Endoscopic ultrasonography-related diagnostic accuracy and clinical significance on small rectal neuroendocrine neoplasms

This research aimed to examine the diagnostic accuracy and clinical significance of endoscopic ultrasonography(EUS)in the context of small rectal neuroendocrine neoplasms(NENs).A total of 108 patients with rectal subepithelial lesions(SELs)with a diameter of<20 mm were included in the analysis.The diagnosis and depth assessment of EUS was compared to the histology findings.The prevalence of NENs in rectal SELs was 78.7%(85/108).The sensitivity of EUS in detecting rectal NENs was 98.9%(84/85),while the specificity was 52.2%(12/23).Overall,the diagnostic accuracy of EUS in identifying rectal NENs was 88.9%(96/108).The overall accuracy rate for EUS in assessing the depth of invasion in rectal NENs was 92.9%(78/84).Therefore,EUS demonstrates reasonable diagnostic accuracy in detecting small rectal NENs,with good sensitivity but inferior specificity.EUS may also assist physicians in assessing the depth of invasion in small rectal NENs before endoscopic excision.

Diagnostic accuracy of endoscopic ultrasonography for rectal neuroendocrine neoplasms

AIM:To investigate the diagnostic accuracy of endoscopic ultrasonography(EUS)for rectal neuroendocrine neoplasms(NENs)and the differential diagnosis of rectal NENs from other subepithelial lesions(SELs).METHODS:The study group consisted of 36 consecutive patients with rectal NENs histopathologically diagnosed using biopsy and/or resected specimens.The control group consisted of 31 patients with homochronous rectal non-NEN SELs confirmed by pathology.Epithelial lesions such as cancer and adenoma were excluded from this study.One EUS expert blinded to the histological results reviewed the ultrasonic images.The size,original layer,echoic intensity and homogeneity of the lesions and the perifocal structures were investigated.The single EUS diagnosis recorded by the EUS expert was compared with the histological results.RESULTS:All NENs were located at the rectum 2-10 cm from the anus and appeared as nodular(n=12),round(n=19)or egg-shaped(n=5)lesions with a hypoechoic(n=7)or intermediate(n=29)echo pattern and a distinct border.Tumors ranged in size from 2.3 to 13.7 mm,with an average size of 6.8 mm.Homogeneous echogenicity was seen in all tumors except three.Apart from three patients(stage T2 in two and stage T3 in one),the tumors were located in the second and/or third wall layer without involvement of the fourth and fifth layers.In the patients with stage T1 disease,the tumors were located in the second wall layer only in seven cases,the third wall layer only in two cases,and both the second and third wall layers in27 cases.Approximately 94.4%(34/36)of rectal NENs were diagnosed correctly by EUS,and 74.2%(23/31)of other rectal SELs were classified correctly as nonNENs.Eight cases of other SELs were misdiagnosed as NENs,including two cases of inflammatory lesions and one case each of gastrointestinal tumor,endometriosis,metastatic tumor,lymphoma,neurilemmoma,and hemangioma.The positive predictive value of EUS for rectal NENs was 80.9%(34/42),the negative predictive value was 92.0%(23/25),and the diagnostic accuracy was85.1%.CONCLUSION:EUS has satisfactory diagnostic accuracy for rectal NENs with good sensitivity,but unfavorable specificity,making the differential diagnosis of NENs from other SELs challenging.

Contrast-enhanced ultrasonographic findings of serum amyloid A-positive hepatocellular neoplasm: Does hepatocellular adenoma arise in cirrhotic liver?

Hepatocellular adenoma(HCA) was recently classified into four pathological subtypes. There have been few studies describing the findings of contrast-enhanced ultrasonography(CEUS) of each type. Our case concerns a 78-year-old man who had undergone routine medical check-ups for hepatitis C for 11 years. Abdominal ultrasonography showed a 28 mm, hypo-echoic mass in the segment 4 of the liver. His integrating amount of drinking was 670 kg convert into ethanol. CEUS with Sonazoid demonstrated mild uniform hypo-enhancement with inflow of microbubbles from the periphery of the tumor in the arterial phase, and heterogeneously hypo-enhancement in the post vascular phase. Because the mass increased in size within 3 mo, a well differentiated hepatocellular carcinoma was suspected, and hepatic resection was performed. Microscopic findings showed homogeneous cell proliferation with low grade atypia, infiltration of inflammatory cells, ductular reactions, fatty deposit in part, and sinusoidal dilation. Immunohistochemistry revealed geographic positive for serum amyloid A(SAA), focal positive for glutaminesynthetase, diffuse and strong positive for C-reactive protein, and positive for liver-type fatty acid binding protein. These pathological features corresponded to that of an inflammatory HCA. However, we could not make a clear diagnosis, because HCAs were defined as not to arise in cirrhotic liver. Finally, this tumor was diagnosed as a SAA positive hepatocellular neoplasm.

