舌癌的超声诊断研究

目的：探讨超声诊断舌癌的临床应用价值。方法：采用高频超声经皮舌骨上区舌检查法诊断舌占位性病变和舌癌患者85例,并行术后随访观察。其中51例原发性舌癌超声检查（US）与核磁共振检查（MR）、临床检查及病理检查结果进行对照。结果：原发性舌癌超声显示率为98．0％,诊断准确率为92．2％。术前原发性舌癌超声、MR和临床检查T分期诊断准确率分别为90．2％、90．0％和80．4％。结论舌癌超声诊断法对舌癌术前分期诊断和术后随访均具有重要的临床应用价值。     

正常下肢静脉的二维彩色多普勒血流显像检查

目的：确定正常下肢静脉的超声特征。方法：对正常人３０例６０条下肢静脉进行了二维彩色多普勒血流显像（２Ｄ－ＣＤＦＩ）检查。结果：２Ｄ－ＣＤＦＩ可迅速清晰地显示下肢静脉的解剖图像,６５％可检出１～３个静脉瓣。正常静脉回流通畅,静脉瓣存在生理性返流。７２０个静脉节段的生理性返流时间为０．２３±０．１４ｓ,９５％正常上限值为０．５ｓ。结论：正常下肢静脉的超声检查,为下肢静脉疾病的诊断提供了理论依据     

TNM staging of gastrointestinal tumors by hydrosonography: results of a histopathologically controlled study in 60 patients

Background: The study is a prospective evaluation of preoperative TNM staging of gastrointestinal tumors by hydrosonography (HUS). Methods: Sixty patients with suspected gastric or colorectal cancer underwent HUS for TNM staging. All patients were operated on and the tumors completely removed when possible. HUS findings were correlated with histopathologic staging. Results: HUS correctly localized tumors in 75% of patients. T stage accuracy was low for gastric cancers (41%). N staging of gastric cancers was accurate in 68% of all cases and was highly specific (100%). Staging was more accurate for colorectal tumors (70%), especially with respect to infiltration of other structures (sensitivity 100%, specificity 95%). N staging, however, was not reliable, mostly owing to impaired examination conditions. Conclusion: HUS easily misses tumors of the gastric cardia and distal part of the rectum. T staging of colorectal tumors with HUS is highly accurate, reaching 92% if the tumor is localized. T1 cancers of the stomach tend to be overstaged, and serosal infiltration by gastric cancers is often misjudged. With the exception of cardial gastric and distal rectal cancers, HUS comes close to endosonography for staging gastrointestinal tumors. HUS does not require intraluminal access. Received: 9 May 1995/Accepted after revision: 15 August 1995     

膀胱移行细胞癌术前CT与病理分期对照分析

目的:探讨膀胱移行细胞癌术前CT分期和术后病理分期诊断的错误原因及改正方法。方法:50例经手术、病理证实的膀胱移行细胞癌患者均行CT平扫和增强扫描。按TNM法分期。结果:术前CT分期结果:T1期13例,T2期17例,T3a期7例,T3b期5例,T4期6例,漏诊1例,无法评估1例。手术及病理分期结果:P1期16例,P2a期22例,P2b期5例,P3期2例,P4期5例。CT分期与病理符合者34例。16例CT分期与病理分期不相符合,其中分期过低者(CT分期低于病理分期)1例;漏诊1例;1例CT不能分期诊断;分期过高者(CT分期高于病理分期)13例。CT分期诊断准确率为82%(41/50)。病理分期诊断准确率为86%(43/50)。结论:CT对T3b期和T4期膀胱癌的分期诊断准确。膀胱癌临床分期需在病理诊断的基础上,充分结合CT等影像资料,综合判断以提高分期诊断的准确率。     

