Three-dimensional ultrasound-guided core needle breast biopsy

A new core needle breast biopsy system guided by 3-D ultrasound (US) is proposed. Our device provides rapid imaging and real-time guidance, as well as breast stabilization and a needle guidance apparatus using 3-D imaging. The targeting accuracy of our device was tested by inserting a 14-gauge biopsy needle into agar phantoms under 3-D US guidance. A total of 18 0.8-mm stainless-steel beads embedded in the phantoms defined each of the four target positions tested. Positioning accuracy was calculated by comparing needle tip position to the preinsertion bead position, as measured by three observers three times each on 3-D US. The interobserver standard error of measurement was no more than 0.14 mm for the beads and 0.27 mm for the needle tips. A 3-D principal component analysis was performed to obtain the population distribution of needle tip position relative to the target beads for the four target positions. The 3-D 95% confidence intervals were found to have total widths ranging from 0.43 to 1.71 mm, depending on direction and bead position.     

超声引导下大网膜穿刺活检诊断结核性腹膜炎的临床应用

摘要 目的 探讨超声引导下大网膜穿刺活检对诊断结核性腹膜炎的临床价值。 方法 通过回顾性分析129例行超声引导下大网膜穿刺活检且最终经临床确诊为结核性腹膜炎的患者,评价超声引导下大网膜穿刺活检对结核性腹膜炎的诊断率、安全性及其临床应用价值。 结果 129例结核性腹膜炎患者共行超声引导下大网膜穿刺活检343针,其中93例病理明确诊断为结核性腹膜炎,21例高度提示诊断为结核性腹膜炎,总的诊断率为88.37％,15例病理未能明确诊断。不同穿刺取材针数的诊断率之间差异无统计学意义(P>0．05)。所有患者均未发生严重并发症,仅11例患者穿刺点出现轻微肿胀、疼痛等,经对症处理,2天后症状消失。 结论 超声引导下大网膜穿刺活检对结核性腹膜炎诊断率高、安全性好,可作为临床高度怀疑结核性腹膜炎时的常规检查。     

Primary thyroid lymphoma: role of ultrasound-guided needle biopsy.

OBJECTIVE: The purpose of this study was to describe the sonographic findings of primary thyroid lymphoma and evaluate the role of ultrasound-guided biopsy in diagnosing thyroid lymphoma. METHODS: This study included 6 patients (age range, 56-72 years; mean, 62.5 years). We searched the database of our institution and retrospectively collected data on the thyroid lymphomas that were confirmed pathologically. All of the sonograms and medical records were reviewed retrospectively. RESULTS: All 6 patients had an enlarged neck mass and underwent ultrasound-guided fine-needle aspiration biopsy. The most notable sonographic feature of primary thyroid lymphoma was a marked hypoechoic mass compared with the residual thyroid tissue. Among the 6 patients with a diagnosis of thyroid lymphoma, 3 (50%) had a diagnosis of lymphoma by ultrasound-guided fine-needle aspiration biopsy. Final pathologic results were obtained by ultrasound-guided core needle biopsy (3/6 patients [50%]) or thyroidectomy (3/6 [50%]). Most patients with thyroid lymphoma (5/6 [83.3%]) were found to have diffuse large B-cell lymphoma and were treated with chemotherapy with or without radiotherapy. In 1 patient with follicular lymphoma, diagnosis and treatment were accomplished by total thyroidectomy. CONCLUSIONS: Our results show that ultrasound-guided core needle biopsy can be a safe and accurate method for diagnosing thyroid lymphoma and may be a suitable replacement for diagnostic thyroid surgery.     

