CT导向肺穿刺标本P53、PCNA蛋白的表达

目的　运用流式细胞仪 (FCM)检测肺穿刺标本P5 3蛋白、增殖细胞核抗原 (PCNA)表达 ,探讨其与肺癌的关系。方法　FCM检测 6 6例穿刺标本P5 3蛋白、PCNA表达。结果　① 5 3例肺恶性病变组穿刺敏感度为 94 .3% ,6 6例总穿刺准确度为 90 .9% ,气胸发生率 4 .6 %。② 5 3例肺恶性、13例良性病变中 ,P5 3蛋白表达为 2 9.9%± 2 .7%和 17.9%± 2 .8% ,差异有显著性 (t=2 .0 ,P <0 .0 5 ) ;PCNA表达为2 7.7%± 3.0 %和 12 .2 %± 1.4 % ,差异有显著性 (t=2 .0 ,P <0 .0 1)。③ 33例P5 3蛋白阳性组与 2 0例P5 3蛋白阴性组间PCNA表达为 33.0 %± 4 .2 %和 19.7%± 3.3% ,差异有显著性 (t=2 .0 ,P <0 .0 5 )。④本组肿瘤病灶直径 >3.0cm ,P5 3蛋白显著高于病灶≤ 3cm ;肿瘤有深分叶征者 ,P5 3蛋白、PCNA显著高于浅分叶征者 ;肿瘤有棘突征者 ,P5 3蛋白显著高于无棘突征者 (χ2 =6 .10 ,P <0 .0 5 ) ;CT检查有肺门纵隔淋巴结转移者 ,P5 3蛋白显著高于无淋巴结转移者 (χ2 =9.71,P <0 .0 1)。P5 3蛋白、PCNA表达与毛刺征、胸膜凹陷无关 (t =2 .0 ,P >0 .0 5 )。⑤P5 3、PCNA表达与肺癌病理类型、肿瘤分期无关 (t =2 .0 ,P >0 .0 5 )。结论　运用FCM检测CT导向肺穿刺标本P5 3、PCNA蛋白表达 ,有助于肺癌的诊断及了解肺     

p~(16)蛋白在不同性质肺部肿块中的表达及意义

目的　通过检测不同性质肺部肿块中 p16蛋白阳性率 ,探讨 p16在鉴别良、恶肿块中的价值。方法　对经病理确诊性质的肺部肿块 5 0例 (其中肺癌 2 5例 ;结核瘤 12例 ;炎性组织 13例 ) ,行 p16蛋白测定 (即用型SABC法 ) ,并计算不同性质肺部肿块 p16蛋白表达阳性率。结果　肺癌组织、结核瘤、炎性肿块中 p16蛋白阳性率分别是 4 8% ,75 % ,84 6 %。结论　p16基因缺失与肺癌发生有关 ,利用 p16蛋白阳性率评估肺部肿块的良、恶性是有价值的     

HnRNPA2/B1与肺癌的早期诊断

目的　研究核内不均一核糖核蛋白A2 /B1(HnRNPA2 /B1)与肺癌的相关性及其用于肺癌早期诊断的可行性。方法　利用RT -PCR方法分别扩增癌组织、癌旁组织、正常组织、良性病变组织、纤支镜和经皮穿刺肺活检标本中HnRNPA2 /B1外显子 1～ 2 ,分析比较其表达水平的差异及变化趋势。结果　①HnRNPA2 /B1在正常肺组织、癌旁组织、肺癌组织中表达水平依次增高 ,其阳性率分别为 6 .98%、37.2 %、76 .7%,三组比较有显著性差异 (Ρ <0 .0 5 ) ;HnRNPA2 /B1表达水平在不同的病理类型中的表达阳性率虽有不同 (鳞癌 88.2 %,小细胞肺癌 5 7.1%) ,而且随病理分化程度的降低而增高 ,但是均无统计学差异 (Ρ >0 .0 5 )。②纤支镜和经皮穿刺肺活检标本中HnRNPA2 /B1外显子 1～ 2mRNA阳性率为 6 0 %( 6 /10 ) ,与手术标本的癌组织阳性率比较稍低 ,但无统计学差异(Ρ >0 .0 5 )。结论　HnRNPA2 /B1是肺癌发生、发展过程中的早期事件 ,有可能用于肺癌的早期诊断。     

