小探头超声内镜对上消化道隆起病变的诊断价值

目的探讨小探头超声内镜在上消化道隆起病变诊断中的应用价值。方法利用超声内镜检查观察分析消化道隆起病变的部位分布情况。结果本文135例患者经小探头超声内镜检查发现其中病变位于食管72例,胃61例,十二指肠2例。按照病变类型进行分类其中平滑肌瘤56例,超声内镜表现为椭圆或梭形,均匀低回声,边界清,有低回声包膜;间质瘤28例,超声内镜表现为低回声,回声可不均匀;囊肿17例,超声内镜表现为无回声,均匀,边界清,压之变形;脂肪瘤9例,超声内镜表现为均质高回声,边界清;异位胰腺8例,超声内镜表现为不均匀中高回声,边界清;外压病变7例,超声内镜表现为来源壁外,胃各层结构完整;息肉5例,超声内镜表现为低回声,来源于黏膜层,管壁各层结构完整;疣状隆起4例,十二指肠布氏腺增生1例。所有患者均经EMR、ESD或手术病理证实,与病理诊断符合率达85.19%。结论小探头超声内镜检查能够显示上消化道隆起病变的起源层次及其与邻近组织结构的关系,并能提示隆起性病变的性质。     

超声引导下乳腺肿块穿刺活检的临床应用

目的：探讨高频超声引导下对乳腺肿块进行经皮穿刺活检的临床价值。方法：对20例乳腺肿块患者采用ALOKA-a5超声诊断仪、7.5-10 MHz高频探头、Bard活检枪对乳腺肿块进行穿刺活检。结果：20例患者均穿刺成功,穿刺成功率100%,获取组织52块。病理检查：良性14例、恶性6例。结论：高频超声引导下穿刺活检,能确定乳腺肿块的病理性质,对指导临床手术和治疗有重要的价值。     

上消化道外压隆起性改变78例诊断分析

常规内镜下难以确诊的上消化道各种外压隆起性改变,有时与消化道管壁黏膜层下占位隆起性病变难以鉴别,而超声内镜和微探头内镜超声检查可以明确占位病变的性质、层次及与消化道管壁的关系。我院内镜中心自2000年8月-2008年6月共进行1200例超声内镜检查,其中确诊上消化道外压性隆起改变78例,约占6．5％,现总结介绍如下。     

食管海绵状淋巴管瘤1例

1病例报告患者女,42岁。因上腹部不适行胃镜检查,发现食管中段隆起性病变,诊断为平滑肌瘤,转来我院进一步诊治。再行胃镜检查,发现食管中段有一约0·7cm×0·7cm半球形隆起,表面光滑,质地软,触之可移动,行胃镜下微探头超声检查,见食管腔内肿物回声不均匀,内有细小低回声及无回声区,起源于黏膜层,部分位于黏膜肌层,细小低密度区为细小管腔,回声密度低于黏膜肌层。行高频电圈套切除,切除后可见局部凹陷,部分黏膜肌层显露。切除标本病理诊断:食管海绵状淋巴管瘤。术后禁食1天,给予抑酸药物治疗,1周后出院。随访1年无复发。2讨论淋巴管瘤为源发…     

彩色多普勒高频超声对涎腺肿物的诊断价值

目的:探讨二维高频超声及彩色多普勒显像对涎腺肿物的诊断价值。方法:对121例涎腺肿物应用高频探头二维超声和彩色多普勒超声进行检查和分析,全部病例经手术及活检或临床治疗性诊断证实。结果:炎性病变37例,囊肿30例,肿瘤54例。通过比较发现慢性炎性腺体多无特征性表现,而有局限性炎症包块时,易与恶性肿瘤的影像混淆。口外型舌下囊肿较多见,且超声图像较为典型,诊断可靠。良性肿瘤均边界清楚,内部回声均匀,诊断可靠。结论:超声有助于确定肿物大小、深度,鉴别肿物的囊实性,发现肿物的内部及周围的血流信号,可提高诊断水平。     