多层螺旋CT后处理技术在下咽癌及喉癌术前评估中的应用

目的探讨多层螺旋CT（MSCT）各种后处理技术在下咽癌和喉癌术前评估中的价值。方法收集45例手术病理证实的下咽癌及喉癌病例,术前行16层螺旋CT检查,并行矢、冠状位多平面重建（MPR）、仿真内镜（CTVE）、表面遮盖显示（SSD）及透明重建（Raysum）等后处理技术,综合对喉癌术前分期进行评估,并与手术病理进行对照。结果16层螺旋CT术前对下咽癌及喉癌TNM分期与临床最终手术病理结果对照,其中T1期符合率为81.2%,T2期为88.9%,T3期为84.6%,T4期为75.0%。总体分期符合率为84.4%。结论下咽癌及喉癌术前MSCT各种后处理技术的综合应用,可明确肿瘤的范围、周围组织受侵及颈部淋巴结转移情况,在下咽癌及喉癌术前评估中具有很高的实用价值。     

Use of transabdominal ultrasonography to preoperatively determine T-stage of proven colon cancers

Purpose: Although noninvasive and highly informative, transabdominal ultrasonography (US) is not yet an accepted means of staging colorectal cancer preoperatively. This prospective study evaluated the diagnostic accuracy of US in preoperative staging of patients with resectable colon cancers. Methods: A total of 98 patients with primary colon cancer diagnosed by colonoscopy at our institute between January, 2011 and June, 2014 underwent preoperative ultrasonographic tumor staging. Depth of tumor infiltration (T-stage) was assessed by standard means (i.e., extent of mural involvement), analyzing agreement in US and histopathology determinations. Results: All but two colon cancers (at splenic flexure) were detected by US (98%, 96/98). Compared with histopathology, overall accuracy of US in determining T-stage was 64% (61/96), indicating moderate reproducibility (κ coefficient 0.48; 95% CI 0.35–0.62; p < 0.001). Using a three-tier approach of graded muscularis propria (MP) involvement (Tis/T1, below MP; T2, within MP; and T3/T4, beyond MP), diagnostic agreement increased to 89% (85/96), with good agreement (κ coefficient 0.77; 95% CI 0.64–0.90; p < 0.001). No tumor characteristics or patient demographics influenced diagnostic agreement at any site in the colon. Conclusions: Given the potential to yield valuable information while limiting patient discomfort, US should be reconsidered as a means of assessing colon cancer.     

扩散加权成像在舌癌术前诊断及分期的应用价值

目的探讨扩散加权成像(DWI)及表观扩散系数(ADC)值在舌癌术前诊断及分期中的应用价值。材料与方法 34例舌癌患者治疗前行常规MRI及DWI检查,其中32例患者行手术治疗。将常规MRI分期、DWI分期与病理分期进行对照,比较两种方法对舌癌分期的准确性的差异。结果 (1)对病灶大小及浸润范围的估计,DWI较常规MRI更准确,有统计学意义(P0.05);(2)DWI序列通过测ADC值诊断53枚淋巴结转移,平均ADC值0.91×10~(–3) mm~2/s,低于非转移淋巴结(1.65×10~(–3) mm~2/s),有统计学意义(P0.01);DWI序列诊断转移性淋巴结的灵敏度89.3%,特异性98.0%,正确度98.8%;常规MRI诊断45枚淋巴结转移,灵敏度71.0%,特异性96.0%,正确度88.9%;对比两种检查方法,无统计学意义;(3)常规MRI序列对6例病例造成过度诊断,正确率为82.0%;DWI将1例IVA期病例过度诊断为IVB期,正确率为97.0%,对比两种检查方法,无统计学意义。结论DWI能准确显示舌癌病灶范围,测量分析ADC值可以为诊断舌癌淋巴结转移提供有效信息,与常规MR联合应用,有助于提高舌癌的术前诊断及分期的准确性。     

螺旋CT扫描在食管癌分期诊断中的价值

目的探讨食管癌螺旋CT的分期诊断价值。方法对196例经病理证实的食管癌患者进行螺旋CT扫描。根据食管癌的浸润程度、周围淋巴结及脏器转移情况进行分期,并与术后病理分期对照。结果螺旋CT对食管癌分期的准确性为72%。结论螺旋CT检查的分期对评估食管癌手术方案及临床治疗有较大的价值。     

