超声在乳腺癌诊断中的应用价值

近年来,乳腺癌的发病率有逐年上升的趋势。由于超声没有电离辐射,在长时间工作状态下不会对医务人员和患者的身体产生损伤,而且简便易行,具有可重复性,因此超声检查已经成为乳腺癌筛查、诊断的主要手段。乳腺癌的超声诊断方法经历了几次重大的革新,从灰阶实时超声、彩色多普勒血流显像、彩色能量多普勒到超声引导下穿刺活检、超声造影以及三维超声。     

粗针肝穿活检对肝肿瘤诊断价值

用粗针Tru-cut(16G)对21例肝占位病变行肝穿活检,组织病理诊断20例,正确率95.2％,细胞学诊断13例,正确10例,正确率47.6％。有6例出现穿刺点疼痛,在3日内自行消失,未出现其他并发症。笔者认为只要掌握好穿刺技术,粗针肝穿活检对肝肿瘤的诊断是一种有效安全和可靠的方法。     

亚甲蓝法在乳腺癌前哨淋巴结活检中的应用

目的:探讨亚甲篮作为示踪法进行前哨淋巴结活检在乳腺癌治疗中的应用价值。方法:对已确诊的172例临床腋窝淋巴结阴性的乳腺癌患者术中亚甲蓝乳晕周围皮下注射后行腋窝前哨淋巴结切除,送冰冻病理检查,再行乳腺癌改良根治术,并常规腋窝淋巴结清扫,术后病理石蜡切片检查前哨淋巴结及手术切除标本。结果:167例(97.1%)成功实施SLNB,5例(2.9%)术中未能发现SLN,立即改行腋窝淋巴结清扫术(ALND)。行SLNB的167例中,术中冰冻报告SLN癌转移21例,即行ALND;146例冰冻检查SLN未见癌转移。5例术后HE染色检查发现SLN存在1枚微转移淋巴结,4例接受ALND,1例拒绝行腋窝淋巴结清扫。142例SLNB代替ALND者中位随访时间18个月(3～64个月),均未发现腋窝淋巴结转移。结论:亚甲蓝法SLNB安全、有效、简便易行,SLNB阴性患者,可以替代ALND。     

细针穿刺诊断囊性乳腺癌1例

患者,女性,44岁,发现右侧乳房肿块1年.查体,右侧乳房外侧象限可及一约8cm×7cm大小肿块,质地中等,边界清,无压痛,可活动,右腋下未触及肿大淋巴结,左侧乳房未及明显肿块.乳腺钼靶摄片考虑为右侧乳房巨大纤维腺瘤.诊断:右侧乳房肿瘤,考虑乳腺癌或肉瘤.细针穿刺检查,抽出棕褐色液体70mL,肿块体积明显缩小.     

术前活检诊断的乳腺导管原位癌前哨淋巴结活检45例分析

目的分析由空芯针穿刺(CNB)或微创旋切活检(VAB)诊断的乳腺导管原位癌(DCIS)的临床及病理特征与前哨淋巴结(SLN)阳性的关系,探讨术前诊断DCIS患者实施美蓝示踪前哨淋巴结活检(SLNB)的准确性、可行性,为临床工作提供理论依据。方法回顾性分析我院2011年3月至2015年3月45例术前活检诊断的DCIS患者,采用美蓝示踪进行SLNB。麻醉后切皮前,于病灶周围或活检残腔以及乳晕周围各分4点皮下注2%美蓝共2m L。10~15 min后进行SLNB。取病灶同侧腋窝胸大肌外侧缘沿腋皱襞长约4 cm弧形切口,切除蓝染淋巴结及淋巴管送术中印片细胞学+冰冻组织学病理检查。再行保留乳房手术或乳房切除手术。结果 1 45例患者均成功检出SLN,共144枚。SLN检出率100%(45/45),准确率98%(44/45)。其中4例患者SLN阳性,阳性率9%(4/45),3例患者后续进行腋窝淋巴结清扫。42例仅行SLNB患者术后随访7~55个月(中位30个月),无一例患者出现患肢肿胀、麻木、疼痛等不适。随访期间无复发、转移及死亡病例。2同时分析SLN阳性与临床及病理特征的关系:患者年龄、肿瘤大小、首发症状、活检方式、检出SLN数目,差异均无统计学意义(P均>0.05)。可能与DCIS患者SLN阳性有关的因素为:肿瘤大小>3.0 cm、首发症状为可触及肿块、术前诊断方式为CNB,行乳房切除手术,最终病理诊断为导管原位癌伴微浸润(DCIS-MI)及浸润性导管癌(IDC)。结论 1术前诊断的DCIS行美蓝示踪SLNB安全、可行;2以下因素对预测DCIS患者可能出现SLN阳性提供帮助:病灶范围>3 cm、可触及肿块、同时伴有雌激素受体(ER)低表达、人表皮生长因子受体过表达。对于此类患者推荐进行SLNB。     

