肝囊肿CT导向经皮穿刺注射无水酒精硬化治疗

目的 评价CT导向经皮穿刺注射无水酒精硬化治疗对肝囊肿的疗效。方法 36例肝囊肿患（30例单发，6例多发）均经CT导向经皮穿刺针吸与注射无水酒精硬化治疗。疗效判定标准是依据囊肿经治疗后较术前缩小程度分类4级，即0级：囊肿大小无变化；Ⅰ级：囊腔缩小＜1／3;Ⅱ级：囊腔缩小≥1／3但≤2／3；Ⅲ级：囊腔消失。结果 术后除3例单发小囊肿患失访外，其余33例（36个囊肿）均经随访1个月－2年。随访发现36个囊肿中0级3个，Ⅰ级5个，Ⅱ级10个，Ⅲ级18个。本组总有效率为91.7%(33/36)。结论 肝囊肿CT导向经皮穿刺针吸与注射无水酒精硬化治疗其操作简便、安全，疗效显，是肝囊肿保守性治疗的一种颇具应用前景的介入性技术，值得向基层医院推广。     

Impalpable breast abnormalities. Contribution of cytologic puncture under stereotaxic guidance. Apropos of 159 cases

The authors report the results of a cooperative study of X ray guided fine needle aspiration for the cytologic diagnosis of non palpable breast lesions. They discuss the limits of this method. In 60% of 159 cases cytologic examination was diagnosis. In their series, no false positive was reported but in 64 cases no sufficient material was obtained.     

Stereotactic fine-needle aspiration for cytologic diagnosis of nonpalpable breast lesions

Fine-needle aspiration for cytologic diagnosis was performed on 219 nonpalpable breast lesions by using a stereotactic localization technique. Cytologic results were correlated with mammographic findings, and therapeutic decisions were based on the results of both procedures. Representative cytologic material was obtained in 74% of the lesions. Strict criteria of representativeness were observed. If only cases with representative cytologic yield are considered, the sensitivity was 93% and the specificity was 97%. The predictive values were high except for the predictive value of a negative cytologic finding in a spiculated lesion (50%). Sampling errors caused by abundant fibrosis, needle deviation, and difficulty in defining the lesion on the stereoscopic views are discussed. Another source of sampling error may be the mixed nature of some lesions consisting of benign and malignant components. Fine-needle aspiration of 219 nonpalpable breast lesions by using a stereotactic localization device yielded representative cytologic samples in 74% of the lesions.     

Fine-needle aspiration of breast biopsy specimens: correlation of histologic and cytologic findings.

The accuracy of fine-needle aspiration (FNA) cytologic diagnosis of nonpalpable breast lesions and the prevalence of neoplasm occurring in areas unrelated to the radiologic abnormality were studied. Template-guided FNA cytologic examination was performed in 101 surgically excised breast specimens. The exact area of the mammographic abnormality was aspirated with radiographic control. Despite accurate placement of the needle for aspiration, seven of 101 aspirates (7%) yielded insufficient cytologic material. Ninety-four of the 101 aspirates (93%) were adequate for diagnosis. The cytologic diagnosis was benign in 58 (62%), atypical in seven (7%), suspicious for malignancy in four (4%), and malignant in 25 (27%). All cases diagnosed as suspicious or malignant and five of 58 cases diagnosed as benign at cytologic examination proved to be malignant at histologic examination. In three of these five the malignancy was in the area of the radiologic abnormality; in two it was not. FNA cytologic examination can be helpful in evaluating nonpalpable breast lesions, but it is not as accurate as histologic examination of surgically excised lesions.     

Sonographically guided aspiration of cerebrospinal fluid pseudocysts in children and adolescents

OBJECTIVE: Cerebrospinal fluid (CSF) pseudocyst formation is an uncommon cause of ventriculoperitoneal shunt malfunction in children. Traditional staged treatment consists of shunt externalization, antibiotics, and later shunt revision and internalization. We sought to evaluate whether sonographically guided pseudocyst aspiration to alleviate acute symptoms and to exclude CSF infection could obviate shunt externalization and expedite the care of these patients. CONCLUSION: Sonographically guided CSF pseudocyst aspiration is an effective technique, allowing exclusion or confirmation of infection and providing relief of abdominal symptoms. In patients with sterile collections, staged surgical revision with shunt externalization can be avoided, speeding and simplifying treatment.     