肺癌的早期诊断—CT与p53、p16对比研究

目的　研究非小细胞肺癌 (NSCLC)的CT征象与 p5 3、p16基因蛋白异常表达之间的相关性。 方法　应用免疫组化SABC法检测 5 2例经手术病理证实的周围型非小细胞肺癌 (NSCLC)石蜡包埋标本 p5 3、p16基因蛋白表达 ,并与相应的CT征象作对比研究。结果　 (1)正常肺组织、癌旁肺组织和肺癌组织中 ,p5 3基因蛋白阳性表达率分别为 0 .0 %、45 .0 %、63 .5 % ;p16基因蛋白阳性表达率分别为 85 .7%、5 5 .0 %、45 .0 %。 (2 )CT显示NSCLC肿块轮廓出现深分叶征、棘状突起征 ,边缘出现短毛刺征组 p5 3蛋白表达率高 ,p16蛋白表达率低。结论　CT征象与p5 3、p16等分子生物学指标对比观察 ,有助于提高肺癌的早期诊断水平。     

巢式PCR测定肺癌患者外周血CEA-mRNA和CK19-mRNA的临床意义

 目的研究肺癌患者外周血中CEA-mRNA、CK19-mRNA的表达及其联合检测的临床意义.方法采用巢式PCR技术检测43例肺癌患者、12例肺良性疾病患者和13例健康人外周血CEA-mRNA、CK19-mRNA的表达,结合肺癌患者常规病理检查、肿瘤类型、临床分期对检测结果的敏感性、特异性进行统计学分析.结果43例肺癌外周血标本中CEA-mRNA阳性21例(48.8%),CK19-mRNA阳性24例(55.8%);12例肺良性病变中CK19-mRNA阳性1例(8.3%),CEA-mRNA均为阴性;13例健康人外周血中CEA-mRNA、CK19-mRNA的表达均为阴性.在小细胞肺癌、腺癌、鳞癌中,CEA-mRNA的表达阳性率分别为16.7%、81.3%、33.3%,CK19-mRNA的表达阳性率分别为33.3%、50.0%、66.7%.Ⅲ、Ⅳ期肺癌CEA-mRNA和CK19-mRNA的表达阳性率高于Ⅰ-Ⅱ期.结论CEA-mRNA、CK19-mRNA可作为标志物来检测肺癌患者外周血微转移,联合检测有助于提高准确性.     

CT引导下肺小结节(≤1.5cm)穿刺活检结果研究

目的探讨CT引导下经皮肺穿刺术在对小于等于1.5cm肺内结节诊断中的应用价值。方法回顾性分析68例收入院行肺穿刺活检病例,所有肺结节病灶直径界于1.5~0.8cm,通过对比穿刺结果及临床随访结果,评估该诊断方式的有效性及安全性。结果所有患者均顺利完成穿刺过程,未见严重并发症。67例患者成功获得细胞或组织标本,成功率为98.5%。其中,穿刺活检证实恶性结节31例,临床随访证实恶性结节35例,恶性病变穿刺诊断阳性率为88.5%;穿刺活检结果为良性及阴性结果共35例,其中4例证实为恶性病变,恶性病变穿刺诊断假阴性率为11.4%;所有患者共有53例患者穿刺结果与临床结果基本一致,临床符合率为77.9%。结论 CT引导向下经皮肺穿刺术可安全、有效诊断肺内小结节病灶,是早期肺癌诊断的重要手段。     

非小细胞肺癌(NSCLC)p16基因甲基化改变及p16蛋白表达研究

目的分析非小细胞肺癌(NSCLC)及癌周正常肺组织p16基因甲基化改变及p16蛋白表达情况。 方法选取各种病理类型的非小细胞肺癌(NSCLC)标本共40例作为研究对象,同时选取癌组织周围的正常肺组织作为对照。运用甲基化特异性PCR(MSP)方法检测肺癌标本及周围正常肺组织中p16基因的甲基化改变情况,运用免疫组化方法检测p16蛋白在肺癌标本及周围正常肺组织中的表达情况。 结果①40例肺癌标本中,29例发生了p16基因甲基化。而其周围正常肺组织只有5例发生了p16基因甲基化。二者有明显差异(P<0.01)。②40例肺癌标本中,26例p16蛋白表达降低,而其周围正常肺组织只有5例蛋白表达降低,二者有明显差异(P<0.01)。③29例p16基因发生了甲基化改变的肺癌标本中,有22例发生了p16蛋白表达降低。在11例未发生p16基因甲基化改变的肺癌标本中,有4例发生了p16蛋白表达降低。 结论p16基因甲基化是导致非小细胞肺癌(NSCLC)p16蛋白表达降低的重要机制。     

