宫颈活检与宫颈环切术后病理检查在宫颈上皮内瘤样病变诊断中临床应用比较

目的:探讨阴道镜下行宫颈多点活检与宫颈环形电切术术后病理检查在宫颈上皮内瘤样病变诊断中临床应用比较。方法:对在我院经治的经阴道镜下行宫颈多点活检确诊的120例宫颈上皮内瘤样病变患者,进行宫颈环形电切术并且术后行病理检查,比较两者符合率。结果:在CINⅠ中两种方法的符合率为71.1%,在CINⅡ中两种方法的符合率为53.8%,在CINⅢ中两种方法的符合率为43.3%。结论:阴道镜下行宫颈多点活检与宫颈环形电切术术后病理检查对宫颈上皮内瘤样病变的诊断结果具有一定的差异,在经阴道镜下行宫颈多点活检诊断为宫颈上皮内瘤样病变的患者,可以在选择行宫颈环形电切术的同时,于术后行病理检查,可以达到进一步明确诊断的目的,提高该疾病诊断的准确率,减少误诊误治的发生。     

Bone Marrow Cell Content and Osteoclasts in Crista Biopsies

The bone marrow cell content was investigated by counting the percentage of cells in the areas between the trabeculae in crista biopsies. There was a decrease in the percentage of cells in bone marrow in osteoporotic women compared with our normal material. in patients undergoing haemodialysis there was a positive correlation between bone marrow cell content and osteoclasts, which could indicate a possible connection between osteoclasts and bone marrow cells.     

Sentinel node biopsy (SNB) in malignant melanoma as same day procedure vs delayed procedure: clinical and economic outcome

Abstract

The aim of this study was to compare a delayed sentinel node biopsy (dSNB) procedure with a same-day procedure (sSNB) in malignant melanoma. In March 2012, Aarhus University Hospital went from the dSNB to the sSNB procedure defined by lymphoscintigraphy (LS) and sentinel node biopsy (SNB) performed on the same day. Before that time, LS was performed 24 hours prior to SNB. The aim was to investigate whether differences between the two procedures exist. Patients who underwent the SNB procedure between April and July 2011 and 2012, respectively, were included in the study. The criteria for SNB were malignant melanoma thickness >1 mm, Clark level IV/V, and ulcus or unknown thickness of the melanoma. All patients underwent re-excision and SNB at the same time. Pathological evaluation was not changed in the observation periods; however, the LS procedures varied. Only a minor turnover among the surgeons was observed. One hundred and eight patients were included in the study, 59 (dSNB) from 2011 and 49 (sSNB) from 2012, respectively. A median of 2.17 (dSNB) and 2.31 (sSNB) SLNs were removed, with no statistical differences. No difference in node positivity rates was observed. However, the number of hospitalisation days differed significantly, with 1.94 days in dSNB and 0.49 days in sSNB. Rates of complications at the site of the SNB procedure were similar. No differences in disease-free survival (DFS) or overall survival (OS) were recorded. SNB does not increase the overall survival. It is, therefore, essential to keep the morbidity and economic costs low, while keeping the quality of the procedure high.     

CT引导下肺穿刺定位装置研制

目前CT引导下的肺穿刺活检采用徒手操作，术中需多次CT扫描验证，穿刺途径的选择和穿刺的进行局限于某一个二维平面内，手术时间长，重复穿刺次率较高，患者遭受X辐射量大，并有一定的气胸、出血甚至致命的并发症。本研究设计了一款CT引导下穿刺定位装置，可以实现三维空间内自由定位，能够定量地调整穿刺角度，克服了传统定位的模糊性和不确定性；装置还提供穿刺方向的引导，同时避免人手抖动对穿刺方向造成偏差，提高穿刺成功率，减少穿刺时间和CT扫描次数。该装置小巧轻便，操作便捷，易于推广使用。     

Fine‐tuning the criteria for strip biopsy and endoscopic submucosal dissection improves the outcome of early gastric carcinoma treatment

