声触诊组织量化成像技术对乳腺BI-RADS 4类病变的诊断价值

摘 要：［目的］ 评估声触诊组织量化成像(vitual touch imaging quantification,VTIQ)对BI-RADS 4类乳腺病变的诊断价值。［方法］ 分析150例BI-RADS 4类乳腺病变的VTIQ值,以病理结果为标准,绘制ROC曲线,确定良恶性诊断的VTIQ最佳阈值,校正BI-RADS分类,分析VTIQ校正前后诊断率有无统计学差异。 ［结果］ 150个病变中良性76个,恶性74个。BI-RADS分类诊断乳腺病变良恶性ROC曲线下面积为0.807,敏感度、特异性、准确率、阳性预测值和阴性预测值分别为81.58%（62/76）、74.32%（55/74）、78.0%（138/150）、76.54%（62/81）和79.71%（55/69）。乳腺恶性病变的SWV值明显高于良性病变(P<0.001),诊断良恶性的最佳阈值SWV为4.09m/s,校正后ROC的曲线下面积为0.884,敏感度、特异性、准确率、阳性预测值和阴性预测值分别为90.79%(69/76)、90.79%(69/74)、92%(138/150)、93.24%(69/74)和90.79%(69/76)。［结论］ VTIQ有助于诊断BI-RADS 4类乳腺病变,优化穿刺适应证的选择。     

TI-RADS分类与常规超声在甲状腺结节定性诊断中的诊断效能

摘 要：［目的］ 对比探讨甲状腺影像报告和数据系统（thyroid imaging reporting and data system,TI-RADS分类）与常规超声在诊断甲状腺结节良恶性中的诊断效能。［方法］ 对253例患者共266个甲状腺结节行常规超声检查,观察病灶的大小、数量、形态、边界、内部回声及后场情况特征并评估良恶性,同时运用TI-RADS分类方法对上述结节进行分类,以TI-RADS分类2、3、4a类为良性结节,4b 、4c、5类为恶性结节;结果均以病理为参照标准进行分析。［结果］ 常规超声诊断甲状腺结节良恶性：灵敏度70.7%、特异度87.5%、准确率85.0%、阳性预测值50.8%、阴性预测值94.3%;TI-RADS分类诊断甲状腺结节良恶性：灵敏度90.2%、特异度81.3%、准确率82.7%、阳性预测值46.8%、阴性预测值97.9%。TI-RADS分类较常规超声具有较高敏感性（P=0.026）。［结论］ TI-RADS分类与常规超声在甲状腺结节定性诊断中均具有较高的诊断价值;TI-RADS分类系统是一个标准化工具,使甲状腺结节超声定性诊断规范化,利于临床对患者分类管理。     

超声造影技术与三维超声成像对乳腺良恶性结节的鉴别诊断价值

目的：探讨超声造影技术（ CEUS）与三维超声成像检查对乳腺良恶性结节的鉴别诊断价值。方法对89例乳腺肿块患者,共计113个病灶分别进行CEUS及三维超声成像检查,分析两种方法的病灶特点,并根据术后病理检查结果进行诊断学效能评价。结果根据术后病理检查结果分为恶性结节51例、良性结节62例,三维超声成像在113个乳腺良恶性结节良恶性鉴别中均具有显著差异（P＜0．05）。 CEUS检查在增强、边缘强化及增强程度方面对良恶性鉴别均具有显著差异（P＜0．05）;在消退模式方面CEUS鉴别良恶性差异不显著（P＞0．05）。三维超声成像检查鉴别结节的灵敏度,特异度、阳性预测值、阴性预测值,与病理学检查结果的一致性Kappa值均高于CEUS;两者联合检查的灵敏度为96．08％、特异度为95．16％、漏诊率为4．84％、误诊率为3．92％、阳性预测值为94．23％、阴性预测值为96．72％、Kap-pa为0．911。结论对乳腺良恶性结节鉴别诊断,单独应用三维超声成像的诊断效能与单独使用CEUS检查相当,将两者联合应用能够显著提高术前诊断与术后病理诊断的一致性。     