低剂量CT引导经皮肺穿刺活检术联合肿瘤标志物对肺癌的诊断价值

目的探讨低剂量CT引导经皮肺穿刺活检术联合肿瘤标志物对肺癌的诊断价值。方法回顾性分析我院275例肺肿块患者,采用18G半自动切割活检针,经CT引导行肺穿刺活检术获取病理诊断,结合肿瘤标志物,评价其在肺癌诊断中的价值。结果 275例经皮肺穿刺活检术均穿刺成功,穿刺成功率为100%。敏感度、特异度、准确度分别为:97.01%、100%、97.82%。肺穿刺阴性肺癌与良性病变NSE阳性率的差异有统计学意义(P=0.020);肺穿刺阴性肺癌与良性病变CEA、CYFRA21-1阳性率的差异无统计学意义(P=0.256、P=0.155)。结论经皮肺穿刺活检术具有安全性高,并发症少,对肺癌具有较高的诊断准确率,联合肿瘤标志物可提高肺穿刺阴性肺癌的诊断准确率。     

CT引导下经皮肺穿刺活检物端粒酶活性检测

目的　研究CT引导下经皮肺肿块穿刺活检物端粒酶活性在肺癌诊断中的价值。方法　采用银染 TRAP法测定 43例肺肿块穿刺活检物端粒酶活性。结果　 43例肺肿块经病理确诊肺癌 32例、肺良性病变 11例 ;32例肺癌中端粒酶阳性率为 87.5 % (2 8/ 32 ) ,而 11例肺良性病变中端粒酶阳性率为 9.1% (1/ 11)。结论　CT引导下经皮肺穿刺活检物端粒酶活性测定 ,可作为诊断肺癌的有效指标 ,端粒酶可成为肺癌的肿瘤标志物     

肺癌的早期诊断一CT与p53、p16对比研究

目的研究非小细胞肺癌(NSCLC)的CT征象与p53、p16基因蛋白异常表达之间的相关性.方法应用免疫组化SABC法检测52例经手术病理证实的周围型非小细胞肺癌(NSCLC)石蜡包埋标本p53、p16基因蛋白表达,并与相应的CT征象作对比研究.结果(1)正常肺组织、癌旁肺组织和肺癌组织中,p53基因蛋白阳性表达率分别为0.0%、45.0%、63.5%;p16基因蛋白阳性表达率分别为85.7%、55.0%、45.0%.(2)CT显示NSCLC肿块轮廓出现深分叶征、棘状突起征,边缘出现短毛刺征组p53蛋白表达率高,p16蛋白表达率低.结论CT征象与p53、p16等分子生物学指标对比观察,有助于提高肺癌的早期诊断水平.     

CT-guided cutting needle biopsy of lung lesions--an effective procedure for adequate material and specific diagnose

Objective

Computed guided percutaneous biopsy of lung lesions is widely accepted as an effective and safe procedure for specific diagnose. The purpose of this study is to present the experience of an oncology center in the use of computed tomography (CT)-guided cutting needle biopsy as an effective procedure for adequate material and specific diagnose of lung lesions.

Subjects and methods

This study reports a retrospective analysis of 94 consecutive patients admitted in an oncologic center, reference in Brazil (Hospital do Câncer—AC Camargo), between 1996 and 2004, who were submitted to 97 CT guided cutting needle biopsy of pulmonary lesions. Informations of material adequacy and specific diagnose were studied.

Results

In a total of 97 biopsies of lung lesions, 94 (96.9%) supplied adequate material for histological analyses with 71 (73.2%) as malignant lesions and 23 (23.7%) diagnosed as benign lesions and in 3 biopsies the material supplied was inadequate. The frequency of specific diagnosis was higher in both malignant and benign lesions with 63 (88.7%) cases and 20 (86.7%) cases respectively.

Conclusions

CT-guided cutting needle biopsy is an effective procedure for adequate material and specific diagnostic for malignant and benign lung lesions.     

Accuracy of CT-guided transthoracic needle biopsy of lung lesions: Factors affecting diagnostic yield

PURPOSE: This study was performed to analyse the variables affecting the diagnostic accuracy of computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions. MATERIALS AND METHODS: A retrospective study of 612 consecutive procedures with confirmed final diagnoses was undertaken. Benign and malignant needle biopsy results were compared with final outcomes to determine diagnostic accuracy. A statistical analysis of factors related to patient characteristics, lung lesions and biopsy technique was performed to determine possible influences on diagnostic yield. A p value less than 0.05 was interpreted as statistically significant. RESULTS: There were 508 (83%) malignant and 104 (17%) benign lesions. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for a diagnosis of malignancy were 90.2%, 99.0%, 99.8%, 67.3% and 91.7%, respectively. Overall diagnostic accuracy was 83.3%. Variables affecting diagnostic accuracy were the final diagnosis (benign 67%, malignant 92%; p<0.001) and lesion size (lesions<1.5 cm 68%, lesions 1.5-5.0 cm 87%, lesions>5 cm 78%; p<0.05). CONCLUSIONS: In CT-guided transthoracic needle biopsy, the final diagnosis and lesion size affect diagnostic accuracy: benign lung lesions and lesions smaller than 1.5 cm or larger than 5.0 cm in diameter provide lower diagnostic yield.     