经腹超声引导下经皮穿刺活检对内镜超声引导下穿刺活检诊断胰腺肿瘤的补充价值

目的 观察经腹超声引导下经皮穿刺活检对内镜超声(EUS)引导下穿刺活检诊断胰腺肿瘤的补充价值。方法 回顾性分析30例因EUS引导下穿刺活检诊断结果不满意(未见肿瘤细胞20例、可见异常细胞但无法明确诊断10例)而接受经腹超声 引导下经皮穿刺活检的胰腺肿瘤患者,评价后者的补充诊断价值。结果 20例EUS引导下穿刺活检未见肿瘤细胞患者中,经腹超声引导下穿刺活检明确诊断11例肿瘤及其病理类型,7例可见异常细胞但未能明确诊断,2例仍未见肿瘤细胞;10例EUS引导下穿刺结果无法明确诊断患者中, 经腹超声引导下穿刺活检明确诊断9例肿瘤及其病理类型,1例为非典型细胞。结论 经腹超声引导下经皮穿刺活检对EUS引导下穿刺活检诊断胰腺肿瘤具有较高补充价值。     

超声引导下粗针穿刺活检诊断肢体骨及软组织病变的准确性分析

目的探讨超声引导下粗针穿刺活检在肢体软组织及骨病变诊断中的应用价值,分析粗针穿刺活检标本病理诊断的影响因素,以提高病理诊断的准确性。方法收集超声引导下粗针穿刺活检的四肢骨及软组织肿瘤77例,观察粗针穿刺活检标本的病理形态,并对其中23例行免疫组化染色,对比研究与之相应的手术切除标本的病理检查结果。结果通过HE染色和/或免疫组化染色,穿刺标本确诊或基本确诊51例(66.2%);提出倾向性诊断21例(27.3%);组织太少不足以诊断5例(6.5%);诊断阳性率(或称敏感性)为93.5%(72/77)。能正确判断良、恶性者71例,特异性达98.6%(71/72);肿瘤假阴性诊断率1.4%(1/72),无假阳性诊断。17例明确了病变性质,但病理类型欠准确,诊断准确率为75%(54/72)。结论超声引导下粗针穿刺活检四肢骨与软组织病变的病理诊断需结合临床和影像学资料,必要时选择适当的免疫组化套餐,可以得到较高的确诊率。     

超声引导下脾粗针穿刺活检的探讨性研究

目的探讨超声引导下经皮粗针穿刺活检在脾中的安全性和有效性。方法25例行超声引导下脾穿刺活检的患者,局灶性病变19例(单发11例,多发8例),结节大小(3.76±1.37)cm;弥漫性病变6例。18G组织切割活检针配以自动弹射式活检枪取病变组织至少2条,活检后患者平卧位监测生命体征1个小时。最后诊断以术后病理(14例)及综合临床相应治疗过程和影像学检查为标准(11例)。结果25例患者,每例进针次数为2～3次,平均(2.28±0.46)次;11例加做了免疫组化(恶性10例,良性1例),24例明确了诊断,准确率96%,1例假阴性患者最后诊断为Castleman's病;1例并发了出血。结论只要患者的凝血功能正常范围,应用18G粗针行超声引导下脾经皮穿刺活检是安全、有效、可行的。     

超声引导穿刺活检对胸膜病变的诊断价值分析

目的探讨和分析超声引导穿刺活检对胸膜病变的诊断价值。 方法回顾性选取浙江省肿瘤医院2010年1月至2017年12月行超声引导胸膜病变穿刺活检、影像及病理资料完整的病例共118例。所有患者均行超声引导下穿刺活检术。以外科手术病理组织学及临床随访结果为"金标准"，应用四格表计算超声引导穿刺活检诊断胸膜病变的敏感度、特异度、阳性预测值、阴性预测值和准确性。 结果依据诊断"金标准"，118例患者中良性病变17例，恶性病变99例，不确定2例。超声引导胸膜病变穿刺活检病理诊断恶性病变87例，良性病变29例，不确定2例。超声引导穿刺活检诊断胸膜病变的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为87.9%、100.0%、100.0%、58.6%和89.7%。118例患者中4例出现并发症。 结论超声引导胸膜病变穿刺活检术具有实时、操作简便、无放射线危害，以及并发症发生率低等特点，对于胸膜病变具有较高的诊断价值，值得临床推广应用。     

超声引导粗针活检技术在甲状腺肿块诊断中的价值

目的探讨超声引导粗针活检技术在甲状腺肿块诊断中的应用价值。方法对68例甲状腺肿块患者进行粗针活检。结果活检成功68例,无并发症。其中结节性甲状腺肿11例,单纯性甲状腺肿33例,桥本氏甲状腺炎8例,亚急性甲状腺炎8例,甲状腺腺瘤5例,甲状腺癌3例。结论超声引导下粗针活检是诊断甲状腺疾病简便、安全及经济的方法。     

