Diagnosis of myocarditis by endomyocardial biopsy

Endomyocardial biopsy is most frequently used to establish a definitive diagnosis of myocarditis, especially since this disorder has been treated with immunosuppressive therapy. Recent diagnostic criteria (the "Dallas Classification") are reviewed, and pitfalls and limitations are discussed.     

Liver biopsy in the diagnosis of malignancy

In a National Audit of 1500 liver biopsies, 38% were for suspectedmalignancy. To measure their contribution to clinical decisions,the initial diagnoses, biopsy diagnoses, final diagnoses, andoutcomes were coded by computer and compared. Most patients(92%) wereinvestigated for advanced malignancy. The accuracyof clinical diagnosis was 78% against final diagnosis. Liverbiopsy was seen as ‘confirming’ clinical diagnosisoverall. This was achieved in 67% (75%with ultrasound guidance),andspecificity was almost 100%. However, hepatocellular cancerwas confirmed by biopsy in only 32% and haematological malignancyin 13% of suspected cases. Within 3 months, 44% of patientswithhistological malignancy had died. Histological tumour typewas not used in 36% of finaldiagnoses. Of patients with a malignancy-negativeliver biopsy—showing reactive hepatitis, normality, orcholangitis/cholestasis—25%, 47% and 60%, respectively,had final malignant diagnoses. In 6% of patients, biopsy showedchronic liver disease. Only 12% of deaths were autopsied. Liverbiopsy contributes very high specificity to the diagnosis ofmalignancy, and detects non-malignant disease. Failure to usetumour type may result in sub-optimal therapy. Improving diagnosticpractice requires more information on outcomes, including autopsies.     

Diagnosis of gastric inflammation and malignancy in endoscopic biopsies based on Fourier transform infrared spectroscopy

BACKGROUND: Fourier transform infrared (FT-IR) spectroscopy is an effective tool for investigation of chemical changes at the molecular level. We previously demonstrated that FT-IR spectroscopy can reliably distinguish multiple types of carcinoma from healthy tissue. Because various stomach diseases are common, it is important to explore a noninvasive and rapid method to detect malignancy and gastritis in endoscopic biopsies. Our aim was to classify endoscopic biopsies into healthy, gastritis, and malignancy through the use of FT-IR spectroscopy. METHODS: A total of 103 endoscopic samples, including 19 cases of cancer, 35 cases of chronic atrophic gastritis, 29 cases of chronic superficial gastritis, and 20 healthy tissue samples, were obtained at the First Hospital of Xi'an Jiaotong University, China. A modified attenuated total reflectance accessory was linked to a WQD-500 FT-IR spectrometer for biopsy measurement. The spectral characteristics for different types of tissues were correlated with the corresponding pathology results. The gastric biopsies were classified by FT-IR spectroscopy and a discriminant analysis method. RESULTS: There were significant differences in the FT-IR spectra of four types of gastric biopsies. The discriminant analysis results demonstrated that the sensitivity of FT-IR detection for healthy, superficial gastritis, atrophic gastritis, and gastric cancer was 90%, 90%, 66%, 74%, respectively, which could help satisfy clinical diagnostic requirements. CONCLUSION: FT-IR spectroscopy can distinguish disease processes in gastric endoscopic biopsies.     

Diagnosis of malignant cardiac disease by endomyocardial biopsy

Among oncology patients, endomyocardial biopsy has been used primarily for the evaluation of anthracycline cardiotoxicity. In addition, however, endomyocardial biopsy may be useful for the detection of malignant cardiac neoplasms. Between 1982 and 1989, metastatic involvement of the heart was diagnosed by endomyocardial biopsy in seven patients at our institution. All except one of these patients were older than 50 years of age and had dyspnea as an initial symptom, and all had a known malignant lesion. Results of endomyocardial biopsy confirmed cardiac involvement by a hematologic malignant lesion in four patients and metastatic melanoma in two patients. In one patient, who had a history of breast cancer and lymphoma, a metastatic neoplasm of uncertain differentiation was observed. Myocyte damage was evident in endomyocardial biopsy specimens from two of the four patients with hematologic malignant disease. Endomyocardial biopsy was performed to confirm the possibility of metastatic involvement in five patients; in the other two, endomyocardial biopsy was performed to determine whether anthracycline cardiotoxicity was present, and metastatic involvement was unanticipated.     

