纤支镜刷片病理细胞学和活检病理组织学在肺癌诊断中的临床意义

目的探讨纤镜刷片病理细胞学和纤支镜活检组织学在肺癌诊断中的价值.方法：用普通显微镜观察465例在临床上诊断为肺癌的病例,进行病理组织学的诊断和病理细胞学诊断.结果：465例肺癌中,纤支镜活检组织病理学诊断中,能分型的176例,末分型的6例,阳性182例,阴性250例.纤支镜刷片细胞学诊断中,能分型的155例.未分细34例,阳性189例,阴性232例.纤支镜活捡组织学和刷片细胞学比较,在肺癌分型时有显著差异（P〈0,05,肺癌的阳性和阴性率无明显差异（P〉0.05）.结论在肺癌的病理诊断中,纤支镜刷片病理细胞学和纤支镜活捡病理组织学诊断,二者要密切结合,相互补充,以利于肺癌的病理诊断,指导临床做治疗.

纤支镜刷片病理细胞学和活检病理组织学诊断在肺癌诊断中的临床意义

目的:探讨纤支镜刷片病理细胞学和纤支镜活检组织学诊断在肺癌诊断中的价值。方法:用普通显微镜观察465例临床诊断肺癌病例,进行病理组织学诊断和病理细胞学诊断,并对比、分析。结果:465例肺癌中,纤支镜活检组织病理学诊断中,能分型176例,未分型6例,阳性182例,阴性250例;纤支镜刷片细胞学诊断中,能分型155例,未分型4例,阳性189例,阴性232例。纤支镜活检组织学和刷片细胞学诊断比较,在肺癌分型时差异有统计学意义(P<0.05),肺癌阳性率和阴性率差异无统计学意义(P>0.05)。结论:在肺癌的病理诊断中,纤支镜刷片病理细胞学和纤支镜活检病理组织学诊断,二者要密切结合,相互补充,以利于肺癌的病理诊断,指导临床治疗。

Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

AIM： To evaluate the diagnostic accuracy of histological evaluation of pancreatic tissue samples obtained by a modified method for recovering and processing the endoscopic ultrasound （EUS）-guided fine needle aspiration （FNA） material in the differential diagnosis of pancreatic solid masses. METHODS： Sixty-two consecutive patients with pancreatic masses were prospectively studied. EUS was performed by the linear scanning Pentax FG-38UX echoendoscope. Three FNAs （22G needle） were carried out during each procedure. The materials obtained with first and second punctures were processed for cytological study. Haterials of the third puncture were recovered into 10% formol solution by careful injection of saline solution through the needle, and processed for histological study. RESULTS： Length of the core specimen obtained for histological analysis was 6.5±5.3 mm （range 1-22 mm）. Cytological and histological samples were considered as adequate in 51 （82.3%） and 52 cases （83.9%）, respectively. Overall sensitivity of both pancreatic cytology and histology for diagnosis of malignancy was 68.4%. Conbary to cytology, histology was able to diagnose tumours other than adenocarcinomas, and all cases of inflammatory masses. Combination of cytology and histology allowed obtaining an adequate sample in 56 cases （90.3%）, with a global sensitivity of 84.21%, specificity of 100% and an overall accuracy of 90.32%. The complication rate was 1.6%.CONCLUSION： Adequate pancreatic core specimens for histological examination can be obtained by EUS-guided FNA. This technique is mainly useful for the diagnosis of different types of pancreatic tumours and evaluation of benign diseases.

Substantial hepatic necrosis is prognostic in fulminant liver failure

To evaluate if any association existed between the extent of hepatic necrosis in initial liver biopsies and patient survival.METHODSThirty-seven patients with fulminant liver failure, whose liver biopsy exhibited substantial necrosis, were identified and included in the study. The histological and clinical data was then analyzed in order to assess the relationship between the extent of necrosis and patient survival, with and without liver transplantation. The patients were grouped based on the etiology of hepatic necrosis. Each of the etiology groups were then further stratified according to whether or not they had received a liver transplant post-index biopsy, and whether or not the patient survived.RESULTSThe core tissue length ranged from 5 to 44 mm with an average of 23 mm. Causes of necrosis included 14 autoimmune hepatitis, 10 drug induced liver injury (DILI), 9 hepatitis virus infection, and 4 unknown origin. Among them, 11 showed submassive (26%-75% of the parenchymal volume) and 26 massive (76%-100%) necrosis. Transplant-free survival was worse in patients with a higher extent of necrosis (40%, 71.4% and 100% in groups with necrosis of 76%-100%, 51%-75% and 26%-50%, respectively). Additionally, transplant-free survival rates were 66.7%, 57.1%, and 25.0% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively. Even after liver transplantation, the survival rate in patients as a result of viral hepatitis remained the lowest (80%, 100%, and 40% in groups of autoimmune hepatitis, DILI, and viral hepatitis, respectively).CONCLUSIONAdequate liver biopsy with more than 75% necrosis is associated with significant transplant-free mortality that is critical in predicting survival.

Pathology of hepatic iron overload

Although progress in imaging and genetics allow for a noninvasive diagnosis of most cases of genetic iron overload, liver pathology remains often useful （1） to assess prognosis by grading fibrosis and seeking for associated lesions and （2） to guide the etiological diagnosis, especially when no molecular marker is available. Then, the type of liver siderosis （parenchymal, mesenchymal or mixed） and its distribution throughout the Iobule and the liver are useful means for suggesting its etiology： HLA-linked hemochromatosis gene （HFE） hemochromatosis or other rare genetic hemochromatosis, nonhemochromatotic genetic iron overload （ferroportin disease, aceruloplasminemia）, or iron overload secondary to excessive iron supply, inflammatory syndrome, noncirrhotic chronic liver diseases including dysmetabolic iron overload syndrome, cirrhosis, and blood disorders.

In vivo histological diagnosis for gastric cancer using endocytoscopy

AIM To examine usefulness of virtual biopsy using endocytoscopy by comparing the in vivo endocytoscopic and histopathological images of gastric cancers.METHODS Endocytoscopy was performed in 30 patients with early gastric cancer. Of these, 26 patients showed well differentiated adenocarcinomas, while 4 patients showed poorly differentiated adenocarcinomas(including one signet ring cell carcinoma). Cancerous and non-cancerous areas were observed after double staining with 0.05% crystal violet and 0.1% methylene blue. The endocytoscopic images obtained were evaluated by an expert endoscopist and an expert pathologist without knowledge of patient clinical data, and endocytoscopic and histopathological diagnoses were compared.RESULTS The endocytoscopic images of the cancerous area were assessed as evaluable in 25(83.3%) and 27(90%) patients by endoscopist A and pathologist B, respectively, and those of the non-cancerous area as evaluable in 28(93.3%) and 23(76.7%) patients by the endoscopist and pathologist, respectively. The sensitivity, specificity, and diagnostic accuracy of gastric cancer diagnosis using evaluable endocytoscopic images were 88.0% and 92.9%, and 90.6% by endoscopist A, and 88.9% and 91.3%, and 90.0% by pathologist B, respectively. Evaluation of the diagnostic concordance rate between the endoscopist and the pathologist by inter-observer agreement calculation revealed no significant difference between the two observers. The inter-observer agreement(κ-value) for endocytoscopic diagnosis was 0.745. CONCLUSION Endocytoscopy is useful for the differentiation of cancerous from non-cancerous gastric mucosa, making it a promising tool for virtual biopsy.