超声造影引导下粗针活检联合XpertMTB/RIF检测在周围型肺结核诊断中的应用价值

目的评估超声造影引导下粗针活检联合半巢式全自动实时荧光定量核酸扩增检测技术（XpertMTB/RIF）在周围型肺结核诊断中的应用价值。 方法回顾性分析2016年6月至2018年6月浙江省中西医结合医院结核科疑似周围型肺结核的71例住院患者，所有患者肺部肿块均经超声造影引导下穿刺活检，穿刺组织标本分别进行常规病理检查、XpertMTB/RIF检测及结核分枝杆菌（MTB）培养，以“肺结核诊断和治疗指南”为诊断金标准，比较３种检测方法诊断周围型肺结核的敏感度、特异度、阳性预测值、阴性预测值及准确性。并计算受试者工作特征（ROC）曲线下面积（AUC），采用t检验比较3种诊断方法的诊断效能差异。以药敏试验为诊断结核标准，评估XpertMTB/RIF方法检验利福平耐药的准确性。 结果71例患者诊断为周围型肺结核40例（结核组），非周围型肺结核患者31例（非结核组）。非结核组包括肺部恶性肿瘤10例，肺部良性肿瘤1例，间质性肺炎14例，胞内分枝杆菌肺炎3例，真菌性肺炎3例。常规病理、XpertMTB/RIF检测及MTB培养3种检测方法的诊断敏感度分别为80.0%、92.5%、12.5%，特异度分别为90.3%、100%、100%，阳性预测值分别为91.4%、100%、100%，阴性预测值分别为77.8%、91.2%、47.0%，准确性分别为84.5%、95.8%、50.7%。XpertMTB/RIF的诊断敏感度高于常规病理检查及MTB培养，差异具有统计学意义（χ²=33.632、5.976，P均＜0.05）。ROC曲线分析显示常规病理、XpertMTB/RIF检测及MTB培养3种检查方法AUC分别为0.814、0.963、0.563，XpertMTB/RIF的诊断效能优于常规病理检查及MTB培养，AUC比较，差异具有统计学意义（t=7.579、2.303，P均＜0.05）。 结论超声造影引导下粗针活检联合XpertMTB/RIF检测技术能快速、准确地对周围型肺结核进行诊断，相对于常规病理检查、MTB培养具有较高的诊断效能。     

Hepatocellular carcinoma: Diagnosis by percutaneous fine needle biopsy

One hundred fifty-nine cases of hepatocellular carcinomas (HCCs) were reviewed from a series of 1060 cases of percutaneous fine needle biopsies of the liver. The biopsies were performed under ultrasonic guidance using a 22-gauge needle with a beveled tip. Specimens were obtained from the lesion and from areas of normal-appearing liver for comparison. Two sets of slides were prepared for Papanicolaou and Giemsa staining. In 147 cases (92%), the diagnosis of malignancy was established. In 134 cases (84%), the specific diagnosis of HCC was made. Fifty-four percent of the HCCs were well differentiated without cytonuclear abnormalities. In these cases, the diagnosis was made by comparison of specimens from the tumor with those obtained from the normal liver. Thirty-seven percent of the HCC were moderately differentiated with cytonuclear abnormalities. Nine percent of the HCCs were poorly differentiated, and in these cases, identification of glycogen on periodate-Schiff's procedure staining permitted differentiation from a metastatic tumor. In 9 cases, the aspirate was inadequate: there was insufficient tissue in 3 cases and the lesion was missed in the 6 other cases. In 3 cases, a biopsy of normal liver was not obtained and the diagnosis of HCC could only be suspected. Significant bleeding after biopsy occurred in 4 of 1060 cases, all with HCC.     

穿刺活检前列腺癌72例病理形态学观察及Gleason分级

目的 观察经直肠超声引导的前列腺癌穿刺活检组织的病理形态学改变,进行系统的Gleason分级.方法 收集经直肠超声引导的前列腺穿刺活检诊断的前列腺癌72例,复习HE组织切片,并依据2005年国际泌尿病理学协会(ISUP)修订的前列腺癌Gleason分级系统进行分级.结果 72例前列腺癌中53例的主要及次要成分为3级结构(73.6％),59例主要及次要成分为4级结构(81.9％),12例主要及次要成分为5级结构(16.7％).结论 本组前列腺癌Gleason 4级结构与3级结构常常混合存在,而且4级结构相比3级结构更为常见.修订后的Gleason分级系统有助于对前列腺癌进行规范分级,以利于进一步研究,准确反映肿瘤的预后差异.     