超声造影对乳腺 BI-RADS 4类结节鉴别诊断价值

目的:研究超声造影对乳腺 BI-RADS 4类结节良恶性的鉴别诊断价值。方法:回顾性分析本院60例乳腺 BI-RADS 4类结节常规超声及超声造影检查资料,观察乳腺超声造影增强模式,分析良恶性结节之间超声造影增强特征的差异,并与穿刺活检或术后病理结果对照。结果:乳腺良恶性结节超声造影增强过程中其增强强度、增强时间、增强完整性方面有显著性差异（P<0.05）,但在超声造影增强过程中增强顺序、增强均匀性方面尚未发现有显著差异（P>0.05）。常规超声 BI-RADS对乳腺良恶性结节诊断效能的的灵敏度、特异度、阳性预测值、阴性预测值分别为81.8%（18/22)、73.7%(28/38)、64%(18/28)和87.5%（28/32）,超声造影判断乳腺 US BI-RADS 4类结节良恶性的灵敏度、特异度、阳性预测值、阴性预测值分别为90.9%(20/22)、86.8%(33/38)、88.0%(22/25)和94.3%（33/35）。超声造影对乳腺良恶性结节的诊断价值与病理结果的Kappa 值为0.75,具有较好的一致性。结论:乳腺超声造影不同增强特征对乳腺 BI-RADS 4类结节良恶性判断有较高的准确性,在指导临床治疗策略方面具有明确的应用价值。     

PET/CT双时相显像对孤立性肺结节诊断价值的ROC曲线分析

摘 要：［目的］ 利用ROC曲线分析评价PET/CT双时相显像对孤立性肺结节（SPN）的诊断价值。［方法］ 回顾性分析病理确诊或随访确诊的SPN行PET/CT双时相检查的142例患者。所有患者注射显像剂后60min行PET/CT早期显像,120min后行延迟显像。以半定量方法测定结节早期及延迟期SUVmax值,并计算代谢滞留指数（RI）。以RI≥10%为阳性判断标准对结节进行定性诊断,计算其诊断的灵敏度、特异性、准确率、阳性预测值及阴性预测值。绘制相应ROC曲线并计算曲线下面积,以分析PET/CT双时相显像诊断SPN的效能。［结果］ 良性结节延迟期SUVmax值与早期比较差异无统计学意义（P>0.05）;而恶性结节延迟期SUVmax值较早期显著增高(P<0.05)。以RI≥10%为阳性,<10%为阴性,其诊断SPN的灵敏度、特异性、准确率、阳性预测值、阴性预测值分别为83.5%、51.3%、74.6%、81.9%、54.1%。PET/CT双时相显像诊断SPN的ROC曲线下面积为0.707±0.053,以约登指数最大值为界点,确立ROC曲线的最佳截断值为5%,对应诊断SPN的灵敏度、特异性和准确率分别为92.2%、48.7%和80.3%。［结论］ PET/CT双时相显像鉴别SPN良恶性有一定的临床价值,对于早期显像诊断困难的SPN,建议双时相PET/CT检查有助于鉴别。     

声脉冲辐射力技术结合BIRADS分类在乳腺实性肿块鉴别诊断中的应用价值

目的:探讨声脉冲辐射力技术（ARFI）结合超声BIRADS分类在乳腺实性肿块良恶性鉴别中的应用价值。方法:对来我院检查诊断为乳腺实性肿块的82位患者,进行ARFI弹性成像和BIRADS分级,以病理结果为金标准,分别对ARFI结合BIRADS诊断肿块良恶性和单一运用ARFI及BIRADS诊断乳腺肿块良恶性的准确性进行统计学分析。结果:ARFI联合BIRADS分类诊断乳腺实性肿块良恶性的特异性、灵敏度、阳性预测值、阴性预测值、准确性各为96%、98.8%、96%、98.8%、98.1%,Kappa值为0.948,单用ARFI诊断乳腺实性肿块良恶性的特异性、灵敏度、阳性预测值、阴性预测值、准确性各为88%、96.3%、88%、96.3%、94.3%,Kappa值为0.843。单用BIRADS分类法诊断乳腺实性肿块良恶性的特异性、灵敏度、阳性预测值、阴性预测值、准确性各为84%、95.1%、84%、95.1%、92.5%,Kappa值为0.791。ARFI联合BIRADS分类诊断效能与较单独运用ARFI及BIRADS相比,差异有统计学意义（P＜0.05）。结论:AFRI联合BIRADS分类诊断肿块良恶性能提高诊断的准确性,值得推广。     