乳腺肿块细针吸取细胞学的诊断及应用

1968～1989年共进行乳腺肿块细针吸取细胞学检查5430例。经病理组织学证实370例。细胞学诊断敏感性为97.84％,特异性为87.5％。针吸细胞学对乳腺肿块诊断具有明显意义。     

经直肠超声引导穿刺在诊断前列腺癌中的价值

目的评价经直肠超声引导下前列腺穿刺活检在前列腺癌早期诊断中的临床价值。方法对82例高度怀疑前列腺癌(PCA)的患者进行经直肠超声引导下前列腺穿刺活检。结果病理证实PCA77例,前列腺增生(BPH)3例,其他2例。结论经直肠超声引导下穿刺活检是早期确诊PCA最有效的方法之一。     

术前活检与术中快速冷冻病理检查诊断早期乳腺癌前哨淋巴结转移的价值研究

目的 分析术前活检和术中快速冷冻病理检查在乳腺癌前哨淋巴结假阴性诊断中的差异.方法 选取2014年12月—2018年7月哈励逊国际和平医院住院的有乳腺癌前哨淋巴结转移并行腋窝淋巴结清扫术患者150例,分为术前活检组和术中冷冻组.依据术前穿刺、术中冷冻和术后石蜡切片病理结果,对术前活检组患者术前、术后病理一致性(术前活检...     

345例乳房肿块穿刺细胞学检查与病理诊断对照分析

345例乳房肿块针吸细胞学检查与病理组织学诊断对照,诊断符合率为88.9％。197例乳腺癌,诊断符合率为85.3％,假阴性率为8.1％。148例良性肿块诊断符合率为92.5％,假阳性为2.7％。对该法在乳腺外科临床应用中的价值及误诊原因做了重点讨论。     

Role of fine needle aspiration cytology in diagnosis of breast lumps.

Objective: The aim of this study is to find out the common causes of breast lump and to determine the sensitivity and specificity of FNAC of breast lump. Materials and methods: This is a retrospective study of FNAC of breast done in pathology department of NMCTH from January 2003 to December 2005. FNAC findings were correlated with data from histopathology records to determine the sensitivity and specificity of FNAC. Results: FNAC of breast constituted 16% of all the FNACs. Age group of the patients ranged from 17 to 56 years with mean of 32 years. Fibroadenoma was the most common diagnosis. Malignancy was diagnosed in only 6.6% of the cases. Histological correlation was done in 21 cases. Sensitivity and specificity of FNAC of breast was found to be 83.3% and 100% respectively. Conclusion: FNAC of breast is simple, cost effective and less traumatic method for diagnosis of breast lump. It is highly sensitive and specific also, and can reduce the needs for open biopsies. So FNAC should be used as a routine method for determining the nature of breast lumps. Key words: FNAC, breast lump, neoplasm.     

细针吸取细胞学在乳腺疾病诊断中的意义

目的:探讨细针吸取细胞学(fine neelde aspiration cytology,FNAC)在诊断乳腺疾病中的价值.方法:我院2003年10月～2008年5月门诊和住院的乳腺疾病患者362例,其中201例经病理组织学对照.结果:201例经病理组织学对照,良性肿瘤136例,恶性肿瘤65例,总符合率为97.50%,细胞学与病理组织学诊断完全一致的占91.54%,定性(良、恶性)正确而组织学类型不一致的占5.79%,良、恶性误诊率为2.49%.结论:FNAC对乳腺疾病的诊断有独到的临床价值.     

Evaluation of fine needle aspiration and imprint cytology in the early diagnosis of breast lesions with histopathological correlation

Fifty-one breast lumps were studied by fine needle aspiration cytology (FNAC) and scrape imprint cytology. Of the 51 cases, 28 were malignant and included infiltrating duct carcinoma (22), well differentiated adenocarcinoma (2), mucinous, papillary and lobular carcinoma (one each) and malignant lymphoma (one). Benign lesions were mastitis, fibroadenoma and fibrocystic disease. The diagnostic accuracy of FNAC was 90.2% and that of imprint 94.1% with no false negatives. Two imprint smears and one aspirate designated suspicious were proved to be benign. The combination of FNAC and imprint cytodiagnosis gave a diagnostic accuracy of 96% thus proving their value in the rapid diagnosis of breast lesions.     