Stereotaxic cytologic examination of non-palpable lesions of the breast. Experience with 791 consecutive cases

The authors report on 791 consecutive cases undergoing stereotaxic cytology for nonpalpable lesions detected at mammography. Histologic diagnosis (malignant = 179, benign = 107) or mammographic follow-up after at least one year (benign = 275) was available in 561 cases. The overall inadequacy rate of stereotaxic cytology was 0.21, and dependent on lesion type (benign = 0.25, malignant = 0.13 p less than 0.001) and on sampling operator experience (range 0.17-0.31, p less than 0.001). Sensitivity (dubious + positive, after exclusion of inadequates) was 0.83 and dependent on histologic type (infiltrating = 0.87, intraductal = 0.68). Specificity (negative/benign, after exclusion of inadequates) was 0.96. Stereotaxic cytology helped in reducing the number of unnecessary benign biopsies and the biopsy ratio was 0.6 benign to 1 malignant biopsy. In cases with moderate suspicion at mammography the radiologist felt reassured by negative cytology and advised mammographic control rather than surgical biopsy. Cytology was determinant in advising surgical biopsy in 9 cancer cases whereas the absence of cytologic positivity contributed to diagnostic delay in 2 cancer cases. Overall, stereotaxic cytology allowed a relevant reduction of unnecessary benign biopsies and should be routinely employed in the diagnostic work-up of nonpalpable lesions detected at mammography.     

Impalpable breast lesions: marking of surgical specimens for pathology.

A simple method is described to indicate the abnormal area in breast biopsy specimens excised following mammographic localization of impalpable lesions. A hypodermic needle is inserted into the specimen through the abnormality immediately following specimen radiography, removing the need to radiograph individual tissue slices. The technique has proved successful in 121 out of 122 specimens.     

超声引导下经皮穿刺抽吸和注射无水乙醇治疗单纯性肾囊肿

目的评价超声引导下经皮穿刺抽吸和注射无水乙醇治疗单纯性肾囊肿的效果。方法46例单纯性肾囊肿患者(男性26例,女性20例,平均年龄65岁)均经超声引导经皮穿刺抽吸和注射无水乙醇硬化治疗。全部操作是在局部麻醉下完成的。治疗后,全部病人经超声或CT随访1至6个月。囊肿与治疗前比较,减小2/3以上为有效,完全消失为治愈。结果46个囊肿中,2个囊肿抽出液蛋白定性试验阴性,抽液后未注入无水乙醇,其余44个囊肿于治后1,3,6个月呈进行性缩小,6个月时复查有效率为100%,治愈率为90.6%。结论超声引导经皮穿刺抽吸和注射无水乙醇是治疗单纯性肾囊肿的一种操作简单、痛苦小、费用低、安全有效的方法,值得临床推广应用。     

Ultrasound guided fine needle aspiration of ovarian cysts: diagnosis and treatment in pregnant and non-pregnant women

Ovarian cysts are conventionally managed by laparoscopy or laparotomy. Twenty-two patients underwent fine needle aspiration of ovarian cysts under ultrasound control. Four patients were pregnant, and in two of these, aspiration of the cyst was performed transvaginally. The aspirate was examined cytologically and correlated with histology where available. The technique and results are discussed. No complications occurred. It is concluded that fine needle aspiration under ultrasound guidance is simple, safe and useful in the management of ultrasonically benign unilocular ovarian cysts in pre-menopausal women. It is of particular use in pregnancy, and in patients unsuitable for laparoscopy or surgery. Surgery can be reserved for cysts which recur after aspiration, cysts with a haemorrhagic aspirate, cysts in post-menopausal women and those with ultrasonic criteria of malignancy.     

超声引导下无水酒精硬化治疗肾囊肿(附68例分析)

目的：探讨超声引导下经皮穿刺注入无水酒精治疗肾囊肿的价值。方法：对68例有临床症状的肾囊肿患，行超声引导下肾囊肿穿刺无水酒精硬化治疗并随访观察。结果：治疗有效率为97．06％，无一例出现并发症，多囊肾的治疗有也有较满意的效果。结论：超声引导经皮穿刺无水酒精硬化治疗肾囊肿安全有效，值得推广应用。     

Treatment of breast abscesses with sonographically guided aspiration, irrigation, and instillation of antibiotics

OBJECTIVE: We studied the feasibility of treating breast abscesses with sonographically guided aspiration, irrigation, and local instillation of antibiotics without placing indwelling catheters. MATERIALS AND METHODS: Seventy-three patients with breast abscesses were seen from 1995 to 2001. Aspiration and irrigation were performed under sonographic guidance. Repeated aspiration was performed when deemed necessary. One gram of cephradine was injected into 29 abscesses measuring more than 25 mm. RESULTS: Six patients refused further treatment after failure of the first aspiration and elected surgical drainage. Of the remaining 67 patients who completed treatment, 38 required one aspiration for cure, 18 required two aspirations, and eight required more than two aspirations. The treatment failed and surgical drainage was required in only three of the 67 patients completing treatment. CONCLUSION: Ninety-six percent of patients completing treatment were cured with this procedure. Local instillation of antibiotics is probably beneficial.     

