采用BioPince^TM活检针在CT引导下肺穿刺活检的诊断价值与安全性

目的：探讨应用BioPince^TM活检针在CT引导下肺穿刺活检的诊断准确性和安全性．方法：对痰细胞学阴性、纤支镜不能确诊的42例肺部外周性病变患者，在胸部CT扫描定位下，应用BioPince^TM 18G活检针经皮肺穿刺活检取材，行病理学诊断．结果：42例患者共行穿刺43次，阳性39例(92．8％)，阴性3例(7．2％)，其恶性病变诊断率96．3％(26／27)，良性病变诊断率86．7％(13／15)．术后少量咯血2例，少量气胸1例．结论：应用BioPince^TM活检针在CT引导下经皮肺活检是一种安全、有效的检查手段，对肺部周围性病变具有较高的诊断价值．     

超声引导下穿刺活检在乳腺疾病中的临床应用

目的探讨超声引导下穿刺活检在乳腺疾病中的临床应用价值。方法63例（64个病灶）乳腺病变患者，年龄31～71岁，平均年龄43岁。其中61例乳腺病变，2例腋窝病变。可触及乳腺包块49例，未扪及明确包块12例。回顾性分析超声引导下穿刺活检的病理学检查结果．并与手术后病理学检查结果及门诊随访结果对照．计算准确率。结果恶性肿瘤31例，良性肿瘤32例，诊断准确率98．4％。假阴性1例。63例中12例触诊阴性，其中3例为恶性。结论对触及或不可触及的乳腺病变．在超声引导下穿刺活检能在术前明确诊断，为外科手术方式、治疗措施的确定提供有价值的诊断依据。     

经纤维支气管镜肺活检失败后超声、CT引导下经皮穿刺肺活检的临床分析

目的比较经纤维支气管镜肺活检失败后超声与CT引导下经皮穿刺肺活检诊断肺部肿块的正确率、安全性及可操作性。方法选择肺部占位性病变患者共382例，经纤维支气管镜肺活检诊断明确154例，余228例分为2组，进一步行经皮穿刺肺活检。其中超声引导组125例（病灶贴近胸膜且与胸壁之间无肺组织），CT引导组103例（病灶位于肺内、超声不能探及）。比较其正确率、安全性及可操作性。结果经纤维支气管镜肺活检和超声、CT引导下经皮穿刺肺活检诊断肺部肿块正确率分别为40-3％、89．6％、90．3％。并发症：超声、CT引导下经皮穿刺肺活检痰中带血发生率分别为8．0％、8．7％；CT引导组气胸发生率为24.3％，B超引导组未发生气胸。结论对于贴近胸膜且与胸壁之间无肺组织的肺部肿块，首选超声引导经皮穿刺肺活检；反之，则选择CT引导经皮穿刺肺活检。     

B超引导下胸膜活检术对胸腔积液病因诊断中的应用价值

目的探讨B型超声引导下胸膜活检在疑恶性胸腔积液病因诊断中的价值。方法选常规胸膜活检A组40例,B超引导下胸膜活检患者40例为B组,活检后的标本送病理检查。结果A组患者病理确诊率65％（26／40）,未检出者有14例,阴性率为35％（14／40）;两组比较,P〈0．05,具有统计学意义。B组患者活检病理确诊为肿瘤34例,3例确诊为结核,总检出率为92．5％（37／40）,未检出者有3例,阴性率7．5％（3／40）。结论胸腔积液病因诊断用B型超声引导下胸腔活检术优于常规胸膜活检术,能提高确诊率和检出率,其方法简单、安全、实用性强,值得推广使用。     

CT引导下腹膜活检对不明原因腹水的诊断价值

目的：探讨CT引导下经皮腹膜穿刺活检对原因不明腹水的诊断价值 方法：在CT引导下对不明原因腹水患者增厚的腹膜穿刺活检并行病理组织学检查。6例患者共行7次穿刺，每次取2-3块腹膜壁层组织。结果：6例中经活检明确腹水原因，其中经病理证实结核性腹膜炎3例，转移性腺癌2例；另1例无明确意义（大致正常腹膜组织）。结论：经皮腹膜穿刺活检对不明原因腹水的诊断，特别是对结核性腹膜炎和腹膜肿瘤的鉴别诊断具有重要的价值。     

