淋巴组织细针吸取细胞HE染片褪色后作免疫组化的体会

目的探讨淋巴组织细针吸取细胞（FNAC）HE染片褪色后作免疫组化的效果。方法10例淋巴组织细针吸取细胞学HE染片,采用高锰酸钾一草酸褪色后应用免疫组织化学S—P法,对10例淋巴组织针吸细胞涂片进行标记,光学显微镜下观察染色效果。结果10例淋巴组织针吸细胞涂片经HE染色细胞学诊断：4例无恶性细胞,4例核异质细胞,2例可疑恶性细胞;活检石蜡切片诊断证实良性病变6例,恶性病变4例,良性符合率67％,恶性符合率50％。HE染片褪色行免疫组化标记后诊断：2例转移性癌,2例可疑恶性淋巴瘤,6例无恶性细胞,良性符合率100％,恶性符合率100％。10例淋巴组织针吸细胞涂片经HE染色细胞学诊断4例有分歧,经免疫组化标记后均能明确诊断。结论FNAC检查对初筛淋巴结疾患的良恶性判断及肿瘤分型有重要意义;淋巴组织细针吸取细胞HE染片褪色后行免疫组化染色,方法简便易行,在病理诊断中有一定的应用价值,为细胞学诊断和鉴别诊断提供了一个新的手段,从而进一步提高细胞学诊断水平。     

甲状腺乳头状癌术后超声引导下淋巴结穿刺195例的临床分析

目的分析甲状腺乳头状癌术后颈部复发、转移性淋巴结的超声表现,探讨超声引导下细针穿刺细胞学检查在甲状腺乳头状癌术后颈部淋巴结转移的应用价值。方法收集我院甲状腺乳头状癌术后接受颈部淋巴结超声引导下细针穿刺的195例患者的资料,分析转移性淋巴结超声影像学特点与病理结果的关系。结果 195例患者中共277枚淋巴结接受穿刺检查,其中86例(123枚)淋巴结为转移性,占穿刺淋巴结的44.4%,复发或转移的淋巴结多分布于颈部III区(33.3%)及IV区(42.3%),超声特征性表现为长径/短径(L/S)比值小、回声分布不均匀、常伴有点状强回声、Adler血流分级2~3级,与非转移性淋巴结相比,差异有统计学意义(P0.01)。结论甲状腺癌术后颈部转移性淋巴结具有特征性超声表现,超声引导下的颈部淋巴结细针穿刺细胞学检查是一种简便且安全有效的确诊手段,有助于指导患者的进一步治疗。     

超声引导下细针吸取细胞学检查在体表肿物诊断中的应用

目的探讨超声引导下细针吸取细胞学检查在体表肿物诊断中的应用价值。方法2010年8月-2012年8月对149例患者167个浅表肿物进行超声引导下细针吸取细胞学检查,将穿刺细胞学诊断资料与手术病理及临床随访结果进行对照分析。细胞学诊断结果分为良性、恶性、可疑恶性及吸出物不足4类。结果超声引导下167个结节共计实施穿刺操作293次,一次性穿刺成功率96．2％,二次穿刺成功率100％。167个结节中,经病理及临床随访证实20个结节为恶性,147个结节为良性;经细胞学诊断132个（79．0％）结节为良性,14个（8.4％）结节为恶性,6个（3．6％）结节为可疑恶性,15个（9．0％）结节为吸出物不足,细胞学诊断敏感性为79．2％,特异性为87．5％,准确性为91．0％。结论超声引导下细针吸取细胞学检查对于浅表肿物诊断具有实时观察、准确安全、创伤小等优点,标本满意率及病理诊断准确性高,可作为体表肿物诊断的首选方法。     

