagnosis of carcinoma of prostate

Transrectal needle aspiration of the prostate was compared to transperineal biopsy in 28 patients with suspected carcinoma of the prostate. This technique was found to have a high sensitivity and specificity for diagnosing carcinoma of the prostate, and no complications were seen. The addition of Nuclear Flow DNA analysis may give further prognostic information from needle aspiration and core biopsy specimens. Transrectal needle aspiration of the prostate is a safe, inexpensive, and accurate method of diagnosing carcinoma of the prostate.     

The Use of Stereotaxic Core Biopsy and Stereotaxic Aspiration Biopsy as Diagnostic Tools in the Evaluation of Mammary Calcification

We compared stereotaxic fine needle aspiration biopsy (SFNA) with stereotaxic core needle biopsy (SCB) in the evaluation of radiographically clustered mammary microcalcification, a common finding at screening mammography. Over a 4-year period, 181 specimens were obtained from 175 patients who underwent both SFNA and SCB of clustered microcalcification. Aspiration and core biopsies were performed by radiologists at a community-based diagnostic radiology facility. All aspiration smears were air dried, stained on site, and assessed for adequacy by the radiologists, then sent to the cytopathologists at New York University for interpretation. Core biopsy specimens were formalin fixed, paraffin embedded, hematoxylin and eosin stained, and interpreted by surgical pathologists at a community hospital. Of 181 SFNA specimens, 133 (74%) were benign, 18 (10%) were atypical, 13 (7%) were suspicious, and 16 (9%) were malignant. One (0.5%) aspiration biopsy was nondiagnostic. Excisional biopsies were performed after 12 benign SFNAs and in 46 of the 47 cases with an atypical, suspicious, or malignant diagnosis on SFNA. Mammographic follow-up in 111 of the 133 cases (92%) diagnosed as benign showed no radiologic change (mean 29.2 months, range 6-60 months). The false-negative rate for cancer was 4% (6 cases) for SFNA alone. There were no false-positive diagnoses for SFNA. There was one false-positive diagnosis on core biopsy [focal cribriform ductal carcinoma in situ (DCIS)], which at excisional biopsy and correlation with the core biopsy was diagnosed as ductal hyperplasia; the false-negative rate for cancer was 8% (13 cases) for SCB alone. Aspiration biopsy identified calcification in 180 procedures, core needle biopsy revealed calcification in 170. SFNA was superior to SCB for the confirmation of clustered mammary microcalcification (99% versus 94%) and in the identification of cancer associated with microcalcification (false negative rate of 4% versus 8%). Patients with benign findings on stereotaxic aspiration and core biopsy can reasonably be followed mammographically.