MRI在直肠癌术前诊断及分期中的应用

目的评价MRI在直肠癌的术前诊断及临床分期中的应用价值。方法对48例直肠癌病人应用MRI进行TN分期,并与病理结果对照。结果 MRI对直肠癌的诊断率为100%（48/48）。MRI正确T分期39例,错误T分期9例,其中6例T1~T2期报告为T3期,3例T3期报告为T1~T2期。T分期的诊断的总准确率为81.3%（39/48）,其中T1~T2期诊断的准确率为86.3%（19/22）,T3、T4期诊断的准确率分别为66.7%（12/18）、100%（8/8）。经统计分析证实,MRI术前分期与病理分期结果的一致性较好（Kappa=0.696,P〈0.01）;MRI对直肠癌淋巴结正确分期36例,错误分期12例,其中高估6例,低估6例,准确率为75.0%（36/48）,灵敏度为68.4%（13/19）,特异度为79.3%（23/29）,MRI能对直肠癌系膜淋巴结分期做出较准确预测（Kappa=0.573,P〈0.05）。结论 MRI可较准确地评估直肠肿瘤浸润深度和淋巴结转移情况,并作出较准确的直肠癌术前TN分期。     

1.5T磁共振表观弥散系数比值对舌癌的诊断价值

目的:评价舌部病灶与病灶周围正常腺体表观弥散系数(ADC)的比值对于舌癌的诊断、病理分级、分期的应用价值及相关性。方法:收集2017年3月—2019年3月吉林大学中日联谊医院经手术病理证实的60例舌部病变患者的资料,术前行常规MRI及DWI序列扫描,测量瘤体及瘤体周围正常腺体的ADC值并计算出ADC比值,将其与术后病理结果进行对照分析。结果:①舌癌40例,舌良性病灶20例,舌癌对应的ADC比值为-0.13±0.17,舌良性病灶对应的ADC比值为0.09±0.10,二者比值间差异有统计学意义(t=5.129,P<0.05)。②高分化组的ADC比值为0.02±0.07,中分化组的ADC比值为-0.14±0.17,低分化组的ADC比值为-0.26±0.09,三组间比较差异有统计学意义(F=3.593,P=0.047)。③晚期舌癌组(T3+T4)的ADC比值(-0.20±0.13)低于早期舌癌组(Tis+T1+T2)的ADC比值(0.00±0.17)(t=3.314,P=0.03<0.05),T4与T1及T2比较差异有统计学意义(P<0.05),其他两两比较无显著差异(P>0.05)。结论:ADC比值能够为舌良恶性病灶的鉴别诊断以及舌癌的病理分级、分期提供参考依据,具有重要的临床指导意义。     

增强CT在食管癌术前分期及切除可行性临床效果分析

目的:探讨增强CT在食管癌术前分期及切除可行性临床效果。方法:回顾性分析我院2017年7月-2019年10月收治的58例食管癌患者,所有患者均采用术前分期和手术病理检查,对比增强CT在食管癌术前T、N分期的准确性,分析两种方法检查肿瘤浸润及淋巴结转移的一致性。结果:对比病理诊断T1、T2、T3、T4结果,CT增强扫描中与其相符的例数分别为3例、12例、30例和4例,诊断准确性为84.48%。对比病理诊断N0、N1结果,CT增强扫描中与其相符的例数分别为39例、7例,诊断准确性为79.31%。对比病理诊断淋巴结有转移、无转移结果,CT增强扫描中与其相符的例数分别为41例、6例,诊断准确性为81.03%。结论:增强CT在食管癌术前分期及切除可行性临床效果好,临床应用价值较高,值得推广使用。     

Staging bladder carcinoma by three-dimensional ultrasound rendering

Organ-confined staging for bladder cancer has major impact on further treatment. Most imaging techniques for this purpose are insufficient. We, therefore, assessed the value and the limitations of a new diagnostic tool, the 3-D ultrasound (US) rendering, to distinguish invasive from noninvasive bladder cancers. A total of 63 patients underwent 3-D US of the bladder before transurethral resection or radical cystectomy. The US findings were compared with the pathologic stages of the transurethral resection material or the cystectomy specimens. Superficial (pTa) carcinomas were correctly staged in 66% by 3-D US. Lamina propria infiltrating (pT1) were correctly staged in 83% and the quota of correct staging of infiltrating carcinomas (>pT1) by 3-D rendering was 100%. The overall accuracy was 79%. Three-dimensional US rendering is most valuable to discriminate between superficial stages pT1. This new technique might improve staging of bladder cancer.     