超声引导下粗针、细针穿刺活检在直径>1 cm可疑甲状腺结节中诊断应用

目的探讨超声引导下细针穿刺细胞学检查、粗针穿刺组织学检查在直径>1 cm可疑甲状腺结节诊断中的应用价值。方法选取自2016年10月至2019年8月曲靖市第一人民医院收治的176例直径>1 cm的可疑甲状腺结节患者为研究对象。所有患者均先在超声引导下进行细针穿刺细胞学检查或粗针穿刺组织学检查。记录两种方法诊断可疑甲状腺结节的大小,假阳性率、假阴性率、诊断符合率,以及并发症情况。结果 64例患者进行了粗针穿刺组织学检查,其中,12例患者结节直径1～2 cm,27例患者结节直径2～3 cm,25例患者结节直径>3 cm。112例患者进行了细针穿刺细胞学检查,其中,43例患者结节直径1～2 cm,48例患者结节直径2～3 cm,21例患者结节直径>3 cm。两种方法检测的假阳性率、假阴性率比较,差异有统计学意义(P<0.05)。两种方法检测的诊断符合率比较,差异无统计学意义(P>0.05)。粗针穿刺组织学检查的并发症发生率为40.6%(26/64),高于细针穿刺细胞学检查的8.9%(10/112),差异有统计学意义(P<0.05)。结论超声引导下粗针与细针穿刺活检诊断直径>1 cm的可疑甲状腺结节,均有效、可行。在保证患者安全的前提下,可根据患者要求及临床推荐、超声评估等多种手段,选择适当的穿刺活检方法对结节进行诊断。     

细针穿刺、超声及甲状腺球蛋白对分化型甲状腺癌清甲后颈部肿大淋巴结诊断价值的比较

目的 探讨DTC手术和131I治疗后细针穿刺细胞学（FNAC）检查对颈部肿大淋巴结定性诊断的价值,并与超声、Tg和TgAb检测作比较.方法 61例经手术和131I清除残余甲状腺组织（简称清甲）治疗后的DTC患者,经体格检查或超声检查发现颈部淋巴结肿大,随后1周内对可疑淋巴结行超声引导下FNAC检查,并将检查结果与同期超声、Tg和TgAb结果进行对比.最终诊断根据病理、治疗后131I全身显像（Rx-WBS）及临床随访作出.3种检查方法间诊断效能的比较采用x2检验和Fisher确切概率法.结果 61例患者中,共58例患者获FNAC诊断,3例不能定性,经综合评判,淋巴结恶性40例,良性18例.39例经FNAC检查确诊为恶性者中20例经手术切除,19例行131I清除转移灶治疗;FNAC与术后病理诊断符合率为100％ （20/20）,与Rx-WBS的符合率为78.9％（15/19）;19例经FNAC检查确诊为良性淋巴结者中15例持续随访3～6个月,余4例行131I治疗;FNAC与随访结果符合率为93.3％（14/15）,与Rx-WBS均符合（4/4）.FNAC检查、超声、Tg和TgAb检测诊断DTC转移淋巴结良恶性的灵敏度分别为97.5％ （39/40）、87.5％（35/40）、92.5％ （37/40）,特异性分别为100％（18/18）、55.6％ （10/18）、72.2％ （13/18）,准确性分别为98.3％（57/58）、77.6％（45/58）、86.2％（50/58）;FNAC检查的准确性明显高于超声、Tg和TgAb（x2=4.336和11.697,均P＜0.05）,而超声与Tg和TgAb检测之间准确性的比较差异无统计学意义（X2=1.450,P〉0.05）.超声与TS和TgAb检测结果一致者39例,与FNAC检查的符合率为97.4％ （38/39）;超声与Tg和TgAb检测结果不一致者19例,经FNAC检查证实4例为恶性,15例为良性.结论 对DTC患者颈部肿大淋巴结的良恶性诊断,FNAC检查明显优于超声与Tg和TgAb检测.当随访中超声与Tg和TgAb结果不一致,可作为FNAC检查的应用指征.     

食管癌病人锁骨上淋巴结的US和US导向细针抽吸活检

应用US和US导向细针抽吸活检(UGFAB)技术,对经组织学证实的37例食管癌患者行锁骨上淋巴结活检。10例病人US显示锁骨上淋巴结肿大,其中2例可触及。对直径大于5mm的淋巴结做UGFAB。单侧多个淋巴结肿大者,穿刺最大淋巴结,双侧淋巴结肿大者,则穿刺两侧最大淋巴结。涂片的细胞学检查证实7例有锁骨上淋巴结转移,其中5例经CT、US发现有腹腔淋巴结、纵隔淋巴结和其它部位转移,余2例未发现胸、腹淋巴结转移,该7例病人不再行手术治疗。3例细胞学检查阴性者,CT和US也未发现有胸、腹淋巴结结转移灶。锁骨上淋巴结是食管癌的常见转移部位,CT常难以做出正确评价。因其表浅UGFAB技术简便易行,又无甚痛苦,可确定肿大淋巴     