彩超引导下经皮肺穿刺活检术在肺周围型病变的应用研究

探讨彩超引导下经皮穿刺活检在周围型肺病变的价值及影响因素。回顾分析55例彩超引导下经皮穿刺周围型肺病变患者的病理结果,发现活检作出病理诊断患者51例,穿刺活检有效率为92.72%（51/55）,穿刺并发症发病率为3.62%（2/55）。实时彩超引导下经皮肺穿刺活检术在肺周围型病变诊断中具有显著的临床应用价值。     

超声引导下乳腺穿刺活检的临床应用

目的：研究超声引导下乳腺穿刺活检的临床应用性。方法选取2013年2月~2014年6月来我院就诊的300例乳腺病变患者,年龄37~71岁,平均年龄为(43±1.5)岁。在300例患者中4例腋窝病变,乳腺病变296例。未明确包块患者12例,可触及乳腺包块288例。对300例患者进行回顾性分析超声引导下乳腺穿刺活检的病理学检查结果,与手术后活检病理诊断结果进行对照比较,确定超声引导下乳腺穿刺活检的准确率。结果良性病变80例,恶性肿瘤208例,良性肿瘤12例,诊断的准确率高达98.8%。300例患者中有4例为恶性,23例为可触阴性。结论超声引导下乳腺穿刺活检安全可靠,在乳腺疾病手术可以通过超声引导穿刺活检明确的诊断其病变的机理,在早期的诊断、外科手术方式与治疗方法的确定提供有价值的临床诊断依据。     

550例经直肠超声引导下前列腺穿刺活检的临床总结

目的　通过回顾性总结经直肠超声引导下前列腺穿刺活检技术旨在评价该方法的临床应用价值 ;方法　疑前列腺癌 (PCA)的患者行经直肠超声引导下前列腺穿刺活检 ,共计 5 5 0例 ,其中 2 6 1例直肠指检 (DRE)发现前列腺结节 ,2 6 8例PSA >10g/ml,最高达 36 0g/L ;结果　在本组资料中 ,有PCA 189例 ,占 34 36 % ,前列腺肉瘤 4例 ,恶性纤维瘤1例 ,良性前列腺增生 2 6 6例 ,前列腺上皮内肿瘤 4 4例 ,鳞状上皮化生 2例 ,不典型增生 2例 ,前列腺炎症 32例 ,非特异性肉芽肿性前列腺炎 6例 ,前列腺结核 4例 ;结论　经直肠超声引导下前列腺穿刺活检是一种安全的检查方法 ,有助于前列腺疾病的诊断和鉴别     

CT引导下经皮穿刺活检术的临床应用

目的探讨CT引导下采用Cook公司生产的REF型活检枪经皮肺穿刺活检的临床应用价值。方法回顾性分析32例CT定位引导下经皮穿刺活检。结果穿刺成功率100%,病理诊断正确率93.6%,术后并发症发生率12.5%。结论采用CT引导经皮穿刺活检术,对肺内病灶进行定性诊断具有定位准确、定性诊断正确率高、并发症少等优点,是临床不可缺少的检查诊断方法之一。     

CT引导下经皮穿刺活检术的临床应用

目的 探讨CT引导下采用Cook公司生产的REF型活检枪经皮肺穿刺活检的临床应用价值.方法 回顾性分析32例CT定位引导下经皮穿刺活检.结果 穿刺成功率100%,病理诊断正确率93.6%,术后并发症发生率12.5%.结论 采用CT引导经皮穿刺活检术,对肺内病灶进行定性诊断具有定位准确、定性诊断正确率高、并发症少等优点,是临床不可缺少的检查诊断方法之一.     