共聚焦内镜诊断食管胃黏膜异位症14例

目的 探讨共聚焦内镜对食管胃黏膜异位症诊断的可行性及准确性.方法 选择经普通胃镜检查时在食管段遇到的界限清楚的橘红色黏膜病灶30个（20例）,对病灶黏膜行共聚焦内镜检查,对所检查部位进行靶向活检并送病理组织学检查,将共聚焦内镜图像诊断与病理诊断进行对照分析.结果 共聚焦内镜诊断食管胃黏膜异位症病灶24个（15例）,4个为食管黏膜炎性改变,2个为早期食管癌,与病理切片检查结果一致.结论 共聚焦内镜能清晰地显示细胞结构,区别鳞、柱状细胞及腺体结构,可区别食管黏膜炎性改变、胃黏膜异位和食管肿瘤,可在内镜检查的同时,获得病理组织学诊断,是诊断食管胃黏膜异位症较为特异的检查方法.     

食管碰撞瘤临床影像及病理分析

目的探讨食管碰撞瘤的临床病理特点,提高对本病的认识。方法对8例食管碰撞瘤进行临床及病理资料分析,并复习文献。结果 8例患者,年龄49~69岁,中位年龄66岁。5例伴有不同程度的进行性吞咽困难或进食阻挡感,3例伴有胸骨后疼痛或胸骨后不适。8例中,病变位于中段食管6例,下段食管2例。X线上消化道钡餐7例显示食管单发性占位性病变,1例未发现明显肿瘤征象;其中6例同时进行了CT检查,4例考虑食管癌,2例发现食管壁僵硬增厚,建议结合胃镜检查;8例患者均行内镜检查,3例镜下见隆起型肿物,5例发现黏膜溃疡形成,6例镜下考虑食管癌,2例诊断食管占位。8例术前活检病理均诊断为鳞状细胞癌。8例均行食管肿瘤切除手术。显微镜观察,8例肿瘤均由两种成分组成,彼此界限清楚,各自弥漫性生长。1例为神经内分泌癌与多形性平滑肌肉瘤碰撞瘤,7例为神经内分泌癌与鳞状细胞癌碰撞瘤。结论食管碰撞瘤比较罕见,临床症状、内镜检查及影像学检查均缺乏特异性,术前诊断困难,确诊需靠术后病理检查并结合免疫组化染色综合判断。     

超声胃镜引导下微创切除食管平滑肌瘤45例临床分析

目的探讨超声胃镜对于食管平滑肌瘤的诊断价值,以及内镜下微创治疗食管平滑肌瘤的疗效和安全性。方法对胃镜发现的食管隆起性病变进行超声胃镜检查,根据病变大小及性质,在胃镜下分别行圈套器电切、内镜下黏膜切除术（EMR）、内镜黏膜下剥离术（ESD）等治疗。结果 45例食管隆起性病变经超声胃镜检查诊断为黏膜下平滑肌瘤,经内镜下微创治疗全部完整切除,所有病例创面愈合良好,均无出血、穿孔、食管狭窄等并发症发生。结论超声胃镜对食管平滑肌瘤有较高的诊断价值,内镜下微创切除是治疗食管黏膜下平滑肌瘤的有效方法。     

彩色多普勒超声在急性阑尾炎诊断中的应用

目的：探讨高频和低频超声联合应用对急性阑尾炎的诊断价值。方法：对我院疑诊为急性阑尾炎的137例腹痛患者进行常规腹部超声检查,联合应用高频（7.5～10.0MHz）探头和低频（3.5MHz）探头,并与手术病理结果进行对照分析。结果：137例中超声显示阑尾区异常回声110例（显示率80.3%）。病理诊断为急性单纯性阑尾炎79例,超声诊断56例（符合率70.9%）;病理诊断为急性化脓性阑尾炎43例,超声诊断39例（符合率90.7%）;坏疽性及穿孔性阑尾炎13例、阑尾周围脓肿2例,超声与病理诊断结果一致。结论：彩色多普勒超声高频和低频探头的联合应用,对提高急性阑尾炎的诊断及其分型有较高的临床价值。     