舌癌的MRI诊断和分期

本文回顾性分析了23例经病理证实为舌癌的MRI表现并进行了分期,结果表明,MRI能很好的显示舌癌的部位、大小、形态和深部侵犯情况,亦能清楚显示舌癌是否侵犯舌中线、舌根和口咽侧壁等邻近结构。本组病例中,MRI所显示的最小癌灶直径是12.4mm。根据TNM分期方法,本组9例原发舌癌中有4例T1期、2例T2期、6例T3期和7例T4期,MRI的正确分期率是84．2％。     

肾癌免疫细胞浸润模式与生存预后分析

目的 探讨肾癌免疫细胞浸润模式,分析浸润模式与生存预后的相关性,预测患者生存期及肿瘤进展.方法 在肿瘤癌症基因图谱(TCGA)中下载肾癌转录本数据和临床信息数据,运用开源数据包CIBER-SORT反卷积算法计算肾癌22种免疫细胞浸润比例.采用R软件包绘制免疫细胞相关性热图.利用R软件包对肾癌免疫细胞浸润模式与肾癌临床分...     

Three-dimensional endorectal ultrasound using a new freehand software program: results in 35 patients with rectal cancer

BACKGROUND AND STUDY AIMS: This paper describes experience in the staging of rectal cancer using a new software program for three-dimensional endoscopic ultrasonography (EUS) that works without electromagnetic sensors and can be used even with electronic radial or linear rectal probes. MATERIALS AND METHODS: From May 2003 to March 2004, 35 three-dimensional endorectal ultrasound (ERUS) examinations were carried out using this program. The indication for ERUS was local staging of rectal cancer in all cases. The three-dimensional software imaging program forms part of a new ultrasound scanning system (Hitachi 6500 or 8000) and allows reconstruction of the two-dimensional EUS images in six different scans. RESULTS: Thirty-five rectal cancers were assessed using two-dimensional and three-dimensional EUS. Using two-dimensional imaging, it was not possible to assess precisely the degree of involvement of the mesorectum (more or less than 50%). No differences were evident with three-dimensional EUS for superficial tumors (T1 and T2N0), but in six of 15 patients classified as having T3N0 lesions, three-dimensional EUS revealed malignant lymph nodes, a finding that was confirmed surgically in five of the six cases. Three-dimensional EUS also made it possible to assess the degree of infiltration of the mesorectum precisely in all cases, demonstrating complete invasion of the mesorectum in eight cases. These findings were confirmed in all cases by the surgical data. Two-dimensional EUS correctly assessed 25 of the 35 rectal tumors (71.4%) in relation to the T and N classifications, and three-dimensional EUS increased this figure to 31 correct evaluations out of 35 (88.6%). CONCLUSION: Three-dimensional ERUS is easy to carry out using this new software program. There is no need for an external sensor mounted at the tip of the probe, and manipulation of the rectal probe is facilitated. Three-dimensional ERUS can be carried out using linear and radial electronic probes with the same ultrasound equipment. Three-dimensional ERUS allows more precise staging of lesions and better definition of the mesorectal margins, and this has a direct impact on therapeutic decision-making in patients with rectal cancer.     

中晚期宫颈癌介入化疗栓塞后的病理及临床意义

目的探讨中晚期宫颈癌在介入化疗栓塞后病理改变及临床意义。方法20例中晚期宫颈癌患者选择蛭活检确诊为宫颈癌．临床分期Ⅱb-Ⅲa患者20例,进行介入治疗1-3次后观察其临床症状及癌灶的病理变化结果20例宫颈癌中15例Ⅱb期、5例Ⅲa期经1-2次术前介入化疗加检塞。所有Ⅱb期患者及4例Ⅲa期最后均成功施行宫颈癌根治术。1例Ⅲa期因疗效不明显改行放射治疗。所有病例手术后标本后的病理切片中可见大量淋巴细胞漫润及坏死组织。结论中晚期宫颈癌术前介入化疗检塞可缩小并软化宫颈局部癌灶。减少痛灶的出血、改变肿瘤分期并顺利进行手术根治。     

B超在宫颈癌诊断中的临床价值

目的探讨B超在宫颈癌诊断中的临床价值及宫颈癌的声像图表现.方法对51例经手术病理证实为宫颈癌患者的声像图作回顾性分析.结果子宫、宫颈、双侧附件未见异常声像(假阴性)7例;宫颈段异常声像14例;合并宫腔、宫体异常12例;合并宫旁或盆腔异常8例;合并膀胱、直肠、盆腔淋巴结、泌尿系受侵犯10例.51例中术后复发2例.结论 B超在宫颈癌诊断的术前分期、鉴别诊断、术后复发、放疗前后观察等方面起重要辅助作用.     