颈部淋巴结在超声弹性引导下细针穿刺与二维超声引导下粗针穿刺的对比研究

目的比较颈部淋巴结在超声弹性引导下细针穿刺与二维超声引导下粗针穿刺的临床价值。方法回顾性分析经病理证实的肺癌伴颈部淋巴结转移的患者180例。试验组和对照组各90例。试验组由超声弹性引导下细针穿刺,对照组由二维超声引导下粗针穿刺,其中45例由16G活检针针吸,45例由18G活检针针吸。观察各组标本的取样成功率和准确率。结果由弹性指导细针穿刺取样成功率均为100%(90/90),由二维超声引导下粗针穿刺的取样成功率均为98.9%(89/90),差异无统计学意义(P0.05)。弹性引导细针穿刺针吸的取样准确率为91.1%(82/90),二维超声引导下粗针穿刺针吸的取样准确率为87.8%(79/90),差异无统计学意义(P0.05)。运用16G活检针取样准确率为86.7%(39/45),18G活检针取样准确率为88.9%(40/45),差异无统计学意义(P0.05)。结论超声弹性引导下细针穿刺与二维超声引导下粗针穿刺颈部淋巴结均具有较高的取样成功率和准确率。在明确细胞学的结果中,超声弹性引导下细针穿刺的取样准确率高于二维超声引导下粗针穿刺,但在诊断价值中无显著性差异。     

18例细针吸取细胞学超微结构观察

１８例细针吸取细胞学超微结构观察梁茹★邹赛英★关键词针吸活组织检查病理诊断学电镜中国图书资料分类法分类号Ｒ４４６．８细针穿刺细胞学诊断已广为应用，在临床病理诊断中有些特殊病例仅靠光镜诊断有一定困难，需借助免疫组织化学、电镜等手段来正确诊断。我室以细针...     

超声引导下淋巴结经皮穿刺活检对颈部肿大淋巴结的诊断价值

目的 :探讨超声引导下淋巴结经皮穿刺活检术(percutafleous needle core biopsy,PNCB)对颈部肿大淋巴结诊断的应用价值。方法:选择104例颈部淋巴结肿大的患者,对其行常规超声检查、PNCB病理诊断及手术切除淋巴结病理诊断。统计进针次数、成功率、PNCB取材效果,并评价结果。将手术切除标本病理学检查结果为金标准,分为恶性(阳性)与良性(阴性),采用ROC分析方法计算常规超声与PNCB病理诊断的敏感度、特异度、阳性预测值、阴性预测值及准确率。结果 :104例均进针3~6次,共穿刺415针,其中386针适合进行病理学检查,成功率93.01%。415针穿刺取材效果评价分4级结果为:优202针,良141针,一般43针,差29针;术后病理学诊断显示,颈部淋巴结结核31例,炎性增生淋巴结5例,恶性淋巴瘤16例,转移或浸润癌52例。PNCB病理诊断除1例将转移癌诊断为炎性增生淋巴结外,其余病理诊断与术后病理学诊断一致;常规超声诊断敏感度97.06%、特异度75.00%、阳性预测值88.00%、阴性预测值93.10%、准确率89.42%,PNCB的病理诊断的敏感度98.53%、特异度100%、阳性预测值100%、阴性预测值97.36%、准确率99.04%。结论 :PNCB诊断颈部肿大淋巴结安全、易操作,且标本满意率及病理诊断准确性高,值得临床推广。     

应用末端切割针对颈部病变行超声引导下活检

颈部肿块的治疗方案决定于其性质、部位和范围。治疗前常需行细针穿刺细胞学检查(FNAC)或芯块组织活检以获取病理诊断。由于多种原因的影响,回报的细胞学结果常常不能满足诊断要求。我们使用的末端切割针设计独特,是超声引导下经皮和经口腔对颈部病变活检的良好     

早期乳腺癌的CR、B超联合针吸细胞学诊断与病理对照分析

目的:探讨钼靶CR摄影、高频超声及针吸细胞学在乳腺肿块术前检查的联合应用,提高早期乳腺癌的诊断符合率。方法:对经手术病理确诊的126例早期乳腺癌(病灶直径≤2.0cm)与术前钼靶CR摄影、高频超声及针吸细胞学联合检查进行对比,分别得出诊断符合率。结果:钼靶CR摄影、高频超声、针吸细胞学及三种检查方法联合应用的诊断符合率分别为85%、83%、91%、98%。结论:对乳腺肿块患者进行术前联合检查是诊断早期乳腺癌的有效方法。     

Complicated Breast Cysts on Sonography: Is Aspiration Necessary to Exclude Malignancy?

