胰腺肿块术中细针穿刺细胞学检查的临床价值

为探讨术中细针穿刺细胞学检查对胰腺肿块的诊断价值。笔者对 48例胰腺肿块术中直视下行细针穿刺涂片观察 ,通过与术后病理诊断作对比进一步确诊。结果示术中细胞学检查总准确率为95 .8% ,阳性准确率为 95 % ,阴性准确率为 80 %。提示术中细针穿刺细胞学检查快速实用 ,安全可靠 ,在胰腺肿瘤诊断上是很有价值的。     

超声引导下粗针穿刺快速活检在乳腺肿块诊断中的应用

为评价超声引导下粗针穿刺活检术 (US CNB) 快速石蜡 (快蜡 )的临床应用价值 ,将 3 2例乳腺肿块患者先后进行粗针穿刺和切除活检 ,分送快蜡、术中冷冻及石蜡切片病理检查。结果示 ,以石蜡切片检查结果为诊断标准 ,快蜡的确诊率为 90 .6% ,术中冷冻为 96.8% (P >0 .0 5 ) ,两者均无假阳性。提示粗针穿刺活检 快蜡可以明确术前诊断 ,缩短手术时间 ,可望能取代手术活检。     

超声造影引导经皮穿刺活检诊断胰腺占位性病变

目的探讨应用CEUS引导经皮穿刺活检对胰腺占位性病变的临床应用价值。方法对因胰腺占位性病变需行穿刺活检、但常规超声定位困难的49例患者行CEUS引导下经皮穿刺活检,以所取组织能够作出明确病理诊断为取材满意;随访至少6个月,以术后病理诊断或随访影像学检查结果为最终临床诊断。结果本组穿刺活检满意率为95.92%(47/49),取材满意者穿刺活检的诊断准确率为97.87%(46/47)。术后恶心呕吐、发热及胆汁性腹膜炎各1例(1/49,2.04%)。结论对于常规超声不能准确定位的胰腺占位性病变,以CEUS引导穿刺可以提高取材的准确性,降低并发症发生率。     

细针穿刺细胞学检查在胰腺及壶腹周围肿瘤手术中的应用

胰腺癌早期诊断比较困难，剖腹探查就是诊断和治疗的重要手段。我们针对临床高度怀疑为胰腺癌、影像学诊断胰腺肿块的患者行剖腹探查术，术中直视下进行细针穿刺吸取细胞学检查，探讨其临床应用价值。     

6针法和13针法前列腺穿刺活检术诊断前列腺癌的分析比较

目的探讨5区13针法和6针法前列腺穿刺活检诊断前列腺癌的差异。方法本组214例,因前列腺特异性抗原>4.0ng/ml或直肠指诊前列腺癌阳性可疑而行13针前列腺穿刺活检术,其中前列腺特异性抗原>4.0ng/ml者203例,直肠指诊前列腺癌阳性可疑者41例。入选病例的年龄为50￣90岁,平均69.8岁;PSA水平0.8￣112.3ng/ml,平均18.7ng/ml;前列腺体积12.3￣182.5ml,平均61.3ml;直肠指诊阴性者173例,阳性者41例。结果6针法和13针法的阳性率分别为30.8(f/214)和36.0(w/214),后者的阳性率提高14.3(/77()P<0.001)。两者的差异在前列腺特异性抗原≤20ng/ml,指诊阴性,体积>40ml,前列腺特异性抗原密度≤0.30,年龄<70岁的患者中更显著。结论5区13针前列腺穿刺活检术比系统6针发现前列腺癌的阳性率更高。     

前列腺穿刺活检的临床价值

1997年 1月～ 2 0 0 0年 1 2月 ,我们对 1 2 2例可疑前列腺癌 (PCa)患者进行经直肠前列腺穿刺活检术 ,以探讨其临床价值 ,现报告如下。1　资料与方法本组 1 2 2例 ,平均年龄 72 .5 ( 5 0～ 90 )岁。表现为尿频、尿急、排尿困难等下尿路梗阻为主症状。常规行直肠指检 (DRE)和前列腺特异抗原(PSA)检查 ,PSA测定我院以≥ 1 0 μg/L为 ( + ) ,<1 0 μg/L为 ( - )。DRE发现前列腺质硬或结节以及PSA升高者均行经直肠内穿刺 (FNA)活检。FNA :采用经肛门直肠穿刺法 1 0 3例 ,在两侧叶的中部矢状平面扇形方向或结节方向穿 4～ 6针 ,取直径 …     