Stereotactic core needle biopsy of nonpalpable breast lesions using a conventional mammography unit with an add-on device

OBJECTIVE: The purpose of this prospective study was to assess the accuracy of an add-on stereotactic unit for core needle biopsy of mammographic lesions. SUBJECTS AND METHODS. Between September 1994 and February 2001, 506 stereotactic core needle biopsies of mammographic lesions in 492 patients were performed in our center on a mammography unit with add-on stereotactic equipment. Of the initial 92 patients, 80 underwent stereotactic core needle biopsy and surgical excision simultaneously. In subsequent cases, surgical biopsy was performed after core biopsy in patients who had malignant or atypical histologic results or discordance between mammographic and pathologic findings. Follow-up mammography was advised for all patients whose core biopsy results were diagnosed as benign lesions. RESULTS: Histologic results for 506 lesions undergoing stereotactic core needle biopsy were as follows: 113 (22.3%) were malignant; 369 (72.9%), benign; and 24 (4.7%), atypical. Of 113 malignant lesions identified at stereotactic core needle biopsy, 111 were confirmed as malignant, whereas two showed no evidence of malignancy at surgical excision. Of 369 lesions diagnosed as benign at stereotactic core needle biopsy, 172 (46.6%) showed no change on follow-up mammography, 114 (30.9%) were lost to follow-up, and 83 (22%) underwent surgical excision. Of 24 lesions with atypical histology, 23 had surgical follow-up, six were malignant, nine were benign, and eight were confirmed as showing atypical histology. Stereotactic core needle biopsy of the 506 lesions was complicated by five (1.0%) cases of vasovagal attack and four (0.8%) cases of bleeding. The resulting sensitivity, specificity, and positive and negative predictive values were 98.3%, 93.0%, 86.0%, and 99.2% respectively. CONCLUSION: Biopsy with an add-on unit is safe, reliable, accurate, and cost-effective with results comparable to those reported for dedicated prone biopsy devices.     

膈顶部肝脏病变CT引导下切割针活检的准确性和安全性

目的评价膈顶部肝脏病变CT引导下切割针活检的准确性和安全性。方法25例患者在CT引导下用16 G或18 G切割针进行穿刺活检。结果组织学检查恶性病变17例,良性病变8例。总体检查假阴性2例(8%),未发现假阳性,恶性病变和良性病变诊断特异度分别为100%和75%,诊断总准确率92%。并发气胸者2例(8%);1例出现针道出血(4%),1例出现肝包膜下出血(4%)。结论CT引导下膈顶部肝脏病变切割针活检是一种可靠和相对安全的诊断方法。     

CT引导下经皮肺穿刺活检对周围型肺部病变的诊断价值

目的探讨CT引导下经皮肺穿刺活检对周围型肺部病变的诊断价值及其安全性。方法对58例周围型肺部病变的患者,在CT引导下行经皮肺穿刺活检。结果 58例患者中穿刺标本经组织病理学检查确诊病例48例,确诊率为82.8%,其中恶性肿瘤32例,良性病变16例。术后出现有症状并发症7例,其中咯血2例,气胸4例,高热伴脓胸1例,总发生率为12.1%。结论 CT引导下经皮肺穿刺活检定位准确,成功率高,安全可靠,在周围型肺部病变诊断中具有较高的应用价值。     