胃癌的液相活检

本文通过系统回顾外周血循环肿瘤细胞、循环细胞外核酸在胃癌早期诊断、预后评估、治疗监测中的作用,阐述其作为新型生物标记物的可能性,介绍胃癌液相活检的概念由来和其潜在的临床应用价值。     

超声引导穿刺活检诊断胰腺部肿瘤

目的:通过超声引导穿刺活检技术的应用,为胰腺癌的早期病理诊断开创了一个安全有效的新途径,并比较18G粗针及21G细针穿刺活检的临床应用价值。方法:应用粗针及细针经超声引导下对113例可疑胰腺癌的患者穿刺活检,活检取出的组织能作出明确组织病理学诊断的为取材满意,以手术后病理诊断或随访6个月~1年的结果为最后诊断。结果:113例中,107例取材满意,能作出明确组织病理学诊断,穿刺获得组织学诊断率为94.7%。粗针活检46例,细针活检67例,两种针型取材满意率间的比较及就良恶性诊断,粗、细针间的敏感性、特异性、准确性、并发症发生率比较均无显著性差异(P>0.05);细针有2例假阴性,粗针无,两种针型间比较无显著性差异(P>0.05)。结论:超声引导胰腺病变穿刺活检,技术方法简便,病理诊断阳性率高,对确定诊断有重要意义。18G粗针较21G细针穿刺同样安全,并且获取标本较完整,取材量大,有利于对病变组织结构的观察,故应值得提倡。     

骨髓活检的诊断

本文从骨髓的正常结构、各系细胞定位和细胞分化规律及其特征等着手,概括了辨识这些细胞的要点,以求正确识别,为活检诊断提供依据,并指出作出一份正确的诊断报告所须具备的条件,包括活检、制片、镜下描述和联系临床等。以供基层同道和初接触骨髓活检者参考。     

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.     

MRI引导下立体定向活组织检查诊断中枢神经系统淋巴瘤

目的:探讨MRI引导下立体定向活组织检查(活检)手术在中枢神经系统淋巴瘤诊断中的应用,提高中枢神经系统淋巴瘤的诊断水平.方法:对16例疑诊中枢神经系统淋巴瘤的患者行MRI引导下立体定向活检手术.安装Leksell立体定向头架,行MRI扫描,计算靶点取标本,所取标本送病理学检查.结果:16例患者手术成功率100％,经病理证实,均诊断为中枢神经系统淋巴瘤,其中15例为弥漫性大B细胞淋巴瘤,1例为Burkitt淋巴瘤.术后复查CT有4例出现血肿,1例患者于术后第4日出现迟发性出血、脑疝,行开颅手术后死亡.结论:立体定向活检术对于明确诊断中枢神经系统淋巴瘤,具有重要的应用价值.     

Diagnosis of abdominal tuberculosis by transabdominal ultrasound-guided needle biopsy.

Laparotomy and laparoscopy have been used for biopsy of pelvic masses in the differential diagnosis between abdominal tuberculosis and ovarian cancer. We suggest the use of transabdominal needle biopsy under ultrasound guidance in such cases. Two women developed abdominal distention, one of whom had been receiving medical treatment for known tuberculosis. In both cases, ultrasonography showed a pelvic mass and ascites associated with high levels of CA 125. A transabdominal ultrasonographically-guided biopsy of the masses with a trucut needle established their tuberculous origin. The transabdominal sonographic needle biopsy is a reliable diagnostic procedure in the differential diagnosis between abdominal tuberculosis and ovarian malignancy. This minimally invasive procedure saves the patient with tuberculosis from unnecessary laparotomy.     

不同肺活检方法对肺部弥漫性间质性疾病的诊断价值

目的 探讨不同肺活检方法在肺部弥漫性问质性疾病诊断中的价值.方法 回顾性分析因弥漫性肺问质性疾病接受经支气管镜肺活检(transbronchial lung biopsy,TBLB)、CT引导下经皮肺活检(CT-guided percutaneous needle aspiration biopsy,PCNA)、外科电视胸腔镜(lung biopsy by video-assisted thoracoscopic surgery,VATS)及小开胸肺活检(openlungbiopsy,OLB)患者的临床和病理诊断资料.结果 73例患者接受TBLB,36例病理诊断为肺间质纤维化,7例诊断UIP,8例诊断结核,2例诊断为肺泡蛋白沉着症.28例患者接受经皮肺活检,其中18例得到病理分型.外科电视胸腔镜肺活检28例,小开胸肺活检20例,除1例未明确外,其余全部病理分类.结论 在诊断弥漫性肺问质性疾病时,可首先考虑创伤性小的经纤维支气管镜肺活检,可除外感染、肿瘤及结节病.肺部弥漫性间质性疾病中特发性问质性肺炎的病理诊断特别是病理分型需要较大的活检组织,应考虑进行外科电视胸腔镜或小开胸肺活检.