Percutaneous ultrasound-guided coaxial core needle biopsy for the diagnosis of multiple splenic lesions: A case report

BACKGROUND The overlap of imaging manifestations among distinct splenic lesions gives rise to a diagnostic dilemma.Consequently,a definitive diagnosis primarily relies on his-tological results.The ultrasound(US)-guided coaxial core needle biopsy(CNB)not only procures sufficient tissue to help clarify the diagnosis,but reduces the incidence of puncture-related complications.CASE SUMMARY A 41-year-old female,with a history of pulmonary tuberculosis,was admitted to our hospital with multiple indeterminate splenic lesions.Gray-scale ultrasono-graphy demonstrated splenomegaly with numerous well-defined hypoechoic ma-sses.Abdominal contrast-enhanced computed tomography(CT)showed an en-larged spleen with multiple irregular-shaped,peripherally enhancing,hypodense lesions.Positron emission CT revealed numerous abnormal hyperglycemia foci.These imaging findings strongly indicated the possibility of infectious disease as the primary concern,with neoplastic lesions requiring exclusion.To obtain the precise pathological diagnosis,the US-guided coaxial CNB of the spleen was ca-rried out.The patient did not express any discomfort during the procedure.CONCLUSION Percutaneous US-guided coaxial CNB is an excellent and safe option for obtaining precise splenic tissue samples,as it significantly enhances sample yield for exact pathological analysis with minimum trauma to the spleen parenchyma and sur-rounding tissue.

Staging the axilla in women with breast cancer: the utility of preoperative ultrasound-guided needle biopsy

Preoperative staging of the axilla in women with invasive breast cancer using ultrasound-guided needle biopsy(UNB) identifies approximately 50% of patients with axillary nodal metastases prior to surgical intervention. Although moderately sensitive, it is a highly specific staging strategy that is rarely falsely-positive, hence a positive UNB allows patients to be triaged to axillary lymph-node dissection(ALND) avoiding potentially unnecessary sentinel node biopsy(SNB). In this review, we extend our previous work through an updated literature search, focusing on studies that report data on UNB utility. Based on data for 10,934 breast cancer patients, sourced from 35 studies, a positive UNB allowed triage of 1,745 cases(simple proportion 16%) to axillary surgical treatment: the utility of UNB was a median 19.8% [interquartile range(IQR) 11.6%-26.7%] across these studies. We also modelled data from a subgroup of studies, and estimated that amongst patients with metastases to axillary nodes, the odds ratio(OR) for high nodal disease burden for a positive UNB versus a negative UNB was 4.38 [95% confidence interval(95% CI): 3.13, 6.13], P<0.001. From this model, the estimated proportion with high nodal disease burden was 58.9%(95% CI: 50.2%, 67.0%) for a positive UNB, whereas the estimated proportion with high nodal disease burden was 24.6%(95% CI: 17.7%, 33.2%) if UNB was negative. Overall, axillary UNB has good clinical utility and a positive UNB can effectively triage to ALND. However, the evolving landscape of axillary surgical treatment means that UNB will have relatively less utility where surgeons have modified their practice to omission of ALND for minimal nodal metastatic disease.

The Diagnostic Significance of Ultrasound and Ultrasound-guided Coarse Needle Biopsy in Breast Cancer in Pregnancy

Objective:To explore the significance of ultrasound and ultrasound-guided coarse needle biopsy in the clinical diagnosis of breast cancer patients in pregnancy.Methods:A total of 10 patients with breast cancer in pregnancy were selected to study from October 2018 to October 2019 in our hospital,who were given preoperative ultrasound results and ultrasound-guided coarse-needle biopsy histopathology,and the results were analyzed.Results:All the 10 patients showed thickening of the mammary gland body,appeared to pick up disorderly situation,most of the dilated catheter,including 8 patients with solid hypoechoic mass,irregular shape,and“crab foot”edge burr.The corresponding aspect ratio value was greater than 1.The other 2 patients presented with cystic mixed masses with poor boundary definition,irregular shape,and mostly accompanied by posterior echo enhancement.Conclusion:Simple ultrasound diagnosis for patients with breast cancer during pregnancy has some errors,and should be used in combination with ultrasound-guided coarse needle biopsy operation.This method has a high clinical diagnosis rate and significant clinical application value,so it is worth promoting.