实时超声弹性成像在甲状腺结节穿刺活检中的应用

目的 观察超声弹性成像技术在超声引导下穿刺活检诊断甲状腺疾病中的应用价值。方法 将78例甲状腺疾病患者随机分为常规组（39例）和弹性组（39例）。对弹性组在甲状腺穿刺活检术前行甲状腺结节超声弹性成像检查,记录偏蓝色部分在结节内的分布;对常规组仅用二维超声观察结节情况。之后对两组患者均行超声引导下甲状腺结节穿刺活检术,将活检病理与术后病理结果进行比较。结果 超声弹性成像技术指导下超声引导穿刺诊断甲状腺恶性结节的准确率为97.44%（38/39）,高于常规组（33/39,84.62%）,差异有统计学意义（P=0.035）。结论 超声弹性成像技术可提高超声引导穿刺活检对甲状腺恶性结节的检出率。     

超声引导下穿刺活检在乳腺非肿块样病变诊断中的应用价值

目的探讨超声引导下穿刺活检在乳腺非肿块样病变中的诊断价值。 方法选取2017年1月至2018年12月杭州市第一人民医院超声科经超声检查评估为乳腺影像报告与数据系统（BI-RADS）4a类及以上的乳腺非肿块样病变患者93例,共计93个病灶。所有病变均行超声引导下穿刺活检,并经手术病理证实。应用四格表计算超声引导下穿刺活检对乳腺非肿块样病变的诊断效能。 结果手术病理结果提示,恶性病灶47个,良性病灶46个。超声引导下穿刺活检结果提示恶性病灶43个,良性50个。穿刺活检漏诊4个恶性病灶,术前超声均提示为BI-RADS 4b,术后病理证实3例为导管原位癌和1例为浸润癌。超声引导下穿刺活检诊断乳腺非肿块样病变的敏感度为91.4%（43/47）,特异度为100.0%（46/46）,假阴性率为8.6%（4/47）,诊断准确性为95.7%（89/93）。 结论超声引导下穿刺活检对乳腺非肿块样病变的诊断存在一定的假阴性率,但敏感度、特异度及准确性均较高,具有良好的诊断价值。     

The role of ultrasound-guided needle biopsy in the diagnosis of soft-tissue tumors

Soft-tissue tumors are not very common, but their diagnosis can be very difficult. In the final analysis, their diagnosis requires a biopsy, which must furnish a sufficient amount of material to allow a reliable histological diagnosis. The authors evaluated the diagnostic efficacy of ultrasound-guided needle biopsy in the diagnosis of soft-tissue tumors of the musculoskeletal system. The aim of the study was to optimize the biopsy procedure, with particular emphasis on the choice of the biopsy needle (large-gauge manual versus semiautomatic) based on the characteristics of the neoplastic mass (consistency, depth, size, location). The results of the study showed that appropriate needle selection significantly reduced the frequency of biopsies that were insufficient for histological diagnosis. The method proved to be highly reliable for diagnosis of soft-tissue tumors but strongly related to the proper selection of the needle to be used.     

Diagnostic sensitivity of ultrasound-guided needle biopsy in soft tissue masses about superficial bone lesions.

We evaluated the value of ultrasound-guided needle biopsy in 20 soft tissues masses about superficial bone lesions in 20 oncology patients. Sonographically guided needle biopsies were performed without an on-site pathologist. A diagnostic sensitivity of 95% and specificity of 100% in separating a benign or a malignant lesion was obtained. Fine needle aspiration cytology allowed the specific cell type of malignancy to be diagnosed in 80% of cases, while core needle biopsy allowed it in 91%. Real-time ultrasonographic guidance permits precise needle placement into the targets, avoidance of hypervascular areas, and flexibility of patient positioning so that needle biopsy can be performed quickly and safely on soft tissue masses about superficial bone lesions.