Background and Aim: Strip biopsy and endoscopic submucosal dissection (ESD) have been developed as a local treatment for early gastric cancer (EGC). However, the lesion criteria for the use of ESD, rather than strip biopsy, remain to be elucidated. Methods: On the basis of reviews of literature and our observations concerning the outcome of strip biopsy, we set the criteria for selecting strip biopsy and ESD as follows. The indications for strip biopsy were lesions less than 10 mm in size and located in the anterior wall or greater curvature of the lower and middle stomach. ESD was indicated for all other lesions. The validity of the criteria was then analyzed prospectively in 156 patients. The rate of en bloc R0 resection and local recurrence were evaluated. Results: Subsequently, 156 lesions were divided according to the criteria and were endoscopically resected by strip biopsy (n = 13) or ESD (n = 143). The en bloc R0 resection rates for the whole group and the strip biopsy and ESD groups was 93.5% (146/156), 92.3% (12/13), and 93.7% (134/143), respectively. None of the patients had suffered from local recurrence in either the strip biopsy or ESD groups. Conclusion: The validity of our criteria for selecting strip biopsy and ESD was verified. Our criteria exploit the advantages of both procedures and obtain better endoscopic therapy outcomes for EGC.     

Diagnosis of different liver fibrosis characteristics by blood tests in non‐alcoholic fatty liver disease

Aims: Our aim was to develop an accurate, non‐invasive, blood‐test‐based method for identifying the main characteristics of liver fibrosis in non‐alcoholic fatty liver disease (NAFLD). Methods: Fibrosis was staged according to NASH‐CRN and Metavir systems in 226 patients with NAFLD. A fully automated algorithm measured the fractal dimension (FD) and the area of fibrosis (AOF). Independent predictors of diagnostic targets were determined using bootstrap methods. Results: (i) Development. Significant fibrosis defined by NASH‐CRN F≥2 was diagnosed by weight, glycaemia, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and prothrombin index [area under the receiver operating characteristic (AUROC)=0.867]; significant fibrosis defined by Metavir F≥2 was diagnosed by weight, age, glycaemia, AST, ALT, ferritin and platelets (FibroMeter AUROC=0.941, P<0.005). AOF was estimated by the combination of hyaluronic acid, glycaemia, AST, ALT, platelets and prothrombin index (_aR²=0.530), while FD was estimated by hyaluronic acid, glycaemia, AST/ALT, weight and platelets (_aR²=0.529). (ii) Evaluation. Although NASH‐CRN was a better system for fibrosis staging, Metavir staging was a better reference for blood test. Thus, the patient rate with predictive values≥90% by tests was 97.3% with Metavir reference vs. 66.5% with NASH‐CRN reference (P<10^?3). FibroMeter showed a significantly higher AUROC than the NAFLD fibrosis score for significant fibrosis, but not for severe fibrosis or cirrhosis, with both staging systems. Relationships between fibrosis lesions were well reflected by blood tests, e.g., the correlation between histological area and FD of fibrosis (r_s=0.971, P<10^?3) was well reflected by the relationship between respective blood tests (r_s=0.852, P<10^?3). Conclusions: Different characteristics of fibrosis in NAFLD can be diagnosed and quantified by blood tests with excellent accuracy.     

Cancer of the lung: staging, radiology, surgery

Primary lung cancer is the leading cause of cancer-related deaths in industrialized countries. Despite advances in treatment, the overall 5-year survival remains poor due to the advanced stage of disease at presentation. Smoking remains the main risk factor being responsible for around 85% of all cases. The most important distinction is that between non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Surgeons primarily deal with NSCLC (SCLC is an aggressive tumour that usually presents with systemic disease). NSCLC has a number of histological subtypes.Patient evaluation aims to establish the cell type of the tumour, determine the stage of the disease, and to determine fitness for surgery. Staging of NSCLC is based on the tumour/node/metastasis (TNM) classification. Procedures used to diagnose or stage lung cancer can include chest X-ray, chest computed tomography (CT) scan, combined positron emission tomography/CT, CT or transbronchial guided needle biopsy, and mediastinoscopy amongst others. Surgery is the only established method for ‘curing’ NSCLC. However, only a quarter of patients have resectable disease at presentation. Surgical resection can be performed using a variety of procedures including lobectomy, pneumonectomy or wedge resections. The 5-year survival of patients with stage I lung cancer following surgical resection is 51-60%.