Overlooked risk for needle tract seeding following endoscopic ultrasound-guided minimally invasive tissue acquisition

Endoscopic ultrasound-guided minimally invasive tissue acquisition can be performed by two approaches as follows: Endoscopic ultrasound-guided fineneedle aspiration(EUS-FNA) and endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB). These have been evolved into leading approaches and widely used for the histological diagnosis of tumors in the gastrointestinal tract and adjacent organs. However, the role of EUS-FNA and EUS-FNB in disease diagnosis and evaluation remains controversial. Although the incidence of surgery-associated complications remains low, the consequences of needle tract seeding can be serious or even life-threatening. Recently, increasing case reports of needle tract seeding are emerging, especially caused by EUS-FNA. This complication needs serious consideration. In the present work, we integrated these case reports and the related literature, and summarized the relevant cases and technical characteristics of needle tract seeding caused by EUS-FNA and EUSFNB. Collectively, our findings provided valuable insights into the prevention and reduction of such serious complication.

Peritoneal dissemination of pancreatic cancer caused by endoscopic ultrasound-guided fine needle aspiration:A case report and literature review

BACKGROUND Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)is a biopsy technique widely used to diagnose pancreatic tumors because of its high sensitivity and specificity.Although needle-tract seeding caused by EUS-FNA has been recently reported,dissemination of pancreatic cancer cells is generally considered to be a rare complication that does not affect patient prognosis.However,the frequency of dissemination and needle-tract seeding appears to have been underestimated.We present a case of peritoneal dissemination of pancreatic cancer due to preoperative EUS-FNA.CASE SUMMARY An 81-year-old man was referred to the Department of Surgery of our hospital in Japan owing to the detection of a pancreatic mass on computed tomography during medical screening.Trans-gastric EUS-FNA revealed that the mass was an adenocarcinoma;hence laparoscopic distal pancreatectomy with lymphadenectomy was performed.No intraoperative peritoneal dissemination and liver metastasis were visually detected,and pelvic lavage cytology was negative for carcinoma cells.The postoperative surgical specimen was negative for carcinoma cells at the dissected margin and the cut end margin;however,pathological findings revealed adenocarcinoma cells on the peritoneal surface proximal to the needle puncture site,and the cells were suspected to be disseminated via EUSFNA.Hence,the patient received adjuvant therapy with S-1(tegafur,gimeracil,and oteracil potassium);however,computed tomography performed 5 mo after surgery revealed liver metastasis and cancerous peritonitis.The patient received palliative therapy and died 8 mo after the operation.CONCLUSION The indications of EUS-FNA should be carefully considered to avoid iatrogenic dissemination,especially for cancers in the pancreatic body or tail.

Comprehensive review on endoscopic ultrasound-guided tissue acquisition techniques for solid pancreatic tumor

Pancreatic ductal adenocarcinoma is speculated to become the second leading cause of cancer-related mortality by 2030,a high mortality rate considering the number of cases.Surgery and chemotherapy are the main treatment options,but they are burdensome for patients.A clear histological diagnosis is needed to determine a treatment plan,and endoscopic ultrasound(EUS)-guided tissue acquisition(TA)is a suitable technique that does not worsen the cancer-specific prognosis even for lesions at risk of needle tract seeding.With the development of personalized medicine and precision treatment,there has been an increasing demand to increase cell counts and collect specimens while preserving tissue structure,leading to the development of the fine-needle biopsy(FNB)needle.EUS-FNB is rapidly replacing EUS-guided fine-needle aspiration(FNA)as the procedure of choice for EUS-TA of pancreatic cancer.However,EUS-FNA is sometimes necessary where the FNB needle cannot penetrate small hard lesions,so it is important clinicians are familiar with both.Given these recent developments,we present an up-to-date review of the role of EUS-TA in pancreatic cancer.Particularly,technical aspects,such as needle caliber,negative pressure,and puncture methods,for obtaining an adequate specimen in EUS-TA are discussed.

Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum

The factors influencing the incidence of common complications（pneumothorax and pulmonary hemorrhage） of CT-guided percutaneous needle biopsy of lumps near pulmonary hilum were investigated. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum was performed on 48 patients. The complications of pneumothorax and pneumorrhagia as well as the contributing factors were analyzed statistically. The major complications associated with CT-guided needle biopsy included pneumothorax（13 cases, 27.1%） and pulmonary hemorrhage（14 cases, 20.24%）. ？2 test revealed that pneumothorax was associated with the lesion size and depth of needle penetration, and pulmonary hemorrhage with the depth of needle penetration and needle retention time with a significant P value. Pneumothorax was observed in 7 cases（17.5%） out of 40 cases with diameter of mass greater than 3 cm, and in 6 cases（60%） out of 10 cases with depth of needle penetration greater than 4 cm. Additionally, pulmonary hemorrhage was identified in 12 cases（41.4%） out of 29 cases with needle retention time longer than 15 min, and pulmonary hemorrhage in 7 cases（70%） out of 10 cases with depth of needle penetration greater than 4 cm. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum is safe and effective. The key factors to prevent the complications include correct evaluation of lesion size, depth of needle penetration and the needle retention time before the operation. Key words： biopsy, CT-guided; hilum; pneumothorax; pulmonary hemorrhage

Septic shock due to Granulicatella adiacens after endoscopic ultrasound-guided biopsy of a splenic mass:A case report

BACKGROUND Endoscopic ultrasound-guided fine needle aspiration or biopsy(EUS-FNA or FNB)has become a popular method for diagnosing various lesions of the gastrointestinal tract and surrounding tissue due to the accuracy and safety.To the best of our knowledge,no case report of severe infection after EUS-FNB of a solid lesion in the spleen has been described.Herein,we report a rare case of septic shock after EUS-FNB of a splenic mass.CASE SUMMARY A 45-year-old male patient presented to the outpatient clinic due to an incidentally detected splenic mass.A definitive diagnosis could not be established based on the abdominal magnetic resonance imaging.EUS of the spleen showed a 6 cm-sized,relatively well-demarcated,heterogeneous mass,and EUS-FNB with a 22G needle was performed.Ten days after the procedure patient developed septic shock and a splenic abscess was identified.Blood culture revealed growth of Granulicatella adiacens.After the treatment with antibiotics the patient underwent surgical resection,and the pathological examination showed diffuse large B-cell lymphoma.The patient received chemotherapy and he is in complete remission.CONCLUSION Infection of a splenic mass after EUS-FNB is a rare complication and prophylactic antibiotics might be considered.

Endoscopic ultrasound fine needle aspiration vs fine needle biopsy in solid lesions:A multi-center analysis