RATIONALE AND OBJECTIVES: To determine the incidence of breast cancer in women presenting for fine needle aspiration of sonographically diagnosed complicated breast cysts. MATERIALS AND METHODS: Institutional review board approval was obtained. A retrospective study was performed of 186 consecutive women who presented for fine needle aspiration of 243 sonographic complicated cysts detected by clinical examination or imaging between January 2002 and August 2003. Sonographic complicated cysts were defined as those meeting most but not all criteria for simple cysts similar to current Breast Imaging Reporting and Data System classification. We excluded solid masses, cysts with solid components, intracystic masses, and simple cysts. Prospective mammography, ultrasound, and procedure reports were reviewed. A case was considered positive if cytology, core needle biopsy, or surgical excision was positive for cancer. Final diagnosis was established by biopsy, cytology, clinical resolution, or stability over time. RESULTS: One of 243 (0.4%) lesions proved malignant (95% confidence interval 0-1.94%); 210/243 (86.4%) of cases yielded fluid on aspiration. Of 141 samples submitted to cytology, 138 (97.9%) were benign and 3 (2.1%) atypical. All cases of atypia were benign at surgical excision. Ninety five of 243 (39.1%) aspiration samples with typical cyst fluid were discarded. A total of 33/243 (13.6%) cases did not yield fluid, 1 of which was positive for cancer. Thirty cases underwent core needle or excisional biopsy for imaging discordance with benign results. CONCLUSIONS: Breast cancer presenting as a complicated cyst by ultrasound was rare (0.4%, 95% confidence interval 0-1.94%). These results provide support for classification of complicated cysts as probably benign.     

甲状腺病变的液基细胞学诊断病理分析

 目的 探讨液基细胞学方法处理标本在甲状腺病变针吸细胞学诊断的应用价值。 方法 采用利普液基细胞学（liquid-PRER,LPT）和传统手工制片方式对229例甲状腺病变患者细针穿刺细胞学诊断结果,并对两种制片方法进行比较。 结果 应用LPT技术保存标本和制片,诊断性细胞数量明显增多,背景清洁,分布均匀,玻片中较少见到甲状腺胶质,而核细节更容易观察。LPT制片甲状腺癌的阳性诊断率6.55%(15/229),传统涂片3.93%（9/229）。 结论 LPT技术用于甲状腺细针穿刺能明显提高标本质量和甲状腺癌阳性诊断率,为诊断甲状腺病变提供了一种可靠而有前景的诊断方法。     

针吸细胞学检查3200例分析

目的　了解针吸细胞学检查的成功率、符合率及在临床上的应用价值。方法　在影像定位或影像增强装置引导下 ,局麻后将穿刺针快速刺入肿物内 ,负压抽吸 2～ 3次后拔出针头 ,涂片检查。结果　 3 2 0 0例中成功 3 187例 ,占99 5 9% ,失败 13例 ,占 0 41%。与术后病理诊断符合率为 99 45 %。结论　该方法简便、迅速、准确、且痛苦小 ,无明显禁忌症。     

Cytopuncture of lymph nodes opacified by lymphography in the pretreatment evaluation of prostatic cancer

Fine needle aspiration of iliac lymph nodes after lymphography was performed in nineteen patients with prostatic carcinoma, ranging from stage A to C. In four patients (21%), fine needle aspiration showed lymph node dissemination. 3 patients were classified as stage B, and 1 as stage C before aspiration. In this study, fine needle aspiration biopsy proved to be useful in the staging of prostatic carcinoma.     

Ultrasound-guided fine needle aspiration cytology of carcinoma involving the intra-abdominal oesophagus.

Ultrasound-guided fine needle aspiration cytology (FNAC) of carcinoma of the intra-abdominal oesophagus was attempted on 21 patients with a 21 G spinal needle using a percutaneous anterior epigastric approach. The results were compared with those of endoscopic biopsy and brush cytology. The ultrasound-guided FNAC had a positive yield in 20/21 (95.2%) compared with 18/21 (85.7%) for endoscopic biopsy and 18/21 (85.7%) for brush cytology (P greater than 0.59). The combination of US-guided FNAC with endoscopic biopsy and the brush cytology achieved a positive yield in 21/21 (100%) whereas combining endoscopic biopsy and brush cytology produced a positive yield of 19/21 (90.5%). Two patients developed temporary epigastric pain. We recommend US-guided FNAC as a safe and effective technique that can be used alone or as an adjunct to endoscopic procedures for the diagnosis of carcinoma of the intra-abdominal oesophagus.     