乳腺X线立体定位穿刺活检术对早期乳腺癌的诊断价值

目的探讨乳腺X线立体定位穿刺活检术（SMCNB）对早期乳腺癌诊断的应用。方法对21例钼钯X线摄片诊断为可疑早期乳腺癌患者应用SMCNB。将手术病理结果与穿刺取材病理结果相比较。结果与手术病理结果比较，SMCNB诊断阳性率为85．71％，无假阳性。结论SMCNB对早期乳腺癌活检定位准确，操作简单，安全可靠。     

乳癌术前细针针吸细胞学选择性替代切除活检的指征探讨

目的 探讨术前应用细针针吸细胞学替代术中切除活检的指征。方法 手术治疗118例“乳房肿块”病人，术前均行临床触诊及细针针吸细胞学检查，观察诊断的灵敏度和阳性预测值。结果 细针针吸细胞学检诊乳癌灵敏度为95.7%，阳性预测值为97.1%。当触诊与细针针吸均阳性时，其联合诊断乳癌的灵敏度仅为47.8%，但联合阳性预测值却达到100％。结论 对于住院接爱手术的乳腺肿块病人，如果术前触诊能基本肯定为乳癌，则应行细针针吸细胞学检查；若针吸涂片又查到癌细胞，则可免除术中切除活检并可据此进行术前化疗。     

超声引导下经皮细针穿刺抽吸及穿刺活检诊断胰腺占位性病变

目的 观察超声引导下经皮细针穿刺抽吸(FNA)及穿刺活检(CNB)诊断胰腺占位性病变的价值。方法 回顾性分析112例接受超声引导下FNA和/或CNB的胰腺占位性病变患者、共114组穿刺病理,根据穿刺方式将其分为FNA组(n=53)及CNB组(n=61)。以手术病理或临床随访为金标准,对比组间患者一般资料、穿刺及诊断效能差异,分析影响穿刺并发症发生的因素,评价FNA及CNB的价值。 结果 114组病理中,113组(99.12%,113/114)取材满意;FNA组取材满意率为98.11%(52/53),CNB组为100%(61/61)。穿刺过程中38例出现轻、中度疼痛、1例一过性晕厥,未见严重并发症。FNA组并发症及疼痛发生率均低于CNB组(P均<0.05),FNA诊断胰腺占位性病变的准确率和敏感度亦低于CNB(P均<0.05)。logistic回归分析显示,年龄和穿刺方式是并发症的独立影响因素。结论 超声引导下经皮FNA及CNB均可安全有效地诊断胰腺占位性病变;CNB诊断准确率及敏感度较高,而FNA并发症率较低。     

少针阳性前列腺穿刺活检的临床病理意义

目的 通过回顾性分析前列腺穿刺活检1～3针阳性并行前列腺癌根治术患者的临床病理资料,了解少针阳性前列腺穿刺结果的临床病理意义.方法 对58例前列腺穿刺活检阳性针数在1～3针并行前列腺癌根治术患者的临床病理资料进行对比分析,评价不同阳性针数的活检结果与根治术后病理分级的一致性,探索可能提示病理分级被低估的危险因素.结果 ...     

Comparison of the Tru-cut biopsy needle with the Abrams punch for pleural biopsy.

In a prospective study pleural biopsy specimens obtained with a Tru-cut needle were compared with those obtained with an Abrams pleural biopsy punch from 36 patients in Zimbabwe judged to have an effusion of at least 1.5 litres; one patient had two biopsies. Both instruments were used on each patient, the Abrams punch being followed by the Tru-cut needle. There were no serious complications. The diagnoses determined by biopsy were: tuberculosis (11); carcinoma (12); chronic inflammation (9); and pleural fibrosis (4); one biopsy showed nothing abnormal. In 23 (62%) patients both biopsy needles produced adequate diagnostic material; in eight the Tru-cut needle alone produced diagnostic material and in six the Abrams punch alone. Thus diagnostic material was obtained in 31 patients from the Tru-cut needle and in 29 from the Abrams punch. The Tru-cut needle was useful and safe for pleural biopsy in this series and appeared to be particularly useful when the pleura was thickened.     

