����ø���Լ�������ٰ�����е�Ӧ���о�

目的 探讨乳腺肿块细针穿刺端粒酶活性检测在乳腺癌术前诊断中的临床应用价值。方法 对８５例乳腺肿块病人者细针穿刺,对穿刺细胞分别用端粒重复扩增法（ＴＲＡＰ）进行端粒酶活履检测和光镜细胞检查。以术后石蜡病理切片结果最地两种检测方法在术前诊断乳腺癌方面的灵敏度、特异性和约登指数进行了比较。结果 术前端粒酶活性检测同穿刺细胞学相比,特异性分别为７３．９％和８２．６％（Ｐ〉０．０５）,差异无显著性;灵敏度分     

端粒酶检测应用于乳腺癌术前诊断的价值

目的探讨端粒酶活性检测在临床的应用价值.方法在118例乳腺肿块患者中,分别比较了术前细针穿刺端粒酶活性检测和细胞学检查两种检测方法在乳腺癌中的诊断率,以及两种方法联合诊断乳腺癌诊断率.并对乳腺肿瘤端粒酶活性表达与乳腺肿瘤生物学特性的相关性进行了研究.结果端粒酶检测同细胞学检查相比灵敏度显著高于后者(85.4%vs.67.1%,P＜0.05);而特异性(72.2%vs.86.1%)、约登指数(57.6%vs.53.2%)、阳性预测值(87.5%vs.91.7%)差异均无显著性意义.两种方法联合诊断的阳性预测值为100%,显著高于阳性预测值较高的细胞学检查(P＜0.05).在乳腺癌中,端粒酶活性表达与雌激素受体、孕激素受体表达显著相关(χ2=5.03,P＜0.05),与患者年龄(χ2=0.65)、肿瘤直径(χ2=0.65)、腋淋巴结转移情况(χ2=0.16)无显著相关性(P＞0.05),在乳腺良性病变中,乳腺纤维腺瘤和乳腺病的端粒酶活性表达率显著高于其他病变(χ2=3.94,P＜0.05).结论细针穿刺端粒酶活性检测在乳腺癌术前诊断中具有较大应用价值.     

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。     

乳癌术前细针针吸细胞学替代术中切除活检的指征探讨

为探讨乳癌术前细针针吸细胞学选择性替代术中切除活检的可能性，对１９９５年９月～１９９６年５月间住院手术治疗的１１８例“乳房肿块”病人均行了术前临床触诊及细针针吸细胞学检查。结果显示：１１８例病人病理证实为乳癌者６９例。细针针吸细胞学检查诊断乳癌灵敏度为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％。提示：对于住院接受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；若针吸涂片查到癌细胞，则可免除术中切除活检而直接行根治性手术     

146例甲状腺结节细胞穿刺病理学分析

目的:探讨甲状腺细针穿刺细胞学检查的临床应用价值。方法:对146例甲状腺结节患者的术前细针穿刺检查结果及术后组织病理学检查结果进行比较。结果:细针穿刺细胞学检查判断甲状腺良恶性结节性质的敏感性、特异性和诊断准确率分别是87.2%、90.9%及89.7%,与组织病理学检查总体诊断符合率为89.7%,滤泡性腺瘤和术后组织病理学总体符合率有显著差异(P<0.05)。结论:甲状腺细针穿刺细胞学检查对于术前甲状腺结节性质判断价值较高,与术后组织病理学检查符合率较好。     

细针穿刺标本中端粒酶活性检测对甲状腺癌的诊断

目的　探讨甲状腺肿块细针穿刺活检 (FNAB )标本中端粒酶活性检测在甲状腺癌术前诊断中的应用价值。方法　在超声引导下穿刺抽取甲状腺组织FNAB标本 ,分别进行细胞学病理检查和端粒酶活性检测。以术后石蜡病理切片结果为最终标准 ,对以上两者结果进行对照、分析。结果　在 3 2例甲状腺癌中 ,FNAB的正确诊断率为 43 .8%(14 /3 2 ) ,端粒酶活性阳性率为 75 .0 %(2 4/3 2 ) ,两者相比有显著差异 (P <0 .0 5 )。在 18例甲状腺癌被FNAB诊断为“可疑阳性”、“取材不够”、“阴性”及“甲状腺炎”者中 ,14例显示端粒酶活性 ,阳性率为 77.8%(14 /18)。两者联合诊断率可提高至 87.5 %。结论　端粒酶活性检测是FNAB很好的辅助诊断方法 ,两者联合应用可明显提高FNAB标本的阳性诊断率。     