高频超声结合超声引导下穿刺活检对非哺乳期乳腺炎的诊断价值

目的 探讨高频超声结合超声引导下穿刺活检对非哺乳期乳腺炎的诊断价值。方法 选取2016年7月～2018年6月期间于我院就诊的经病理证实为非哺乳期乳腺炎患者106例,均接受超声检查,所有患者接受超声引导下穿刺活检,回顾分析106例患者的超声声像图特点。结果 106例患者穿刺前超声检查的检出率为74. 5%(79/106)。穿刺病理结果包括肉芽肿性小叶性乳腺炎34例,乳腺导管扩张症6例,慢性化脓性乳腺炎21例,淋巴细胞性乳腺炎1例,慢性乳腺炎44例。结论 非哺乳期乳腺炎的超声表现复杂、多变,各种类型的乳腺炎超声表现具有相似性、重叠性,部分容易与乳腺恶性肿瘤相混淆。高频超声结合超声引导下穿刺活检对非哺乳期乳腺炎的诊断及鉴别诊断有重要的临床应用价值。     

不典型肺结节的螺旋CT与临床病理诊断的对比分析

目的: 探讨螺旋CT在不典型肺结节诊断中的应用价值.材料和方法: 回顾性分析36例经手术(33例)、穿刺(7例)确诊为不典型肺结节的CT图像和临床病理学资料.结果: CT表现: 浅分叶征(17/36)、形态不规则(25/36)、长毛刺征(5/36)、空气支气管征(1/36)、空泡征(1/36)、部分非实性结节(3/36)和实性结节(33/36).螺旋CT拟诊肺癌19例、肺结核瘤11例和肺炎性假瘤6例.病理证实: 肺癌15例(腺癌8例、鳞癌4例、肺泡癌2例和类癌1例)、肺结核瘤15例和肺炎性假瘤6例.诊断符合率: 肺癌为10/15、肺结核瘤为9/15和肺炎性假瘤为1/6.结论: 螺旋CT对不典型肺结节的定性诊断较局限,常需穿刺活检或手术病理确诊.但其对不典型肺内结节具有很好的定位、密度分辨、形态描述和复查对比价值.     

Pre-operative radiological and clinical assessment of hepatic tumours--is biopsy necessary?

The pre-operative investigations of 72 consecutive patients who underwent liver resection for hepatic tumours have been reviewed. A combination of clinical, biochemical and radiological findings correctly predicted histology in 93% of cases (the benign or malignant nature in 97%). Biopsy was performed in only 20 patients. Five of the biopsy reports were incorrect (75% accuracy, benign or malignant nature accuracy 90%). Although guided biopsy can be performed during radiological assessment of focal hepatic lesions we argue that it is rarely indicated and can be misleading in patients proceeding to hepatic resection.     

Superficial esophageal carcinoma: an in vitro study of high-resolution MR imaging at 1.5T

The purpose of this study was to determine the diagnostic accuracy of high-resolution MR imaging at 1.5T for evaluating the mural invasion of superficial esophageal carcinoma. Forty-one esophageal specimens taken from patients suspected of having superficial carcinoma were studied using a 1.5T MR system with a surface coil. Spin-echo MR images were obtained with a field of view of 50mm, matrix of 256 x 256, and section thickness of 2mm (voxel size = 0.08 mm3). MR findings were compared with histopathologic findings. T2-weighted images clearly depicted the normal esophageal wall as consisting of 8 layers. In 39 (95%) of 41 carcinomas, the depth of mural invasion determined by MR imaging correlated well with that determined with histopathologic examination. The MR-based stage was higher in 2 (5%) cases than the histopathologic stage. High-resolution MR imaging at 1.5T shows a high diagnostic accuracy for evaluating the mural invasion of superficial esophageal carcinoma, thus potentially enabling preoperative histopathologic staging.     