胰头部肿块术中组织芯活检临床价值

目的 评价胰头部肿块术中组织芯活检的定性诊断价值.方法 对11 年间行胰头部肿块术中组织芯活检245 例患者的结果,结合手术后病理切片,进行比较和分析.结果 全组患者术中组织芯活检诊断结果示:胰头腺癌188 例(76.7%),慢性胰腺炎39 例(15.9%)、胰腺不典型增生8 例(3.3%)、胰腺神经内分泌肿瘤10 例...     

Value of Tru-cut biopsy in the diagnosis of soft tissue tumours

The light microscopic appearances of Tru-cut needle biopsies from 50 consecutive soft tissue tumours were assessed by three pathologists and compared with the definitive histological diagnosis. Forty-four patients had soft tissue sarcomas and six had benign soft tissue lesions. A correct predictive diagnosis of sarcoma was made on 87-98 per cent of adequate Tru-cut specimens, the accuracy varying between pathologists. Three sources of diagnostic error were recognized: false positive cores (8 per cent), false negative cores (8 per cent), and cores inadequate for diagnosis (16 per cent). The major source of confusion related to difficulties in differentiating infiltrating fibromatosis from malignant fibrous histiocytoma. The high sensitivity of Tru-cut needle biopsy suggests that it could be a valuable aid in the diagnosis of clinically suspected soft tissue sarcomas.     

The complementary role of fine needle aspiration cytology and Tru-cut needle biopsy in the management of breast masses

Fine needle aspiration cytology (FNA) and Tru-cut needle biopsy (TNB) have been used for the pre-operative diagnosis of cancer in breast masses as alternatives to open breast biopsy. The accuracy of clinical examination, fine needle aspiration biopsy and Tru-cut needle biopsy was assessed in 230 patients with palpable breast masses and the value of using both biopsy methods in the management was prospectively evaluated. Clinical diagnosis had a sensitivity of 89.2% and specificity of 78.4% (32.7% false positive, 6.5% false negative). Aspiration cytology was diagnostic in 78.4% of cancers and 71.6% of benign lesions [excluding non-diagnostic samples (27.4%), sensitivity was 96.6% and specificity was 100%]. Tru-cut needle biopsy identified 82.9% of cancers and 61.7% of benign lesions [excluding non-diagnostic samples (33.3%), sensitivity was 96.7% and specificity was 100%]. There were no false positive errors with either aspiration cytology or needle biopsy. Statistical comparison showed that there was no significant difference between aspiration cytology and needle biopsy. The combined result of both biopsies was superior to clinical examination when non-diagnostic samples were excluded. With the routine use of both biopsy techniques, frozen section was avoided in 73% of all cancers and unnecessary operations were avoided in 33.5% of patients which included breast cysts, benign mammary dysplasia and inflammatory lesions.     

Ultrasound-guided Tru-cut biopsy of the breast.

Ultrasound-guided automated Tru-cut needle biopsy may be used as an alternative to fine needle aspiration cytology for the assessment of discrete mass lesions of the breast. This is a retrospective study of 187 biopsies, comparing the results with a final diagnosis obtained from subsequent excision or outpatient follow-up. Biopsies were performed using a spring-loaded gun under ultrasound guidance. Invasive malignancy was demonstrated in 114 biopsies, 98 of which were subjected to surgery, with no false-positives. Twelve biopsies contained 'atypical cells', pre-invasive malignancy or risk factors for invasive carcinoma, ten of which proved to be invasive malignancy on excision. Normal or benign tissue was found in 61 biopsies, but of those that proceeded to excision biopsy, 16 were invasive or in situ carcinoma. The sensitivity of the procedure for detecting significant pathology was 88.7%, and the specificity 100%. When used as part of triple assessment, the sensitivity increases to 97.9%. Ultrasound-guided Tru-cut needle biopsy is a well-tolerated and reliable procedure for providing a tissue diagnosis of malignancy before definitive treatment, and obviating the need for formal excision biopsy of lesions for which there is a low index of suspicion.     

Testicular needle biopsy in diagnosis of infertility

Testicular needle biopsies were performed on 10 patients who at the same time underwent open testicular biopsy. The tracts and puncture sites were explored on each of these patients, and an open biopsy was obtained at the puncture site simultaneously. Both needle specimen and open tissue specimen were fixed in Bouin solution and sent for histologic examination. In none of the cases was there found to be bleeding or extrusion of the testis at the puncture site. In one of the needle specimens, however, insufficient tissue was obtained for diagnosis. In the other 19 specimens, diagnostic accuracy was not compromised by the technique. The main differences appear to be fewer tubules obtained by the needle technique as well as decreased preservation of the interstitial tissue. This is a rapid, simple, and inexpensive method for testes biopsy which has proved to be both safe and diagnostically accurate.     