BACKGROUND While endoscopic ultrasound(EUS)-guided fine needle aspiration(FNA)is considered a preferred technique for tissue sampling for solid lesions,fine needle biopsy(FNB)has recently been developed.AIM To compare the accuracy of FNB vs FNA in determining the diagnosis of solid lesions.METHODS A retrospective,multi-center study of EUS-guided tissue sampling using FNA vs FNB needles.Measured outcomes included diagnostic test characteristics(i.e.,sensitivity,specificity,accuracy),use of rapid on-site evaluation(ROSE),and adverse events.Subgroup analyses were performed by type of lesion and diagnostic yield with or without ROSE.A multivariable logistic regression was also performed.RESULTS A total of 1168 patients with solid lesions(n=468 FNA;n=700 FNB)underwent EUS-guided sampling.Mean age was 65.02±12.13 years.Overall,sensitivity,specificity and accuracy were superior for FNB vs FNA(84.70%vs 74.53%;99.29%vs 96.62%;and 87.62%vs 81.55%,respectively;P<0.001).On subgroup analyses,sensitivity,specificity,and accuracy of FNB alone were similar to FNA+ROSE[(81.66%vs 86.45%;P=0.142),(100%vs 100%;P=1.00)and(88.40%vs 85.43%;P=0.320].There were no difference in diagnostic yield of FNB alone vs FNB+ROSE(P>0.05).Multivariate analysis showed no significant predictor for better accuracy.On subgroup analyses,FNB was superior to FNA for non-pancreatic lesions;however,there was no difference between the techniques among pancreatic lesions.One adverse event was reported in each group.CONCLUSION FNB is superior to FNA with equivalent diagnostic test characteristics compared to FNA+ROSE in the diagnosis of non-pancreatic solid lesions.Our results suggest that EUS-FNB may eliminate the need of ROSE and should be employed as a first-line method in the diagnosis of solid lesions.

Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience

BACKGROUND Establishing a diagnosis of pancreatic cystic lesions(PCLs)preoperatively still remains challenging.Recently,endoscopic ultrasound(EUS)-through-the-needle biopsy(EUS-TTNB)using microforceps in PCLs has been made available.AIM To assess the efficacy and safety of EUS-TTNB in the diagnosis of PCLs.METHODS We retrospectively collected data of patients with PCLs who underwent both EUS-fine-needle aspiration(FNA)for cytology and EUS-TTNB at our institution since 2016.EUS-FNA for cytology was followed by EUS-TTNB in the same session.Evaluation of the cyst location,primary diagnosis,adverse events,and comparison between the cytologic fluid analyses and histopathology was performed.Technical success of EUS-TTNB was defined as visible tissue present after biopsy.Clinical success was defined as the presence of a specimen adequate to make a histologic or cytologic diagnosis.RESULTS A total of 56 patients(mean age 66.9±11.7,53.6%females)with PCLs were enrolled over the study period.The mean cyst size was 28.8 mm(12-85 mm).The EUS-TTNB procedure was technically successful in all patients(100%).The clinical success rate using EUS-TTNB was much higher than standard EUS-FNA,respectively 80.4%(45/56)vs 25%(14/56).Adverse events occurred in 2 patients(3.6%)who developed mild pancreatitis that resolved with medical therapy.Using TTNB specimens,23 of 32 cases(71.9%)with intraductal papillary mucinous neoplasm were further differentiated into gastric type(19 patients)and pancreaticobiliary type(4 patients)based on immunochemical staining.CONCLUSION EUS-TTNB for PCLs was technically feasible and had a favorable safety profile.Furthermore,the diagnostic yield for PCLs was much higher with EUS-TTNB than standard EUS-FNA cytology and fluid carcinoembryonic antigen.EUSTTNB should be considered as an adjunct to EUS-FNA and cytologic analysis in the diagnosis and management of PCLs.

Strategic insights into the cultivation of pancreatic cancer organoids from endoscopic ultrasonography-guided biopsy tissue