超声造影对判断膀胱癌浸润程度的价值

目的探讨超声造影方法对膀胱癌分期的价值。方法将53例膀胱癌的超声造影分期和病理分期进行对照,分析超声造影分期的特点和符合率。结果超声造影提示T1期24例,T2和T3期26例,T4期3例;病理分期T1期22例,T2期和T3期28例,T4期3例。超声造影与病理相比,诊断T1、T2和T3及T4的符合率分别是90.31%、92.14%及100%,总符合率为92.24%。结论超声造影作为无创性诊断膀胱癌浸润程度及分期的方法,有较高的可靠性。     

Endoscopic ultrasonography in patients with gastro-esophageal cancer.

For patients with gastro-esophageal cancer ultrasonography (EUS) is superior to any other imaging modality in the assessment of local tumor infiltration and local lymph nodes status. EUS is especially important in the preoperative staging of patients with esophageal cancer and patients with proximal gastric cancer. Here it allows for the identification of those patients with advanced disease who are unlikely to benefit from surgery and in whom a conservative palliative treatment is indicated. In advanced gastric cancer the clinical implications of EUS less clear. Still preoperative EUS is indicated in every patient with cancer of the proximal stomach to assess tumor infiltration in the esophagus. Relatively new is the use of EUS in staging early cancers in order to select patients for local endoscopic treatment. High-frequency miniprobes are the instruments of choice for imaging these lesions. Strict criteria should be applied in the selection of patients for local endoscopic treatment of early gastro-esophageal cancers. EUS guided fine needle aspiration (EUS-FNA) is currently only indicated in patients with esophageal cancer and suspicious celiac lymph nodes. It may become more important if new treatment protocols demand more objective and reliable assessment of lymph node status.     

Rectosigmoid endometriosis: endoscopic ultrasound features and clinical implications

BACKGROUND AND STUDY AIMS: The main area of the gastrointestinal tract affected by deep pelvic endometriosis is the rectosigmoid colon in 3-37% of cases. Due to the risk of infiltration and the clinical symptoms of endometriosis, with pain and infertility, the condition may require surgical resection. Preoperative imaging diagnosis of rectosigmoid involvement is therefore important. Rectal endoscopic ultrasonography (EUS), which is already used for the staging of anorectal carcinoma and submucosal lesions, may be a promising technique for this indication. The present study was conducted in order to describe the endosonographic appearance of rectosigmoid endometriosis, and to define the potential relevance of the technique to the choice of resection method. PATIENTS AND METHODS: Between 1993 and 1997, 46 women (mean age 31) with deep pelvic endometriosis underwent imaging investigations and surgical resection. The clinical and imaging findings, and the surgical and histological features identified--mainly with regard to infiltration of the rectal wall--were compared retrospectively. The impact of the EUS findings on the decision on whether or not to carry out resection, either by laparoscopy or open abdominal surgery, was also examined. RESULTS: When there was deep pelvic endometriosis with suspected rectal wall infiltration, EUS showed normal anatomy in nine patients, endometriotic lesions without rectal wall infiltration in 12, and typical rectal infiltration in 25. The lesions were confirmed by the surgical findings during therapeutic laparoscopy (n = 22) and laparotomy (n = 25), as well as by clinical follow-up. Rectal wall infiltration, demonstrated in all cases using EUS, had initially been suspected on the basis of clinical examinations, rectoscopy, barium enema, computed tomography, and magnetic resonance imaging in 62%, 50%, 33%, 67% and 66% of cases, respectively. CONCLUSIONS: EUS is a simple and noninvasive technique capable of correctly diagnosing rectal wall infiltration in deep pelvic endometriosis. It may be helpful in determining the choice between laparoscopy and laparotomy when complete resection is indicated.