超声引导粗针活检在诊断甲状腺结节中的应用价值

目的：探讨超声引导下粗针活检（ultrasound-guided core-needle biopsy,US-CNB）在诊断甲状腺结节中的应用价值。方法将术前超声诊断为甲状腺恶性结节的120例患者分为两组,观察组60例,采用超声引导下粗针活检;对照组60例,采用超声引导下细针穿刺细胞学检查（fine needle aspiration cytology ,FNAC）。比较两组病例取材满意度、诊断准确性和安全性。结果观察组取材满意度、诊断准确性明显高于对照组,差异具有统计学意义（P＜0.05）。两组敏感性、特异性、阳性预测值、阴性预测值和并发症比较,差异无统计学意义（P＞0.05）。结论超声引导下粗针活检甲状腺结节取材满意度和诊断准确性高于细针活检,同时也安全可靠,更值得临床推广应用。     

Differentiation of malignant and benign solitary thyroid nodules using 30- and 120-minute tc-99m MIBI scans

Technetium-99m methoxy isobutylisonitrate (MIBI) has been found to be taken up by various tumors, including thyroid cancer. We prospectively evaluated 77 patients with cold thyroid solitary nodules on Tc-99m pertechnetate scintigraphy to evaluate the diagnostic value of Tc-99m MIBI scintigraphy. The aim of this study was to find out if thyroid nodules can be characterized on the basis of retention of MIBI and whether preoperative evaluation of malignancy is possible using this method. Single injection, dual-phase (30 and 120 minutes) thyroid scintigraphy using Tc-99m MIBI was performed in all these patients. In the following days and weeks, all patients underwent surgery. Using the 120/30-minute thyroid lesion to background radiouptake ratio (RUR), malignant and benign thyroid nodules could be separated with a sensitivity, specificity, and positive predictive value of 84.4%, 95.45%, and 93.33%, respectively. The mean RUR for malignant thyroid lesions was found to be 1.57+/-0.32, whereas for benign lesions, the ratio was significantly lower, 0.32+/-0.19. In conclusion, fine needle aspiration cytology along with the 120/30 minutes Tc-99m MIBI scintigraphy ratio appears to be useful in the preoperative assessment of solitary thyroid nodules.     

TLT制片技术在甲状腺FNAC标本制作中的应用价值探讨

目的探讨TLT制片技术在甲状腺FNAC标本制作中的应用价值。方法对120例甲状腺细针穿刺标本,分别采用液基薄层细胞制片技术和传统制片技术进行制作,并对标本质量进行对比分析。结果采用液基薄层细胞制片技术所得标本中,诊断性细胞明显增多,细胞呈单层均匀分布,排列清晰,背景干净,具有诊断参考意义的成分得到部分保留。结论液基薄层细胞制片技术能明显提高甲状腺FNAC标本的质量和诊断准确率,具有临床应用价值。     

Imprint cytology from ultrasound-guided core biopsies: accurate and immediate diagnosis in a one-stop breast clinic

AIM: To investigate whether imprint cytology from ultrasound-guided core biopsy specimens was adequate for the National Health Service Breast Screening Programme (NHSBSP) guidelines. METHODS: We prospectively audited imprint cytology from ultrasound-guided core biopsy specimens. The performance indicators for imprint cytology specimens from 111 consecutive ultrasound-guided core biopsy were compared with standards set by the NHSBSP for fine-needle aspiration cytology (FNAC). RESULTS: Imprint cytology fulfilled the "preferred" targets for absolute and complete sensitivity, specificity, positive predictive value, false-positive and false-negative rates, inadequate rate and inadequate rate from cancers. It also satisfied the minimum target for suspicious rate. The complete sensitivity was 97%, full specificity 78%, with 100% positive predictive value for C5 cytology and an inadequate rate from cancers of 1.5%. CONCLUSION: Imprint cytology from ultrasound-guided core biopsy allows same-day diagnosis and the collection of data regarding the grade of the carcinoma for treatment decisions from a single needle test.