BACKGROUND The frequent suboptimal efficacy of endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)to culture pancreatic cancer(PC)organoids(PCOs)poses a major challenge in the advancement of personalized medicine for advanced PC.AIM To explore how to obtain appropriate puncture tissues from EUS-FNB and optimize the strategy for efficiently constructing PCOs,providing an efficient tool for the advancement of personalized medicine.METHODS Patients who underwent EUS-FNB for the diagnosis of PC tissue were prospectively enrolled.We refined the endoscopic biopsy procedures and organoid cultivation techniques.All tissue specimens verified by on-site pathological assessment were cultured in a semi-suspended medium in a microfluidic environment.We assessed differences in PCOs cultured beyond and below five generations examining patient demographics,specimen and organoid attributes,and the sensitivity of organoids to a panel of clinical drugs through cell viability assays.RESULTS In this study,16 patients with PC were recruited,one sample was excluded because onsite cytopathology showed no tumor cells.Successful organoid generation occurred in 93.3%(14 of 15)of the EUS-FNB specimens,with 60%(9 of 15)sustaining over five generations.Among these patients,those with a history of diabetes,familial cancer,or larger tumors exhibited enhanced PCO expandability.The key factors influencing longterm PCOs expansion included initial needle sample quality(P=0.005),rapid initiation of organoid culture postisolation(P≤0.001),and high organoid activity(P=0.031).Drug sensitivity analysis revealed a partial response in two patients following therapeutic intervention and surgery and stable disease in four patients,indicating a moderate correlation between organoid response and clinical outcomes.CONCLUSION Optimal initial needle sampling,rapid and precise biopsy sample processing,process isolated samples as soon as possible,and sufficient cellular material are crucial for successful cultivating PCOs.High organoid activity is an important factor in maintaining their long-term expansion,which is essential for shortening the time of drug sensitivity analysis and is the basis of PC research.

细针穿刺、粗针穿刺及两者联合诊断甲状腺结节的前瞻性对比研究

目的:对比研究超声引导下细针穿刺(FNA)、粗针穿刺(CNB)和粗细针穿刺结合(FNA+CNB)对同一甲状腺结节的诊断效能。方法:选取105例甲状腺结节患者(112个结节)作为研究对象,对每个结节同时行超声引导下细针(FNA)和粗针(CNB)穿刺,分别比较FNA、CNB、FNA+CNB对甲状腺结节的诊断效能;根据超声特征(结节最大径、粗大钙化、纵横比、囊实性)进行分组,比较FNA、CNB的诊断准确度。结果:剔除14个穿刺失败结节后,剩余98个结节进入研究,FNA、CNB取材成功率分别为89.4%、97.3%(P<0.05)。FNA、CNB、FNA+CNB诊断甲状腺结节的敏感度分别为93.1%、75.9%、100%,FNA、FNA+CNB优于CNB(P<0.05);特异度分别为60%、90%、57.5%,CNB优于FNA、FNA+CNB(P<0.05);阴性预测值分别为85.7%、72%、100%,FNA+CNB优于CNB(P<0.05)。ROC曲线分析显示,CNB曲线下面积(AUC)大于FNA(0.829 vs.0.766,P<0.05)。亚组分析中,对于直径<0.5 cm的结节,CNB诊断特异度高于FNA(100%vs.50%,P=0.014),FNA诊断敏感度高于CNB(93.3%vs.46.7%,P=0.033)。结节大小和纵横比可能会影响CNB的诊断结果,直径≥0.5 cm敏感度更高,纵横比≤1准确度更高(P<0.05);结节囊实性可能会影响FNA诊断结果,实性结节准确度更高(P<0.05)。结论:CNB对甲状腺结节良恶性的检出具有更高的诊断价值,但直径<0.5cm的结节使用FNA具有更高的敏感度。