细针穿刺细胞学检查在涎腺肿块诊断中的应用

目的 :探讨细针穿刺细胞学检查在涎腺肿块诊断中的应用价值。方法 :对 13 7例涎腺肿块患者术前做细针穿刺细胞学检查 ,术后做常规组织病理检查 ,将两种方法所得结果对比 ,计算出符合率。结果 :13 7例细针穿刺细胞学检查与病理检查符合者 115例 ,占 83 .2 1% ,其中良性肿瘤相符者占 84.3 8% ,恶性肿瘤相符者为 82 .6% ,炎性包块为 84%。结论 :细针穿刺细胞学检查在涎腺肿块的诊断中具有重要价值     

针吸细胞学检查在乳癌诊治中的意义--附86例临床报告

乳腺肿块是乳癌病人最常见的症状 ,快速而准确的病理学诊断是乳癌病人合理治疗的依据和关键。近年来我院采用细针穿刺细胞学检查的方法结合术后病理切片诊断的结果比较 ,认为针吸细胞学检查有重要的临床意义 ,现总结报告如下。1　资料与方法1 1　一般资料　本组回顾总结有病理证实的乳癌病人 86例 ,术前均初步诊断为乳癌或怀疑乳癌。男1例 ,女 84例 ;年龄 2 2～ 74岁 ,平均 4 6岁。左侧乳腺肿块 4 6例 ,右侧 36例 ,双侧 4例。肿块直径 1～ 2cm者 2 6例 ,2～ 5cm者 4 8例 ,大于 5cm者 12例 ,其中多发性肿块 4例。1 2　方法　所有病人术前均行…     

细针穿刺细胞学检查对乳腺肿块的诊断价值

目的探讨细针穿刺细胞学检查(FNAC)对乳腺肿块的诊断价值。方法选取拟诊为乳腺恶性肿瘤而接受手术的116例乳腺肿块患者,术前实施FNAC检查,术中及术后行病理学检查。对比分析细胞学检查和病理学检查的结果。结果 FNAC检查结果显示良性肿瘤的44例中,病理学检查结果为42例,FNAC诊断的符合率为95.5%;FNAC检查结果为恶性肿瘤的72例中,病理学检查结果为70例,FNAC诊断的符合率为97.2%。结论乳腺肿块FNAC检查简便易行,快速准确,经济安全,对乳腺肿块的诊断和鉴别诊断具有较高的临床价值。     

湿细针穿刺细胞学检查对乳腺癌的诊断意义

目的探讨乳腺癌术前最佳病理学诊断方法. 方法对68例怀疑乳腺癌者用 7号针头、10 ml注射器进行湿细针穿刺细胞学检查. 结果 19例穿刺阳性找到癌细胞,无假阳性.余49例穿刺阴性中46例行乳腺区段切除, 1例术后石蜡切片为乳腺纤维肉瘤,其余均为良性病变;3例未行手术者随访 11～ 20个月均未发现乳腺癌.敏感性95.0%(19/20),特异性100%(48/48),准确率98.5%(67/68),假阴性率5.0%(1/20),假阳性率为0(0/48). 19例穿刺阳性无一例出现针道种植癌.无任何并发症. 结论湿细针穿刺细胞学检查具有安全、经济、方便、快速、痛苦小、准确率高的特点,可作为诊断乳腺癌的首选方法.     