Value of CT guided renal biopsies: retrospective review of 67 cases

PURPOSE: To assess the value of the CT guided percutaneous biopsy of renal tumors and to promote the interest of this procedure. MATERIAL AND METHODS: We report a retrospective study of 67 patients (average age, 51 years) who underwent CT guided biopsy of a single renal mass. The average size of tumors was 5 centimeters. The biopsy of tumors was carried out with needles between 16 and 21 gauge by using a conventional CT. Two to three passes per tumor were obtained. RESULTS: Biopsy material was sufficient for diagnosis in 48 cases (72%). A renal cell carcinoma was found in 29 (43%) samples of biopsy. The remainder included 13 metastases or lymphomas (18%). A benign lesion was found in 6 cases (9%). 59 patients had a final diagnosis. Accuracy of the biopsy for histopathologic evaluation was 81%. The average lesion size of failed biopsies was 1.5 centimeters. Morbidity occurred in 13% of cases, without immediate life threatening consequence. CONCLUSION: CT-guided renal biopsy is an effective means of obtaining tissue for the diagnosis of focal renal masses. The indications are renal lesions locally advanced, multimetastatic patients, mass in patients with a single kidney and focal lesions in patients with prior history of malignancy.     

Testicular microlithiasis: US findings in six pediatric cases and literature review

The aim of this article is to report on six pediatric cases of testicular microlithiasis (TM) and to review literature reports, in order to schedule US and/or other control examinations, particularly when concomitant focal or diffuse alterations of the testicular parenchymal structure are present, considering the possible association of TM with testicular tumors. Six patients (age range 4–12 years) underwent US examination for scrotal trauma (two cases) unilateral cryptorchidism (one case) follow-up after orchidopexy for bilateral cryptorchidism (one case), and varicocele (two cases). Five examinations were performed with high-frequency probes (10/13 MHz) and seven with 5/7.5-MHz frequency transducers. Follow-up US examinations were performed at different times depending on initial clinical indications, presence of underlying disease, and initial US findings. Two of the six patients underwent three US examinations, two patients underwent two US examinations, and the remaining two patients underwent only one US examination. The patients underwent a total of 12 US examinations. Microliths were bilateral in four patients and unilateral in two patients. In these two latter cases, the contralateral testis was, in one case, cryptorchid and could not be evaluated by US; in the other case it was small and hyperechogenic with orchidopexy sequelae. In three cases microliths were distributed throughout the testis. In the remaining three cases they were present in limited areas of parenchyma. As to the importance of microliths, it was defined as mild in three cases and moderate/severe in three cases. Intratubular testicular microlithiasis is a well-proved histological finding (biopsy or autopsy). More recent is the US demonstration of TM with consequent definition of its pattern: usually bilateral hyperechogenic multiple small foci without acoustic shadows with complete or partial extension to the parenchyma. Testicular microlithiasis is a rare finding. Moreover, the pediatric cases reported in the literature are very few. However, the use of high-frequency US transducers (10–13 MHz) has recently allowed an easier demonstration of this disease also in children. Of particular interest is the study of the still-debated association of microliths with other diseases such as neoplasms. Some aspects need further investigation, namely the real incidence of microliths in the healthy population, the incidence of tumors in patients with microliths, the differences between adults and children, and the different types of follow-up at different ages. In pediatric age, if TM represents an isolated sign, patients need non-invasive US follow-up until adult age. Only if TM is in association with focal lesions of testis parenchyma is it mandatory to perform biopsy or surgical treatment. Received: 17 June 1998; Revision received: 26 August 1998; Accepted: 21 September 1998     