同轴活检技术应用于CT引导经皮肺活检对不明原因肺部病变的临床意义

目的探讨同轴活检技术应用于CT引导经皮肺活检对不明原因肺部病变的临床意义。方法选取2015年5月至2019年5月清远市人民医院收治的306例不明原因肺部阴影患者作为研究对象,按照不同活检方式分为实验组(n=154)与对照组(n=152)。实验组采用同轴活检技术,对照组采用单纯针刺活检技术。比较两组手术成功率、并发症发生率、成功手术时间和成功手术接受辐射剂量。结果实验组小结节病灶手术成功率为98.3%,高于对照组的84.5%,差异有统计学意义(P<0.05);实验组深部病灶手术成功率为98.9%,高于对照组的90.7%,差异有统计学意义(P<0.05);实验组气胸、咯血发生率均低于对照组,差异有统计学意义(P<0.05);实验组成功手术时间短于对照组,成功手术接受辐射剂量少于对照组,差异有统计学意义(P<0.05)。结论同轴活检技术应用于CT引导经皮肺活检中对疑难穿刺病灶(小病灶和深部病灶)的手术成功率高于单纯针刺活检技术,可降低气胸和咯血发生率,减少患者接受的辐射剂量,缩短手术时间,且该项技术操作简单,成本低廉,只需在传统的单纯针刺活检技术的基础上附加同轴技术即可,值得临床推广应用。

173例关节炎患者新型细针滑膜盲穿活检的滑膜质量和安全性评价

目的:探讨新型滑膜活检装置所采集的滑膜质量以及该技术的安全性。方法:回顾性分析2023年1月至2023年12月在南昌大学第一附属医院风湿免疫科采用新型滑膜活检装置行滑膜活检的173例患者临床及滑膜组织信息,包括记录采集的样本组织大小,分析滑膜组织HE染色后滑膜结构完整性,滑膜碎片占比,RNA完整性(RIN)评分等。同时对患者进行问卷调查,内容包括穿刺前后的关节疼痛、僵硬和肿胀,穿刺过程的不适,术后的不良反应、恢复时间等。结果:穿刺部位131例为膝关节,12例为踝关节,23例为腕关节,7例为肘关节。其中25例未见到滑膜组织,取样成功率为85.55%。取样样本平均为10.86 mm^(2)。所有滑膜样本均可见到完整的滑膜结构。可评级的滑膜碎片占比为85.13%,RIN的中位数为7.00。PRO数据显示,在活检前后和活检后1周,VAS评分差异无统计学意义(P>0.05)。未报告严重并发症,包括关节感染、出血或血管迷走神经体征。结论:新型滑膜活检装置可有效进行滑膜取材,且临床安全,患者耐受性良好。

动态对比增强磁共振成像对术前空芯针穿刺活检诊断为乳腺导管原位癌术后病理升级为乳腺浸润性导管癌的评估价值

目的通过分析术前空芯针穿刺活检(CNB)诊断为乳腺导管原位癌(DCIS)术后升级为乳腺浸润性导管癌(IDC)病例的MRI特征,探讨乳腺动态对比增强磁共振成像(DCE-MRI)的评估价值。方法回顾性分析2012年1月~2022年12月华南理工大学附属第六医院收治的经超声引导下CNB诊断的乳腺DCIS(含微浸润)患者104例,所有患者均进行乳腺MRI检查,对比分析术后未升级DCIS和术后升级为IDC的大小、形态、边缘及内部强化特征等。结果术前CNB诊断为DCIS 104例,手术后仍为DCIS(含微浸润)64例,病理升级为IDC 40例,升级比例(病理学低估)约为38.5%。未升级DCIS组肿块病变18例,非肿块病变46例,升级为IDC组肿块病变19例,非肿块病变21例,两者间差异有统计学意义(P<0.05)。DCE-MRI特征方面,病灶表现为非肿块样强化时,未升级DCIS主要表现为段样分布,不均质强化;术后升级为IDC主要表现为区域分布,集簇强化。病灶表现为肿块样强化时,未升级DCIS组边缘清晰,术后升级IDC组多为边缘毛刺状。时间-信号强度曲线分型上,术后未升级DCIS主要为平台型,其次为渐增型,而术后升级为IDC则主要为流出型,其次为平台型,两者间差异有统计学意义(P<0.05)。结论乳腺MRI成像对于CNB证实的DCIS是否存在手术后病理学升级具有潜在价值,有利于临床制定针对性治疗方案。