超声声触诊量化在乳腺肿块良、恶性鉴别中的价值分析

摘 要：［目的］ 探讨超声声触诊组织量化（VTQ）在乳腺肿块良、恶性鉴别中的临床价值。［方法］ 运用VTQ法对100例乳腺病变患者的乳腺良、恶性肿块各种剪切波波速（SWV）值进行比较,比较二维超声法、弹性比值法、声触诊组织成像（VTI）法及VTQ法检测良、恶性病变的正确诊断率、漏诊率、误诊率及敏感性、特异性、阳性预测值、阴性预测值、准确性。［结果］ 良性肿块内部SWV的Vmax、Vmean及Vmean/Vmean*与恶性肿块相比,差异均有统计学意义（P<0.05）;而良性组的 Vmin及正常腺体 SWV 值与恶性组比较差异均无统计学意义（P＞ 0.05）。VTQ法与二维超声法及弹性比值法比较其良、恶性病变的正确诊断率较高,漏诊及误诊率较低,差异具有统计学意义（P＜0.05）;VTQ法与VTI法相比其恶性病变的正确诊断率较低,漏诊率较高,但对良性病变的正确诊断率显著高于VTI法,误诊率显著低于VTI法,差异具有统计学意义（P＜0.05）。与VTQ法相比,二维超声法及弹性比值法的特异性、敏感性、准确性、阳性及阴性预测值均较低,差异具有统计学意义（P＜0.05）;VTI法敏感性较高,但阳性预测值、特异性及准确性较低,差异具有统计学意义（P＜0.05）。［结论］ VTQ技术有助于乳腺肿块良、恶性的鉴别诊断,联合其他方法进行鉴别,能进一步提高其准确度。     

全自动乳腺容积成像对乳腺病灶诊断效果的Logistic回归模型分析

[目的]探讨全自动乳腺容积成像（ABVS）对乳腺病灶诊断效果,及影响诊断效果的危险因素。[方法]经过手术或穿刺病理检查证实的40例乳腺病灶患者使用彩色多普勒超声诊断仪进行常规超声、彩色超声与ABVS等,并对变量进行回归分析。[结果]常规超声诊断乳腺良、恶性病灶的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为：86.4%、87.1%、86.9%、70.5%、94.7%。ABVS诊断乳腺疾病的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为96.1%、91.9%、94.5%、74.0%、94.1%。经Logistic回归分析,＂火山口＂征,病灶内微小钙化,病灶边缘、患者年龄对乳腺恶性病灶的诊断效能高。[结论]ABVS系统基于乳腺全容积扫查的特点,有助于提高超声医师对乳腺病变的检出率。     

MRI快速检查法在致密型乳腺鉴别诊断中的应用

摘 要：［目的］ 探讨致密型乳腺中恶性肿瘤鉴别诊断期间MRI快速检查法（abbreviated protocol,AP）的应用效果。［方法］ 选取经X线摄影检查符合致密型乳腺的50名女性为研究对象,对其进行MRI动态增强检查,包括AP与常规检查法（full diagnostic protocol,FDP）,并进行穿刺活组织检查。以穿刺活组织检查结果为金标准,分别计算并对比X线摄影检查、AP、FDP对致密型乳腺中恶性肿瘤检出的灵敏度、特异度、阴性预测值、阳性预测值及准确率。采用受试者工作特征（receiver operating characteristic,ROC）曲线分析各检查方法的诊断效能。［结果］ X线摄影检查对致密型乳腺中恶性肿瘤检出的灵敏度、特异度、阴性预测值、阳性预测值及准确率分别为64.52%、63.16%、74.07%、52.17%和64.00%,AP分别为87.10%、94.74%、93.10%、81.82%和90.00%,FDP分别为90.32%、94.74%、96.67%、90.00%和94.00%,AP和FDP的诊断准确率均高于X线摄影检查（P=0.002、0.001）。ROC曲线分析显示,X线摄影检查、AP、FDP对致密型乳腺中恶性肿瘤诊断的曲线下面积分别为0.677、0.871、0.886（95%CI：0.581~0.762、0.782~0.927、0.794~0.942）,AP、FDP的曲线下面积均明显高于X线摄影检查（P=0.013、0.001）,AP与FDP间比较差异无统计学意义（P=0.896）。［结论］ MRI快速检查对致密型乳腺中恶性肿瘤鉴别具有较好的诊断效能,其诊断效能高于X线摄影检查,值得在临床推广。     