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 Fine Needle Aspiration Biopsy Update 1998

Abstract: Breast ultrasound using a high-resolution, realtime, hand-held probe was performed on 19, 714 patients. Ultrasound-guided fine needle aspiration biopsy was done on 2,453 solid masses. We report on 2,075 of these lesions, 629 malignant and 1,446 benign, confirmed either by excisional biopsy or adequate follow-up. Of the cancers, 597 (95%) had either malignant or suspicious cytology with 1 false positive case and 32 false negative cytologic results. The diagnosis of cancer was delayed in four patients because of benign appearances on imaging and cytology. Surgery was performed promptly after the first imaging follow-up in each case. There was no delay in diagnosis in the remaining 11 patients because of the suspicious appearance of the masses on mammogram. Mammography missed 147 (23%) of the 629 cancers, 102 of which were clinically palpable. Forty-five cancers were both nonpalpable and not seen by mammogram (incidental cancers). A correct cytologic diagnosis, either fibroadenoma or nonspecific benign, was made in 1,339 of the 1,446 benign masses. The sensitivity of this technique in the diagnosis of solid breast lesions was 95%, the specificity was 93%, and the overall accuracy was 93%. We conclude that real-time, ultra sound-guided fine needle aspiration cytology is a valuable adjunct to the clinical, mammographic, and sonographic assessment of solid breast lesions.     

Wire-guided biopsies of nonpalpable breast lesions

The purpose of this study was to review the results of mammographic wire-guided biopsies of nonpalpable breast lesions and the features of the lesions in the preoperative examinations. Sixty women, mean age 50.2 years (range 31 to 74), underwent a wire-guided biopsy of the lesion. Twenty-nine patients had preoperative fine needle aspiration of the lesion. The radiographic diagnosis was correct in 33 patients (55%); 25 had breast cancer and 8 patients had a benign lesion. In 9 of the 14 patients with clustered microcalcifications in mammography and in 13 of the 15 patients with a mass noted in mammography, the cytological examination was correct. Nonpalpable mammographic masses with regular borders and normal fine needle aspiration examination do not require biopsy. In malignant mammographic appearances associated with a normal fine needle aspiration examination, biopsy of the lesion should always be done.     

Diagnostic value of ultrasound-guided fine-needle aspiration biopsy, core-needle biopsy, and evaluation of combined use in the diagnosis of breast lesions

BACKGROUND: To investigate whether ultrasound-guided core-needle biopsy (US-CNB) has more diagnostic value for breast tumors than ultrasound-guided fine-needle aspiration biopsy (US-FNAB) and to evaluate their combined use in patients with breast tumors. STUDY DESIGN: US-FNAB was carried out in 233 patients with breast tumors (254 lesions); both US-FNAB and US-CNB (combined biopsy) were performed in 81 of these patients (82 lesions). The diagnosis obtained by US-FNAB and US-CNB was compared with the surgical findings and the diagnostic value of US-CNB and combined biopsy were retrospectively evaluated. RESULTS: The sensitivity of US-FNAB was 86.9%, the specificity was 78.6%, and the accuracy was 84%. In contrast, the sensitivity of US-CNB was 86.2%, the specificity was 95.8%, and the accuracy was 89%. The specificity of US-CNB was significantly higher than that of US-FNAB and the inadequate biopsy rate of US-CNB was significantly lower than that of US-FNAB. For combined biopsy, the sensitivity, specificity, and accuracy were all 100%. The sensitivity, specificity, and accuracy of combined biopsy were significantly higher than those of US-FNAB. CONCLUSIONS: These findings suggest that US-CNB is more useful than US-FNAB, and that a combination of US-CNB and US-FNAB can markedly improve the preoperative diagnosis of breast cancer.     

Replace fine needle aspiration cytology with automated core biopsy in the triple assessment of breast cancer

All patients presenting with a symptomatic breast lump are assessed by means of triple assessment (clinical examination, radiology in the form of mammography and cytology by means of a fine needle aspiration) performed by the clinician in the rapid access breast clinic at the Royal Gwent Hospital, Newport, UK. In our initial experience, it was found that a significant number of patients were returning to clinic for the results of the triple assessment to find that the cytology was not conclusive and hence needed a core biopsy, thus delaying diagnosis and definitive treatment. Therefore, a prospective study was carried out over a 6-month period, where all patients presenting with a symptomatic lump with a clinical or radiological suspicion of breast cancer had, in addition to the standard triple assessment, an automated core biopsy, thus giving rise to the quadruple assessment of the breast lump. A total of 52 patients with a clinical or radiological suspicion of breast cancer were included over this 6-month period. Of these 52 patients, 31 had a definitive diagnosis of breast cancer on fine needle aspiration (sensitivity 60%) compared with 50 of the 52 patients on core biopsy (sensitivity 96%). When radiology was diagnostic of breast cancer (R 5), the sensitivity of cytology was 61% compared with 97% with core biopsy. However, when radiology was not diagnostic of cancer (R 1-4), the sensitivity of cytology fell to 53% while the sensitivity of core biopsy remained high at 95%. The overall cellularity rate for cytology was 96%, which exceeds the BASO requirement for fine needle aspiration cytology. From these results, we conclude that automated core biopsy has a superior diagnostic power when compared with fine needle aspiration cytology and hence should replace fine needle aspiration cytology in the assessment of symptomatic breast lumps.     