超微血管成像联合同轴针在肝脏占位性病变穿刺活检中的应用价值

目的:探讨超微血管成像(SMI)联合同轴针在超声引导下肝脏占位性病变穿刺活检中的应用价值。方法:超声引导下肝脏占位性病变穿刺活检144例病人均接受外科手术治疗。将所有病人划分为2组,即接受SMI联合同轴针肝占位性病变穿刺活检为SMI+同轴针组;接受肝脏占位性病变单针穿刺活检为单针组,记录并分析取材过程的相关数据、穿刺病理结果及外科手术病理结果,评价SMI联合同轴针在超声引导下肝脏占位性病变穿刺活检中的应用价值。结果:SMI+同轴针组在取材时间、穿刺次数、术后疼痛发生率及疼痛数字评分法评分低于单针组,在诊断准确率、肝脏恶性病变检出率及平均标本长度优于单针组,差异均具有统计学意义(P<0.05),2组取材次数、标本有效率、术后肝包膜下出血方面差异均无统计学意义(P>0.05)。结论:SMI联合同轴针在超声引导下肝脏占位性病变穿刺活检中具有一次穿刺多点取材的优势,能够减少穿刺次数、缩短取材时间、提高诊断准确率、肝脏恶性病变检出率、平均标本长度、降低疼痛发生率及疼痛数字评分的优点,具有较好的临床应用前景。

USCNB联合肿瘤标志物诊断乳腺癌、评估腋窝淋巴结分期中的价值

目的 探讨超声引导下空芯针穿刺活检(USCNB)联合肿瘤标志物诊断乳腺癌、评估腋窝淋巴结分期中的价值。方法 选取我院114例疑似乳腺癌患者,以病理诊断为金标准,评价USCNB、肿瘤标志物对乳腺癌的诊断价值,并对比不同腋窝淋巴结分期患者USCNB阳性率、肿瘤标志物水平及与腋窝淋巴结分期的相关性。结果 114例经手术病理检查确诊乳腺癌83例,腋窝淋巴结分期N0期17例、N1期30例、N2期20例、N3期16例;USCNB检查显示阳性82例,腋窝淋巴结分期N3、N2期患者USCNB阳性率>N1期患者>N0期患者,差异有统计学意义(P<0.05);乳腺癌患者血清癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原153(CA153)水平高于非乳腺癌患者,差异有统计学意义(P<0.05);腋窝淋巴结分期N3期患者血清CEA、CA125、CA153水平>N2期患者>N1期患者>N0期患者,差异有统计学意义(P<0.05);ROC曲线分析,USCNB、血清CEA、CA125、CA153联合诊断乳腺癌的AUC为0.936(95%CI:0.875~0.974);USCNB阳性率、血清CEA、CA125、CA153水平与腋窝淋巴结分期呈正相关(P<0.05)。结论 USCNB联合血清CEA、CA125、CA153在乳腺癌诊断中具有可靠的应用价值,还能为临床评估腋窝淋巴结分期提供数据支持。

穿刺活检联合不同涂片技术诊断甲状腺结节良恶性研究

探讨细针超声引导下穿刺活检联合传统涂片、液基薄层细胞学技术在甲状腺结节良恶性病变诊断中的应用价值。将2021年9月—2022年12月在衢州市柯城区人民医院治疗的75例甲状腺结节患者作为研究对象,均行细针超声引导下穿刺活检(US-FNAB)、传统涂片、液基薄层细胞学技术,以US-FNAB联合传统涂片作为对照组,US-FNAB联合液基薄层细胞学技术作为观察组,以手术病理结果为金标准,对比两组的标本满意率、与病理结果对照、诊断效能、诊断一致性。结果显示,观察组甲状腺结节直径明显长于对照组,标本满意率明显高于对照组(P<0.05);观察组对甲状腺结节诊断的特异度、准确度、阳性预测值高于对照组(P<0.05)。研究发现,US-FNAB联合液基薄层细胞学技术在甲状腺结节良恶性病变诊断鉴别中的应用效果更好,诊断效能更高,与病理结果的一致性更高。