乳腺肿块细针吸取细胞学与术中冰冻切片诊断比较

目的：分析乳腺肿块细针吸取细胞学(FNAC)与术中冰冻切片诊断(IFSD)的不同特征，探索两者的临床应用价值。方法：对乳腺肿块205例分别进行FNAC和IFSD检查。结果：乳腺良性病变FNAC和IFSD的准确率分别为96．4％和98．6％，乳腺恶性肿瘤FNAC和IFSD的准确率分别为91．0％和97．0％。FNAC假阴性率为2．4％，无假阳性诊断；IFSD未出现假阴性和假阳性诊断。结论：乳腺肿块FNAC和IFSD检查是两种实用、可靠的诊断方法。     

1731例乳腺肿块细针穿刺诊断的临床应用分析

目的：探讨乳腺肿块细针穿刺细胞学检查（FNAC）的临床应用价值。方法：对2006～2010年的1 731例乳腺肿块细针穿刺细胞学检查结果进行对比分析。结果：1 731例乳腺细针穿刺病例,2009～2010年的病例及阳性病例明显高于2006～2008年,其中924例做了活检对照,恶性肿瘤敏感性为96.68%（233/241）,假阴性率为3.32%（8/241）,无假阳性。FNAC诊断的总准确率为97.29%（899/924）。结论：乳腺肿块细针穿刺诊断技术,操作简易、快速、安全、可靠、价格低廉,可在基层医院及乳腺癌筛查中大力推广。     

细针穿刺技术在乳腺癌手术治疗中的应用价值

目的 研究乳腺细针穿刺细胞学(FNAC)检查在乳腺癌手术治疗中的临床应用价值.方法 选取2004年1月至2009年1月在北京协和医院初诊考虑乳腺癌可能性大的530例女性患者行FNAC检查.根据FNAC结果决定进一步的治疗方案.所有患者均接受了乳腺手术,术后进行组织病理学诊断.结果 FNAC检查阳性的325例患者直接行乳腺癌根治性手术,术后组织病理学证实均为乳腺癌.FNAC检查阴性的205例患者接受开放活检手术,术后组织病理学证实137例为乳腺癌,68例为非乳腺癌.结论 FNAC有助于为怀疑乳腺恶性肿瘤者选择适当的术式.     

Diagnosis of breast lump by fine needle aspiration cytology and mammography

Breast carcinoma is the most common malignant tumour and the leading cause of death from cancer in women. A large number of patients in Bangladesh have been suffering from breast cancer. Now-a-days, Fine needle aspiration cytology (FNAC) is being performed as a pre-operative test to evaluate breast lump. FNAC is cost effective and can prevent unnecessary surgery. As FNAC became more reliable in diagnosing malignancy and thereby the use of frozen-section histology had been reduced by about 80%. But erroneous diagnosis is more common with FNAC than with histopathology. However, mammography can identify breast cancers too small to palpate on physical examination and theoretically beneficial to diagnose even noninvasive lesions. Present study aimed to see the accuracy of FNAC and mammography in the diagnosis of palpable breast lumps and to study their correlation. In this study 222 patients were included in the study and FNAC was done in all the patients. Mammography was done in 112 cases. Among these 112 patients 32 cases were found malignant. Histopathology was done in total 89 cases. Among 112 patients who were underwent mammography only 43 were found for histopathology. Finally, 36 cases were found malignant. Fibroadenoma is mostly found in below 20 years group and malignancy is mostly occurring in older age group. Mammography shows total 8 false positive and 5 false negative cases. FNAC shows only 1 false positive and 1 false negative case. On analysis mammography showed 82.76% sensitivity, 90.36% specificity, 75% Positive predictive value (PPV), 93.75% Negative predictive value (NPV) and 88.39% accuracy. FNAC showed 97.22% sensitivity, 99.46% specificity, 97.220% PPV, 99.46% NPV and 99.095% accuracy. Mammography was found to be less sensitive, specific and accurate in the diagnosis of breast lump though there is highly significant correlation among them. However, the study has shown a much higher performance of FNAC than other previous studies indicating the improved skill in cytological diagnosis to a satisfactory level.     

乳腺肿块细针穿刺细胞学与组织病理学对照分析

目的比较乳腺肿块细针穿刺细胞学与组织病理学检査结果。方法选择我院2015年1月~2016年10月收治的382例乳腺肿块患者作为研究对象,对患者分别行细胞学与组织病理学检査,对比两种检査方法的诊断结果。结果 382例乳腺肿块患者的FNAC检査结果:Ⅰ级341例(89.27%),Ⅱ级19例(4.97%),Ⅲ级4例(1.05%),Ⅳ级18例(4.71%),与组织病理学检测结果比较无明显差异(P0.05)。382例患者行FNAC诊断的准确率为98.43%,敏感性为78.57%,假阴性率为17.14%,特异性为98.33%,假阳性率为0。结论对乳腺肿块患者采用细针穿刺细胞学检查具有微创、安全、经济、准确率高、患者痛苦小等优点,但是也有一定局限性,应结合组织病理学检査,以提高诊断率,为临床诊断与治疗提供可靠依据。