超声引导下经皮肺自动穿刺活检的临床应用

目的通过超声引导下经皮肺自动穿刺活检对肺及胸膜肿块作出病理诊断,为早期诊断肺及胸膜肿块提供可靠依据方法对３０例经Ｘ线及ＣＴ诊断为肺部外周型肿块或怀疑结核或炎症但临床高度怀疑癌变或胸膜病变,需进一步明确诊断者,在超块引导下经皮用自动穿刺活检针进行穿刺活检及病理检查．结果全部获得病理学诊断．其中良性病变１１例（占３６７％）,恶性病变１９例（占６３．３％）结论对于胸膜病变及贴近胸壁的肺占位病变,经皮肺自动穿刺活检是一种良好方法．     

81例CT引导下经皮肺穿刺活检标本临床病理结果

目的:分析CT引导下经皮肺穿刺活检标本的临床病理学及免疫组织化学诊断,结合血清肿瘤标志物检测探讨其对肺部占位性病变的诊断价值.方法:回顾性分析81例肺部占位性病变患者CT引导下肺穿刺活检标本病理学、25例免疫组织化学诊断及73例血清肿瘤标志物癌胚抗原(carcinoembryonic antigen,CEA),细胞角蛋白19片段(cytokeratin-19-fragment,CYFRA21-1),神经元特异性烯醇化酶(neuron-specific enolase,NSE)检测结果.结果:81例CT引导下肺穿刺活检标本组织病理学诊断率为96.3％,其中恶性病变53例(腺癌29例,鳞癌20例,小细胞癌1例,未明确类型的非小细胞肺癌1例,其他类型肺癌1例,胸腺恶性肿瘤1例);良性病变25例(炎性包块7例,结核5例,肺炎7例,硅沉着病3例,炎性假瘤2例,神经鞘瘤1例);25例行免疫组织化学检查的病例中诊断恶性肿瘤24例(腺癌13例,鳞癌8例,小细胞癌1例,未确定分型2例),其中P63及CK5/6在鳞癌阳性率为87.5％,TTF-1及CK-7在腺癌阳性率为69.2％和76.9％,差异有统计学意义(P＜0.05);CEA,CYF RA21-1,NSE及3项联合对肺癌诊断的灵敏度分别为54.9％,68.6％,37.3％,80.4％.结论:CT引导下经皮肺穿刺活检标本病理诊断阳性率高,结合免疫组织化学及血清肿瘤标志物联合检测可为肺癌的诊断及病理分型提供辅助性参考依据.     

Fine‐needle aspiration of soft tissue myoepithelioma

Soft tissue myoepithelioma is a rare neoplasm composed of myoepithelial cells. We describe the cytologic features of a soft tissue myoepithelioma arising in the right lower chest wall in a 65‐year‐old woman. The fine‐needle aspiration (FNA) smears showed round to oval, spindle, epithelioid, and plasmacytoid cells in the myxoid background. The nuclei were uniform, round to ovoid, with finely distributed chromatin and eosinophilic or pale cytoplasm, and resembled lobular carcinoma of breast. Ultrasound guided core biopsy showed the tumor cells had bland cytologic features, arranged in small cords, nests, and dissociated single cells, with no glandular differentiation or breast tissue seen. The tumor cells demonstrated immunoreactivity for cytokeratin (AE1/AE3) and glial fibrillary acidic protein, but were negative for estrogen receptor. Fluorescence in situ hybridization demonstrated the EWSR1 rearrangement, confirming the diagnosis of myoepithelioma. Diagn. Cytopathol. 2016;44:152–155. © 2015 Wiley Periodicals, Inc.     

超声彩色多普勒诊断胸壁结核的临床研究

目的 探讨超声在胸壁结核诊断中的临床价值.方法 超声诊断134例胸壁结核并与CT、X线诊断结果进行相关性对比研究.结果 实性回声型27例,液性暗区型42例,混合回声型65例.超声诊断病灶内钙化及“蟹足样”窦道与CT检查结果比较,其差异有统计学意义(P＜0.05).超声与CT诊断胸壁结核的特异性分别为95.52％和93.28％,其差异无统计学意义(P＞0.05).结论 超声诊断胸壁结核具有临床价值,可确定胸壁结核大小、范围及与周围组织的关系,是临床确诊胸壁结核的有效方法.     