超声引导下经皮穿刺抽吸和注射无水乙醇治疗甲状腺囊肿47例

甲状腺囊肿在甲状腺肿瘤中居第二位，传统治疗方法为手术切除，创伤大，费用高，副损伤较多。自2004年起我院采取超声引导下穿刺注射无水乙醇治疗甲状腺囊肿，效果满意，现报道如下。     

Renal tuberculosis: diagnosis with sonographically guided aspiration cytology.

Sonographically guided fine-needle aspiration cytology was performed in 19 patients suspected to have renal tuberculosis. This procedure enabled a diagnosis of renal tuberculosis to be made in six of seven patients with urine cultures consistently negative for acid-fast bacilli and confirmed the diagnosis in nine patients with focal renal lesions on sonography and urine cultures positive for acid-fast bacilli. The fine-needle aspiration cytologic samples were positive for acid-fast bacilli in seven (44%) of the 16 confirmed cases, and acid-fast bacilli were present in 80% of the samples containing necrotic material. Epithelioid granulomas were present in 15 (94%) of 16 patients diagnosed with renal tuberculosis. One patient had no evidence of acid-fast bacilli or epithelioid granulomas, but seminal fluid ultimately grew acid-fast bacilli. Two patients (13%) with evidence of tuberculosis had minor self-limiting complications from the fine-needle aspiration: one perirenal hematoma and one abdominal wall intramuscular hematoma. Sonographically guided fine-needle aspiration cytology is useful as a means of diagnosing renal tuberculosis in patients with urine cultures negative for acid-fast bacilli, and is of value in defining the granulomatous nature of sonographically visible lesions in patients with positive urine cultures.     

US-guided fine-needle aspiration biopsy of thyroid nodules: adequacy of cytologic material and procedure time with and without immediate cytologic analysis

PURPOSE: To compare the adequacy of aspirated material and procedure time when performing ultrasonography-guided fine-needle aspiration biopsy of thyroid nodules with and without immediate cytologic analysis of the aspirated sample. MATERIALS AND METHODS: One hundred twenty-one thyroid nodules were sampled for biopsy in 109 patients. In group A, results of 50 biopsies in which immediate cytologic analysis was performed were retrospectively reviewed for cytologic adequacy. In group B, 50 biopsies were performed without immediate cytologic analysis, and the procedure time was recorded. In group C, 21 biopsies were performed with immediate cytologic analysis, and the procedure time was recorded. Cytologic adequacy rates were compared by using the proportional odds model, and procedure times were compared by using linear regression to adjust for differences in the character of the nodules. RESULTS: For groups A and C (immediate cytologic analysis performed), the adequacy categories included the following results: 39 (55%) satisfactory, 15 (21%) limited, and 17 (24%) unsatisfactory. For group B (immediate cytologic analysis not performed), the adequacy categories included the following results: 25 (50%) satisfactory, 15 (30%) limited, and 10 (20%) unsatisfactory (Wald test, P =.815). The average procedure time was 12.5 minutes for group B and 44.4 minutes for group C (P <.001). CONCLUSION: There was no significant difference in cytologic adequacy whether immediate cytologic analysis of aspirated material was performed or not. The procedure time was significantly shorter when immediate cytologic analysis was not performed.     

Management of ovarian cysts with aspiration and methotrexate injection

PURPOSE: To evaluate prospectively ultrasonography (US)-guided cyst aspiration and methotrexate injection in the management of simple and endometriotic ovarian cysts in selected patients. MATERIALS AND METHODS: Authors obtained informed patient consent and approval from hospital ethics committee. Study included 162 female patients (aged 15-77 years) with simple or endometriotic ovarian cysts (3.0-10.6 cm) at a tertiary hospital. Criteria for inclusion in the study were (a) persistence of the cyst for at least 6 months, (b) benign appearance of the cyst at US, and (c) normal serum CA-125 level measurement before the procedure. Authors performed transabdominal aspiration of the cysts with direct US guidance and injection of methotrexate (30 mg). Cytologic examination was performed in all cases. Follow-up US was performed at 1, 3, and 6 months. If the cyst persisted, the procedure could be repeated. Main outcome measure was resolution or persistence of cysts. chi(2) Test or Mantel-Haentszel chi(2) tests for univariate analysis and multiple logistic regression were used for multivariate statistical analysis. RESULTS: Of 162 patients, 148 were available for follow-up. Malignant cells were not found in any of the cases at cytologic examination. At follow-up US, cysts had disappeared in 124 patients (83.8%) and persisted in 24 (16.2%). Cyst diameter proved to be a significant prognostic factor for cyst resolution (P = .01). No major complications were observed. Patients received neither analgesia nor antibiotics. CONCLUSION: US-guided transabdominal aspiration of cyst fluid and subsequent methotrexate injection appears to be an alternative treatment for both simple and endometriotic ovarian cysts in selected cases.