食管造影与胸部CT对食管多发癌的诊断敏感性（附12例报告）

目的评价X线钡餐造影与CT扫描对食管多发癌的诊断敏感性。方法 12例经手术病理证实的食管多发癌患者术前均经食管X线钡餐造影检查,其中7例又经胸部CT扫描。结果 12例中X线钡餐造影检出9例为两处病灶,均有典型的X线表现,诸如管腔狭窄,充盈缺损,管壁僵硬,黏膜中断等;另外3例只检出一处病灶,后经食管镜检查和病理证实存在另外的微小病灶。经CT检查的7例均被发现两处食管壁增厚,其中5例伴腔内软组织肿块影,管腔呈偏心性狭窄,4例伴病灶处食管外缘不整,与邻近组织（气管、主动脉）间隙不清。结论在食管多发癌的影像诊断中,CT的敏感性高于X线钡餐造影,而两者结合可显著提高其检出率。     

Evaluation of the stereotactic 8G vacuum-assisted breast biopsy in the histologic evaluation of suspicious mammography findings (BI-RADS IV)

PURPOSE: The purpose of this study was to evaluate the potential of the new 8G stereotactic vacuum-assisted breast biopsy (ST-driver, Mammotome; Ethicon Endosurgery) in the histologic evaluation of BI-RADS IV microcalcifications. MATERIALS AND METHODS: Fifty-eight patients with 61 mammographic BI-RADS IV microcalcifications underwent stereotactic vacuum-assisted breast biopsy (SVAB). The new 8G system was mounted on the ST driver, which was formerly used only with the hand-held version under sonographic guidance. The evaluation criteria for each biopsy were minimally invasive and operative histologies, the time needed for biopsy, the amount of bleeding, number of rotations and specimen, the degree of resection, and the complications. RESULTS: Fifty-eight of 61 biopsies were technically successful because > or = 50% were resected (29 x 100%, 8 x 90%, 5 x 80%, 6 x 70%, 3 x 50%, 3 x 0%). In 7 cases with representative biopsies of segmental suspicious microcalcifications, the degree of resection could not be exactly measured. All but 2 biopsies were performed without clinically relevant complications and after gaining enough specimens (? 12.6 specimen, 1.85 rotations). Those 2 patients showed evidence of severe bleeding into the breast tissue and operative revision had to be performed (3.5%). The size of intramammary hematoma was measurable in 27 biopsies and showed a range from 0.5 to 5 cm (? 2.7 cm). The average external bleeding was still low with 16 mL (5-80 mL). In 3 of 61 lesions, it was not possible to gain representative tissue as a result of displacement of the lesion after introducing or shooting the needle. The average time needed for all biopsies was 28.2 minutes for all but 5 very complicated biopsies, which took 16.1 minutes. The histologic findings with further operative workup were: 10 ductal carcinomas in situ (DCIS), 4 atypical ductal hyperplasias, 1 atypical lobular hyperplasias (ALH), 3 lobular carcinomas in situ (LCIS), and 6 invasive ductal carcinomas. In 7 of 12 of the initial DCIS histologies, the operative histology was also DCIS, whereas in 4 of 12, no residual malignant tumor was found. In 1 of 12 patients with an initial DCIS histology, operative histology revealed invasive ductal cancer (8.3%). The cases with lobular lesions (ALH, LCIS) did not show any evidence for residual tissue in the operative workup. Most frequent benign histologies were mastopathy (13), ductal hyperplasia (9), fibroadenoma (8), and sclerosing adenosis (5). The control examinations (maximum 1 year) did not show any signs for a false-negative biopsy. CONCLUSION: The 11-G SVAB has proven to be a perfect adjunct to the existing breast biopsy methods. The new 8G SVAB speeds up the method when used for the same size of lesions and enables the user to representatively biopsy lesions up to 3 cm in diameter. The method is still minimally invasive; however, the amount of hematomas as well as clinically relevant complications is increased.     

Imaging features of focal breast fibrosis: mammographic-pathologic correlation of noncalcified breast lesions.