Lobular breast carcinoma metastasis to skeletal muscle,two case reports diagnosed by ultrasound guided FNA with evaluation of the roles of interventional cytopathology

Skeletal muscle metastasis from breast carcinoma is a relatively rare clinical entity. We report two cases of breast cancer metastatic to the skeletal muscle, diagnosed by ultrasound guided fine needle aspiration (US‐FNA) biopsy done by interventional cytopathologists at an outpatient cytopathology center. Our two patients presented with lower anterior neck firmness and chest wall mass, respectively. Ultrasound evaluation of our first case demonstrated hypo‐echoic thickened anterior strap muscles while in the second case there was significant distortion of the anatomy from previous surgeries. It was necessary to proceed with FNA biopsy even when their ultrasound findings were equivocal, to establish a definite rapid diagnosis. The immediate onsite evaluation findings were suggestive of malignancy in both cases with subsequent core biopsy confirming the diagnosis of metastatic breast carcinoma. In cytopathology, point‐of‐care (POC) ultrasound is used as an adjunct tool that offers visual guidance during FNA of nonpalpable masses and enables sampling of lesional “hot” spots to ensure specimen adequacy. Studies have demonstrated a reduction in FNA nondiagnostic rates with the use of ultrasound‐guidance consequently reducing health care costs associated with nondiagnostic FNAs. US‐FNA also provides adequate samples for cell block preparations. Metastatic lobular carcinoma of the breast has a wide range of clinical presentations and a high level of suspicion is advised. Cytopathologists‐performed US‐FNA is a proven, less‐invasive, cost‐effective tool that provides timely cytologic diagnosis.     

胃肠道肿瘤诊断中彩色多普勒超声的应用价值

目的了解彩色多普勒超声在诊断胃肠道肿瘤中的应用价值，提高术前正确诊断率。方法临床彩色多普勒超声所见腹腔或盆腔占位，后经手术或超声引导下活检病理诊断进一步证实。结果临床彩超所见腹腔或盆腔占位，后经手术或超声引导下活检病理证实来源为胃、小肠或结肠良恶性肿瘤27例，其中小肠及胃平滑肌肉瘤各3例，空结肠恶性间质瘤5例，胃及结肠腺癌14例，胃淋巴瘤2例。27例病人中26例行纤维内窥镜检查，15例病理活检为恶性肿瘤（15／27），1例病理回报炎症（1／27），10例未见明显占位（10／27）。结论临床彩超在诊断腹腔或盆腔占位中的价值应得到临床医师的重视，在某些病例中甚至优于经典的纤维内窥镜和钡餐及气钡剂双重造影。     

Fine-needle aspiration cytology of hemangiopericytoma: report of two cases

The fine-needle aspiration biopsy (FNAB) findings in two cases of hemangiopericytoma (HP), arising in the parotid gland and on the inner chest wall, respectively, are reported. Smear preparations in each case showed cytologic features of an undifferentiated spindle-cell neoplasm, whereas a core needle biopsy specimen of the chest wall mass showed a spindle-cell tumor with a "staghorn-like" arrangement of endothelium-lined vascular channels. Immunostains performed on this core biopsy, and on the surgical resection specimens in both cases, showed positive staining of tumor cells for vimentin and CD34, with negative staining for a variety of smooth muscle, epithelial, neural, and neuroendocrine markers. Electron microscopy performed in one case further supported the diagnosis of HP. With adequate sampling and appropriate use of ancillary studies, a diagnosis of HP can be reliably suggested on the basis of FNAB and core biopsy of a soft-tissue mass.     

Electromagnetic navigation bronchoscopy‐guided fine needle aspiration for the diagnosis of lung lesions