超声引导下乳腺癌细针穿刺标本中癌胚抗原和雌激素受体检测的临床意义

目的 探讨癌胚抗原（carcinoembryonic antigen,CEA)和雌激素受体（estrogen receptor,ER)的检测在乳腺癌早期、晚期辅助诊断中的临床意义。方法 采用放射免疫技术检测118例乳腺细针穿刺标本（69例乳腺癌，49例乳腺良性病变）中的CEA。并用免疫组化技术检测69例乳腺癌穿刺标本及相应组织切片的ER表达。结果 乳腺癌与乳腺良性病变组织中的CEA活性差异有显著意义（P＜0.01)，前者明显升高。乳腺癌细针穿刺标本和组织切片中ER表达有极显著的一致性（P＜0.01)，两者一致率为90％。结论 细针穿刺取材检测其CEA水平和ER表达，有助于早、晚期乳腺癌的诊断和制定合理的治疗方案。     

Accuracy of combined clinical-mammographic-cytologic diagnosis of dominant breast masses. A prospective study

Excisional biopsy is considered a mandatory part of the workup for patients with dominant breast masses. To evaluate the efficacy of a combined physical, mammographic, and fine-needle aspiration cytologic examination, 113 women were prospectively evaluated. Breast masses were listed as either benign or suspicious/malignant. All patients underwent a subsequent biopsy. Fifty-two (46%) of 113 patients had a malignant mass. The sensitivity and specificity of the individual tests were as follows: 96% and 66% for the physical examination; 94% and 73% for the mammographic examination; 90% and 93% for the fine-needle aspiration cytologic examination. For the 86 patients who underwent all three studies, the 25 patients with benign test results on all three examinations had a benign pathologic result. One (6%) of 18 patients with a single suspicious/malignant test result had cancer, 9 (64%) of 14 patients with two suspicious/malignant test results and 28 (97%) of 29 patients with three suspicious/malignant results also had breast cancer. We conclude that the combined triad of physical, mammographic, and fine-needle aspiration cytologic examinations is highly accurate in the diagnosis of breast masses, and patients in whom all three examination results are benign can be safely observed, obviating the need for an open biopsy.     

Preoperative axillary staging in breast cancer-saving time and resources

Abstract:  This study was performed to assess the feasibility and accuracy of ultrasound guided fine needle aspiration biopsy for axillary staging in invasive breast cancer. Data were collected prospectively from June 2005 to June 2006. In all, 197 patients with invasive breast cancer and clinically nonsuspicious axillary lymph nodes were included. Patients with suspicious nodes on ultrasound had fine needle aspiration biopsy. Those with fine needle aspiration biopsy positive for malignancy were planned for axillary nodes clearance otherwise they had sentinel node biopsy. Patients (41) had ultrasound guided fine needle aspiration biopsy. Three cases were excluded for being nonconclusive. Postoperative histology showed 18/38 cases (47.4%) axillary lymph nodes positive and 20/38 cases (52.6%) axillary nodes negative. Ultrasound guided fine needle aspiration biopsy was positive in 8/38 cases (21.1%), negative in 30/38 cases (78.9%). The sensitivity of ultrasound guided fine needle aspiration biopsy was found to be 47.1%, specificity 100%, positive predictability 100%, negative predictability 70%, and overall accuracy 76.3%. Ultrasound guided fine needle aspiration biopsy was found to be more accurate and sensitive when two or more nodes were involved, raising the sensitivity to 80% and negative predictability to 93.3%. Preoperative axillary staging with ultrasound guided fine needle aspiration biopsy in invasive breast cancer patients is very beneficial in diagnosing nodes positive cases. These cases can be planned for axillary lymph nodes clearance straightaway therefore saving patients from undergoing further surgery as well as time and resources.