剪切波弹性成像对乳腺小结节鉴别诊断的价值

目的探讨剪切波弹性成像(SWE)对乳腺小结节的鉴别诊断价值。方法选取2018年6月到2019年1月山西省儿童医院及山西医科大学第二医院经手术病理证实的女性乳腺小结节(结节最大径≤10 mm)患者77例,共101个结节(良性35个,恶性66个),术前均行常规二维超声及SWE检查。以术后病理结果为金标准,比较良、恶性小结节的弹性模量值[最大值(Emax)、平均值(Emean)、最小值(Emin)],并绘制受试者工作特征曲线(ROC),得到Emax、Emean、Emin的最佳诊断界值及三者诊断乳腺恶性小结节的准确度。以准确性高的弹性模量值作为SWE诊断乳腺恶性小结节的标准,以美国放射学会建立的乳腺影像报告和数据系统(BI-RADS)分级作为常规二维超声诊断乳腺恶性小结节的标准,分别计算出SWE、BI-RADS诊断的灵敏度、特异度、准确度、阴性预测值及阳性预测值。结果乳腺恶性小结节的Emax、Emean、Emin均大于良性小结节,差异均有统计学意义(均P<0.01)。Emax、Emean、Emin诊断乳腺恶性小结节的最佳诊断界值分别为40.5、35.5、20.5 kPa,曲线下面积分别为0.986、0.980、0.746。以Emax≥40.5 kPa作为诊断乳腺恶性小结节标准的灵敏度、特异度、准确度、阴性预测值、阳性预测值分别为93.7%、90.2%、92.1%、88.6%、79.5%,以Emean≥35.5 kPa作为标准时分别为92.4%、94.3%、93.1%、96.8%、86.8%,均高于BI-RADS的70.8%、74.2%、71.4%、62.8%、46.3%;以Emin≥20.5 kPa作为标准时的灵敏度、特异度、约登指数分别为56.8%、98.2%、55.0%。结论相对于常规二维超声,SWE对乳腺恶性小结节具有较高的诊断价值。     

Bacteria and cancer--antagonisms and benefits

There is considerable historical and recent evidence concerning the antagonisms between acute bacterial infections or their toxins and cancer and allied diseases. These data provide renewed incentives to undertake clinical programmes with mixed bacterial vaccines in many countries at the present time.     

Religiosity and physical and emotional functioning among African American and White colorectal and lung cancer patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Renal irradiation and the pharmacology and toxicity of methotrexate and cisplatinum

We used a rat model to study the effects of renal irradiation on the pharmacology of methotrexate (MTX) and cisplatinum (cis-Pt). Unanesthetized rats were given bilateral kidney irradiation (20 Gy in 9 fractions). At 9 months after irradiation, 3% of the animals had died and survivors showed moderately impaired renal function. At 15 months, 30% of the animals had died and survivors showed severely impaired renal function. Some animals were given i.v. MTX 1 week to 15 months after irradiation. In irradiated rats, the area under the MTX plasma clearance curve equaled that of controls through 6 months, and was significantly above controls from 9 months on. Other animals were given i.p. cis-Pt 1 week to 9 months after irradiation. The acute toxicity of cis-Pt was the same in control and irradiated rats when cis-Pt was given immediately before or after irradiation. Beginning 3 months after irradiation there was a progressive increase in cis-Pt toxicity and a simultaneous decrease in urinary platinum excretion. Irradiated animals that survived cis-Pt treatment showed increased radiation nephritis; the greatest effect occurred when cis-Pt was given 3 months or more after irradiation. MTX and cis-Pt clearance decreased when renal dysfunction was first observed and changes in renal function preceded changes in drug clearance and toxicity.     

Morphine and tumor growth and metastasis

Morphine is an analgesic widely used to alleviate cancer pain. In addition, the perioperative management of pain in cancer surgery patients most often includes opioids. However, there are reports that these drugs may alter cancer recurrence or metastasis. Several mechanisms have been proposed, such as the modulation of the immune response or cellular pathways that control the survival and migratory behavior of cancer cells. The published literature, however, presents some discrepancies, with reports suggesting that opioids may either promote or prevent the spread of cancer. It is of great importance to determine whether opioids, in particular the most widely used, morphine, may increase the risk of metastasis when used in cancer surgery. This review examines the available data on the effects of morphine which influence cancer metastasis or recurrence, including immunomodulation, tumor cell aggressiveness, and angiogenesis, with special emphasis on recently published clinical and laboratory based studies. We further discuss the parameters that may explain the difference between reports on the effects of morphine on cancer.     

肾上腺素能β受体与肿瘤生长及转移

大量研究表明肿瘤细胞可表达β受体，而一些神经递质、药物和社会心理因素可能通过β受体影响肿瘤的生长和转移，β受体激动剂、β受体阻滞剂以及抑郁等社会心理因素可加强或削弱这种作用。这为表达β受体肿瘤的治疗开辟了新的道路，提供了新的治疗靶点。