Many peripheral lung lesions are beyond the reach of conventional bronchoscopes, and require percutaneous CT‐guided or open surgical biopsy, which carry increased risks to the patient. Electromagnetic navigation bronchoscopy (ENB) is a relatively new technique, which uses an image guided localization system to direct steerable bronchoscopic tools to predetermined points within the bronchial tree. This technology allows improved access to peripheral lesions in particular. We investigated the sensitivity and specificity of ENB‐guided fine needle aspiration (FNA) in the diagnosis of lung lesions. All ENB‐guided FNAs performed at one institution were included in the study. The superDimension i‐Logic System? was used in all cases. Pathologic reports of the ENB‐guided FNAs, as well as all other pulmonary sampling performed simultaneously with the FNA and within 1 year of the ENB‐guided FNA were reviewed. Patients with a positive ENB‐guided FNA or malignancy within the same lobe within the follow‐up period were considered positive for malignancy. Patients with an atypical diagnosis but no definitive malignancy were considered negative for malignancy for statistical purposes. Ninety‐one patients underwent 95 ENB‐guided FNAs over a 3‐year period. Thirty‐five patients (38%) were positive for malignancy. ENB‐guided FNA had a sensitivity of 63% for the detection of malignancy. The sensitivity for the detection of malignancy using all ENB‐guided sampling methods, including FNA, bronchoscopic biopsy, and bronchial brushing was 83%. Pathologists and cytotechnologists should be aware of ENB‐guided FNA as an emerging technology with a relatively high sensitivity for the diagnosis of peripheral lung lesions. Diagn. Cytopathol. 2014;42:1045–1050. © 2014 Wiley Periodicals, Inc.     

乳腺原发性血管肉瘤的临床及病理学特征

目的探讨乳腺原发性血管肉瘤的临床及病理特点。方法复习5例乳腺原发性血管肉瘤切片,依据2003年WHO乳腺肿瘤组织学分类标准诊断和分级。采用第Ⅷ因子相关抗原、CD31、CD34、雌激素受体（ER）、孕激素受体（PR）、细胞角蛋白（cK）及c-erbB-2等抗体进行免疫组织化学SP法染色观察。结果5例患者均以乳腺无痛性肿块为首发症状,术前B超、钼靶检查缺乏特异性诊断。组织学呈多样性表现是乳腺血管肉瘤组织学形态特点。免疫组织化学染色显示,5例血管内皮相关抗原均呈阳性表达,ER、PR、CK及c—erbB-2均阴性。结论乳腺原发性血管肉瘤非常罕见,临床表现缺乏特异性,病理形态多样,诊断困难,血管内皮相关抗原均呈阳性表达对确诊有帮助。     

鼻腔鼻窦畸胎癌肉瘤的病理特征及其诊断

目的探讨鼻腔鼻窦畸胎癌肉瘤的临床病理学特征及诊断和鉴别诊断。方法对5例经病理证实的鼻腔鼻窦畸胎癌肉瘤的临床、放射影像学和病理学资料作回顾性分析,对标本行免疫组织化学染色（EnVision法）,并对所有病例进行了随访。结果患者5例,均为男性,年龄34—43岁,平均39岁。临床表现主要为单侧鼻腔堵塞、涕中带血和头痛,检查发现鼻腔充满新生物,表面光滑,有蒂,触之易出血;放射影像学均为局部占位,密度均匀,未见明显的囊性变、钙质沉着和骨化。病理检查：肿瘤多为碎组织,质地中等偏嫩,镜下观察肿瘤常由3个胚层的组织构成,外胚层的鳞状上皮团、中胚层瘤样增生的平滑肌纤维、软骨和骨组织及内胚层的富有黏液细胞的纤毛柱状上皮及排列成腺管样结构的消化道、呼吸道上皮,其中未成熟的神经上皮细胞、胞质透明的鳞状细胞团、梭形细胞肉瘤和腺癌成分最具诊断价值。免疫组织化学染色,不同胚层的组织对应相应的免疫标记,细胞角蛋白、上皮细胞膜抗原标记外胚层的复层鳞状上皮、内胚层的消化道和呼吸道上皮,波形蛋白、平滑肌肌动蛋白等标记梭形细胞肉瘤区域和平滑肌等组织,S-100蛋白、神经元特异性烯醇化酶、突触素等标记未成熟的神经上皮组织,且nestin阳性,CD99标记较为原始小细胞。5例患者首次病理诊断分别为毛细血管瘤、嗅神经上皮瘤、嗅神经母细胞瘤、颅咽管瘤及恶性混合瘤。随访结果：2例复发,1例颈部转移。结论鼻腔鼻窦畸胎癌肉瘤是一种由3胚层组成,具有畸胎瘤和癌肉瘤特征的罕见恶性肿瘤,具有特征性的组织病理学和免疫组织化学染色特点,应多取材多切片,以免误诊和漏诊。