A prospective controlled study of fine-needle aspiration and Tru-cut® needle biopsy of dominant thyroid nodules

In order to evaluate the relative merits of fine-needle aspiration (FNA) and Tru-cut^® needle biopsy (TNB), we conducted a prospective controlled trial in 384 patients who had dominant thyroid nodules. FNA had a slightly higher diagnostic yield and fewer complications than TNB. Definitive confirmation of the biopsy diagnoses was obtained in 41.1% of the patients. Both techniques achieved a very high degree of overall accuracy, and false-positive errors among non-follicular lesions occurred only in cases labeled as possibly malignant. However, neither method could reliably distinguish between a benign and malignant follicular neoplasm. Including follicular neoplasms as suspicious for malignancy, the individual sensitivity rates for cancer were 86.5% and 91.9% for FNA and TNB, respectively. The combined use of FNA and TNB, however, detected 97.3% of the 37 malignancies.Rather than demonstrating any overwhelming relative advantage, this study would support the use of both FNA and TNB to investigate dominant nodules. When combined with clinical information and imaging studies, needle biopsy can reduce the number of unnecessary operations without seriously compromising the removal of thyroid cancers.

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Resumen Con el propósito de evaluar los méritos relativos de la aspiración con aguja fina (AAF) y de la biopsia Tru-cut (BTC), establecimos un ensayo prospectivo controlado en 384 pacientes con nódulos tiroideos dominantes. La AAF exhibió un mejor rendimiento diagnóstico y menos complicaciones que la BTC. La confirmación definitiva del diagnóstico por biopsia fué obtenida en el 41,1% de los pacientes. Ambas técnicas lograron un muy elevado grado de certeza, y los errores positivos falsos ocurrieron sólo en lesiones no foliculares en casos señalados como posiblemente malignos. Sin embargo, ninguno de los dos métodos pudo distinguir en forma confiable la neoplasia folicular benigna de la maligna. Incluyendo las neoplasias foliculares como sospechosas de malignidad, las tasas de sensibilidad individual para cáncer fueron de 86,5% para AAF y de 91,9% para BTC. Sin embargo, el uso combinado de AAF y BTC pudo detectar el 97,3% de 37 tumores malignos.En vez de demostrar una ventaja abrumadora para ninguno de los métodos, este estudio da apoyo al uso tanto de la AAF como de la BTC en la investigacíon de nódulos tiroideos. Cuando se combina con la información clínica y con los procedimientos imagenológicos, la biopsia percutánea con aguja (AAF y la BTC) reduce el número de operaciones innecesarias sin comprometer la necesidad de resección de los cánceres tiroideos.

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Résumé Pour évaluer les mérites respectifs de la biopsie aspiration à l'aiguille et de la biopsie à l'aiguille tranchante, les auteurs ont procédé à une étude prospective contrôlée chez 384 sujets qui présentaient des nodules thyroïdiens. La première méthode permet plus de précision dans le diagnostic et présente moins de complications que la seconde. Le diagnostic porté grâce aux biopsies a été confirmé dans 41,1% des cas. Les deux méthodes atteignent un très haut degré d'exactitude et les faux positifs concernant les lésions autres que folliculaires n'ont été constatés que dans les lésions considérées comme potentiellement malignes.Cependant, aucune des deux méthodes ne permet la distinction entre tumeur folliculaire bénigne et maligne. Les tumeurs folliculaires susceptibles d'être malignes étant incluses, le taux de sensibilité a été de 86,5% pour la première méthode et de 91,90% pour la seconde. L'association des deux méthodes de biopsie a permis de porter le diagnostic exact dans 97,3% des 37 cas de tumeurs malignes.Plutôt que de démontrer la supériorité d'une méthode par rapport à l'autre, cette étude confirme la valeur de l'association des deux types de biopsie. En combinaison avec les données de la clinique et les données des explorations morphologiques, la biopsie à l'aiguille réduit le nombre des interventions inutiles, sans pour autant comporter le risque de laisser en place des cancers de la thyroïde.

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Presented at the International Association of Endocrine Surgeons at Hamburg, September 1983.

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Supported by grants from the University Research and Grants Committee, University of Hong Kong, and the Glaxo Company, Hong Kong.