肺癌组织中P-gp、MRP、p53蛋白的表达及其临床意义

目的探讨P-糖蛋白、多药耐药相关蛋白、p53蛋白在肺癌中可能的临床意义及相互间的关系。方法采用免疫组化法检测31例石蜡包埋的肺癌及相应远离肿瘤部位的正常肺组织中P-糖蛋白、多药耐药相关蛋白、p53蛋白的表达情况,同时用流式细胞术检测其中29例冻存的肺癌组织中P-糖蛋白、p53蛋白水平,并与免疫组化法结果比较。结果免疫组化法显示P-糖蛋白、多药耐药相关蛋白、p53蛋白在正常肺组织中未见表达,在肺癌组织中阳性率分别为61.3%、54.8％、71.O％。P-糖蛋白与多药耐药相关蛋白表达有相关性(P<0.01),但P-糖蛋白与p53蛋白,多药耐药相关蛋白与p53蛋白之间均无相关性。P-糖蛋白和多药耐药相关蛋白阳性集中在非小细胞肺癌,阳性率分别为76％、68％,且肺癌细胞分化程度越低,P-糖蛋白阳性率越低(P<0.05)。p53蛋白阳性率在鳞癌(100％)明显高于腺癌(33.3％)(P<0.01),吸烟患者(88.9％)明显高于不吸烟患者(46.2%)(P<0.05),而与P-TNM各项指标无关。采用流式细胞术测得P-糖蛋白、p53蛋白阳性率分别为65.5％、79.3％,两种方法的符合率在P-糖蛋白、p53蛋白分别为62.1％、75.9％。结论P-糖蛋白、多药耐药相关蛋白过表达在肺癌中可能具有一定的协同作用,而与p53蛋白异常无关。     

开放式MRI导航系统导引行肺病变穿刺活检137例

目的 探讨MRI导引下肺穿刺活检术的可行性、准确性及其临床应用价值.方法 应用配备iPath 200光学追踪系统的低场开放式MR仪,对137例肺内结节或肿物患者行穿刺活检术,其中肺内孤立性结节或肿物103例,肺内多发病灶34例;病灶最大径≥3.5 cm的57例、1.5～3.4 cm的71例、≤1.4 cm的9例.结果 病灶最大径≥3.5 cm组、1.5～3.4 cm组、≤1.4 cm组及总的穿刺成功率分别为100.0%(57/57)、98.6%(70/71)、77.8%(7/9)、97.8%(134/137);穿刺组织病理检查诊断恶性肿瘤98例,良性39例;MRI导引肺穿刺活检的敏感度为94.2%(98/104),特异度为100.0%(33/33),准确性为95.6%(131/137),阳性预测值为100.0%(98/98),阴性预测值为84.6%(33/39).结论 开放式MRI导引肺穿刺活检术具有较高的安全性、准确性和有效性,值得在临床进一步推广和应用.     

乳腺隐匿性病灶的微创活检

目的:探讨X线立体定位下核芯针穿刺活检(SCNB)对乳腺隐匿性病灶(NPBL)的临床应用价值。方法:运用乳腺X线立体定位系统对59例NPBL进行SCNB,其中42例行手术切除,将活检标本病理结果与X线表现、手术标本病理结果进行对照。结果:59例SCNB结果中良性病变43例,恶性病变16例(导管原位癌5例、浸润性导管癌11例),其中26例良性病变及16例恶性病变共42例行手术治疗,术后病理结果为良性病变25例,恶性病变17例(导管原位癌5 例、浸润性导管癌11例、硬癌1例)。与手术病理结果对照,SCNB对NPBL的诊断敏感度为94％,特异度为100％。结论:SCNB是诊断NPBL简便、实用、微创的方法,可获得准确的组织病理学结果,提高早期乳腺癌的检出率及降低良性病变的手术活检率。     

Experience with breast biopsies using the Advanced Breast Biopsy Instrumentation system

OBJECTIVE: A retrospective review of our experience with advanced breast biopsy instrumentation (ABBI) was undertaken to evaluate its efficacy for excisional breast biopsy of lesions detected on mammography. To our knowledge, experience with ABBI has not been previously reported in the radiology literature. MATERIALS AND METHODS: Biopsies using the ABBI system and an adapted dedicated table were performed in 53 patients who had 54 mammographically evident lesions. Samples were obtained with cannulas ranging in size between 5 and 20 mm. Indications for biopsy were calcifications (n = 22) and masses (n = 31). RESULTS: Forty-five specimens (44 patients) had benign results at pathology: 15 specimens were diagnosed as fibroadenoma, 15 as cystic breast disease, and four as reactive lymph nodes; the remaining 11 specimens had benign diagnoses of adenosis, fibrosis, and hyperplasia. The average specimen size was 4.8 cm in greatest longitudinal dimension. One patient had a nondiagnostic biopsy for calcifications later found to be dermal. Seven patients were diagnosed as having breast cancer; in six of these, the tumor involved the margins of the specimen. One patient had marked atypia that required reexcision for the diagnosis of intraductal carcinoma to be made. CONCLUSION: The ABBI procedure is a more invasive and less readily available procedure than core needle biopsy for sampling of benign breast lesions. In seven cases of malignancy diagnosed at breast biopsy, the ABBI technique completely excised only a single lesion. In our experience, the ABBI procedure offered no advantages over core needle biopsy for either benign or malignant lesions.