OBJECTIVE: Our objective was to describe the spectrum of imaging and histologic findings of focal breast fibrosis with an emphasis on noncalcified lesions, thereby offering a means of confirming mammographic-pathologic concordance on core biopsy of this increasingly encountered diagnosis. MATERIALS AND METHODS: Retrospective review of 610 core needle biopsies revealed the histologic diagnosis of focal fibrosis in 89 (15%). Thirty-nine cases were excluded: 17 in which focal fibrosis was not the primary diagnosis and 22 in which calcifications were the main imaging findings. The 50 remaining patients with noncalcified lesions that proved on histology to be focal fibrosis constituted the basis of the study. RESULTS: Mammographically, focal fibrosis presented as a mass in 68% of patients (n = 34), architectural distortion in 12% (n = 6), and asymmetric density in 10% (n = 5); focal fibrosis was mammographically occult in 10% (n = 5). Sonographically, 72% (n = 36) of cases of focal fibrosis presented as masses with three echo texture patterns: hypoechoic, isoechoic, and centrally echogenic with a peripheral hypoechoic rim. The sonographic margins were well circumscribed (n = 21), lobulated (n = 10), or ill defined (n = 5). Histologic review revealed three morphologic patterns of collagen deposition: perilobular, septal, and haphazard fibrosis. Correlation with the imaging findings showed that septal and perilobular fibrosis most often presented as hypoechoic or centrally echogenic masses, whereas the haphazard form was more often seen with architectural distortion. CONCLUSION: Focal fibrosis often presents as a noncalcified mass on mammography or sonography. The diagnosis of focal fibrosis on core needle biopsy can be considered concordant for a mass exhibiting well-circumscribed or partially obscured margins. Imaging findings discordant with focal fibrosis, such as marginal spiculation, require excisional biopsy.     

原发性腹膜后肿瘤诊断与外科治疗体会（附58例报告）

目的探讨原发性腹膜后肿瘤诊断和外科治疗经验。方法回顾性分析本院2000年1月～2010年3月58例经手术治疗的原发性腹膜后肿瘤的临床资料。结果 58例中,临床症状主要表现为腹部肿块33例（56.9%）,腹痛21例（36.2%）,腹胀13例（22.4%）;术后病理检查结果良性肿瘤19例,恶性肿瘤39例;肿瘤完整切除41例,姑息性切除16例,剖腹探查肿瘤活检术1例。58例患者围手术期无死亡,肿瘤完全切除组中位生存时间59个月,其l、3、5年生存率分别为88.2%、68.7%、35.8%;肿瘤姑息性切除组中位生存期35.3个月,其1、3、5年生存率分别为82.9%、53.8%、9.2%。结论手术切除是腹膜后肿瘤的最有效治疗方法,积极的外科治疗、争取完整切除可以延长患者的生存期,降低复发率。对于复发患者,应争取再次手术切除。     

MSCT对肺真菌病的诊断价值

目的：探讨肺真菌病的多层螺旋CT表现,以提高对本病的诊断水平.方法：回顾分析23例肺真菌病患者的病例资料,其中经手术病理证实9例、痰和脑脊液培养证实7例、经皮穿刺活检证实2例、纤支镜刷检5例.全部痛例均行全肺MSCT扫描,14例行病灶处HRCT检查.结果：23例中表现为肺内散在结节影4例,直径1～3 cm,密度均匀,周围见＂晕轮征＂;肿块及空洞影6例,肿块直径〉3 cm,密度较高,周围可见＂晕轮征＂,其中4例有空洞形成,内壁光滑;肺部炎症样改变8例,多位于两肺中下部,病变可融合呈地图状或蜂窝样实变影,侵犯一个肺段或肺叶,似肺段性或大叶性肺炎的表现,其中胸膜下楔形实变影3例,不规则片状实变影5例;曲菌球5例,表现为空洞内边缘光滑的球形致密影,随体位而变化,并见＂空气半月征＂.结论：肺部真菌感染的MSCT表现复杂,病变分布广泛,呈多种性质、多灶性及多形性改变,MSCT能准确显示病灶的细节,是观察肺真菌感染的重要手段.