Liver biopsy:analysis of results of two specialist teams

AIM:To analyze the safety and the adequacy of a sample of liver biopsies(LB)obtained by gastroenterologist(G)and interventional radiologist(IR)teams.METHODS:Medical records of consecutive patients evaluated at our GI unit from 01/01/2004 to31/12/2010 for whom LB was considered necessary to diagnose and/or stage liver disease,both in the setting of day hospital and regular admission(RA) care,were retrieved and the data entered in a database.Patients were divided into two groups:one undergoing an ultrasonography(US)-assisted procedure by the G team and one undergoing US-guided biopsy by the IR team.For the first group,an intercostal approach(US-assisted) and a Menghini modified type needle 16 G(length 90 mm) were used.The IR team used a subcostal approach(US-guided) and a semiautomatic modified Menghini type needle 18 G(length 150 mm).All the biopsies were evaluated for appropriateness according to the current guidelines.The number of portal tracts present in each biopsy was assessed by a revision performed by a single pathologist unaware of the previous pathology report.Clinical,laboratory and demographic patient characteristics,the adverse events rate and the diagnostic adequacy of LB were analyzed.RESULTS:During the study period,226 patients,126 males(56%) and 100 females(44%),underwent LB:167(74%) were carried out by the G team,whereas 59(26%) by the IR team.LB was mostly performed in a day hospital setting by the G team,while IR completed more procedures on inpatients(P < 0.0001).The groups did not differ in median age,body mass index(BMI),presence of comorbidities and coagulation parameters.Complications occurred in 26 patients(16 G team vs 10 IR team,P = 0.15).Most gross samples obtained were considered suitable for basal histological evaluation,with no difference among the two teams(96.4% G team vs 91.5% IR,P = 0.16).However,the samples obtained by the G team had a higher mean number of portal tracts(G team 9.5 ± 4.8; range 1-29 vs IR team 7.8 ± 4.1; range 1-20)(P = 0.0192) and a longer mean length(G team 22 mm ± 8.8 vs IR team 15 ± 6.5 mm)(P = 0.0001).CONCLUSION:LB can be performed with similar outcomes both by G and IR.Use of larger dimension needles allows obtaining better samples,with a similar rate of adverse events.

甲状腺细针穿刺针感对Bethesda Ⅲ类结节良恶性的预测价值

目的评估甲状腺细针穿刺针感对BethesdaⅢ类结节良恶性的预测价值。资料与方法回顾性分析2018年7月-2021年3月在河北省人民医院行超声引导下甲状腺结节细针穿刺活检(FNA)并有手术病理的487例患者共562个结节。依据FNA时穿刺针有无阻力感、砂砾感将针感分为0、1、2级。观察上述结节的针感分级与结节良恶性之间的关系,分析针感分级预测99例FNA病理为BethesdaⅢ类甲状腺结节性质的敏感度、特异度、阳性预测值、阴性预测值、准确度及受试者工作特征曲线下面积。结果良性结节共241个(42.88%),恶性结节共321个(57.12%),良、恶性结节针感分级差异有统计学意义(χ^(2)=170.94,P<0.001)。BethesdaⅢ类结节恶性率为31.31%(31/99),FNA针感分级在该类结节良、恶性中差异有统计学意义(χ^(2)=44.09,P<0.001),FNA针感评估BethesdaⅢ类结节良恶性的曲线下面积为0.830(95%CI0.731~0.930),预测良恶性的敏感度为74.19%,特异度为91.18%,准确度为85.86%,阳性预测值为79.31%,阴性预测值为88.57%。BethesdaⅢ类结节在针感0级时良性率为88.57%(62/70),在针感1级和2级时恶性率分别为76.47%(13/17)和83.34%(10/12)。结论甲状腺细针穿刺针感可协助FNA病理鉴别甲状腺结节的性质,可用于预测BethesdaⅢ类结节良恶性。