Systematic review of ablative therapy for the treatment of renal allograft neoplasms

BACKGROUND To date,there are no guidelines on the treatment of solid neoplasms in the transplanted kidney.Historically,allograft nephrectomy has been considered the only reasonable option.More recently,nephron-sparing surgery (NSS) and ablative therapy (AT) have been proposed as alternative procedures in selected cases.AIM To review outcomes of AT for the treatment of renal allograft tumours.METHODS We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 Checklist.PubMed was searched in March 2019 without time restrictions for all papers reporting on radiofrequency ablation (RFA),cryoablation (CA),microwave ablation (MWA),high-intensity focused ultrasound (HIFU),and irreversible electroporation (IRE) of solid tumours of the kidney allograft.Only original manuscripts describing actual cases and edited in English were considered.All relevant articles were accessed in full text.Additional searches included all pertinent references.Selected studies were also assessed for methodological quality using a tool based on a modification of the Newcastle Ottawa scale.Data on recipient characteristics,transplant characteristics,disease characteristics,treatment protocols,and treatment outcomes were extracted and analysed.Given the nature and the quality of the studies available (mostly retrospective case reports and small retrospective uncontrolled case series),a descriptive summary was provided.RESULTS Twenty-eight relevant studies were selected describing a total of 100 AT procedures in 92 patients.Recipient age at diagnosis ranged from 21 to 71 years whereas time from transplant to diagnosis ranged from 0.1 to 312 mo.Most of the neoplasms were asymptomatic and diagnosed incidentally during imaging carried out for screening purposes or for other clinical reasons.Preferred diagnostic modality was Doppler-ultrasound scan followed by computed tomography scan,and magnetic resonance imaging.Main tumour types were: papillary renal cell carcinoma (RCC) and clear cell RCC.Maximal tumour diameter ranged from 5 to 55 mm.The vast majority of neoplasms were T1a N0 M0 with only 2 lesions staged T1b N0 M0.Neoplasms were managed by RFA (n = 78),CA (n = 15),MWA (n = 3),HIFU (n = 3),and IRE (n = 1).Overall,3 episodes of primary treatment failure were reported.A single case of recurrence was identified.Follow-up ranged from 1 to 81 mo.No cancer-related deaths were observed.Complication rate was extremely low (mostly < 10%).Graft function remained stable in the majority of recipients.Due to the limited sample size,no clear benefit of a single procedure over the other ones could be demonstrated.CONCLUSION AT for renal allograft neoplasms represents a promising alternative to radical nephrectomy and NSS in carefully selected patients.Properly designed clinical trials are needed to validate this therapeutic approach.

Localized type 1 autoimmune pancreatitis superimposed upon preexisting intraductal papillary mucinous neoplasms

A 70-year-old woman was found to have 2 cystic lesions in the head of the pancreas on abdominal ultrasonography during a routine medical examination.Endoscopic ultrasonography(EUS)and magnetic resonance cholangiopancreatography showed multilocular cysts in the head of the pancreas without dilation of the main pancreatic duct.The patient was followed-up semiannually with imaging studies for suspected branch duct-type intraductal papillary mucinous neoplasm(IPMN).At 3 years after initial presentation,hypoechoic lesions were observed around each pancreatic cyst by EUS.Diffusion-weighted imaging showed high-intensity regions corresponding to these lesions.Therefore,a diagnosis of invasive carcinoma derived from IPMN could not be excluded,and subtotal stomach-preserving pancreaticoduodenectomy was performed.The macroscopic examination of the surgical specimen showed whitish solid masses in the head of the pancreas,with multilocular cysts within each mass.Microscopically,each solid mass consisted of inflammatory cells such as lymphocytes and plasma cells.Furthermore,immunochemical staining revealed immunoglobulin G4-positive cells,and many obliterating phlebitides were observed.The cysts consisted of mucus-producing epithelial cells and showed a papillary growth pattern.Based on these findings,we diagnosed multiple localized type 1 autoimmune pancreatitis occurring only in the vicinity of the branch ducttype IPMN.

Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrastenhanced endoscopic ultrasonography

AIM: To elucidate the role of contrast-enhanced endoscopic ultrasonography(CE-EUS) in the diagnosis of branch duct intraductal papillary mucinous neoplasm(BD-IPMN).METHODS: A total of 50 patients diagnosed with BDIPMN by computed tomography(CT) and endoscopic ultrasonography(EUS) at our institute were included in this study. CE-EUS was performed when mural lesions were detected by EUS. The diagnostic accuracy for identifying mural nodules(MNs) was evaluated by CT, EUS, and EUS combined with CE-EUS. In the patients who underwent resection, the accuracy of measuring MN height with each imaging modality was compared. The cut-off values to diagnose malignant BD-IPMNs based on MN height for each imaging modality were determined using receiver operating characteristic curve analysis.RESULTS: Fifteen patients were diagnosed with BD-IPMN with MNs and underwent resection. The remaining 35 patients were diagnosed with BD-IPMN without MNs and underwent follow-up monitoring. The pathological findings revealed 14 cases with MNs and one case without. The accuracy for diagnosing MNs was 92% using CT and 72% using EUS; the diagnostic accuracy increased to 98% when EUS and CE-EUS were combined. The accuracy for measuring MN height significantly improved when using CE-EUS compared with using CT or EUS(median measurement error value, CT: 3.3 mm vs CE-EUS: 0.6 mm, P < 0.05; EUS: 2.1 mm vs CE-EUS: 0.6 mm, P < 0.01). A cut-off value of 8.8 mm for MN height as measured by CE-EUS improved the accuracy of diagnosing malignant BDIPMN to 93%. CONCLUSION: Using CE-EUS to measure MN height provides a highly accurate method for differentiating benign from malignant BD-IPMN.

Long-term growth of intrahepatic papillary neoplasms: A case report

BACKGROUND Intraductal papillary neoplasm of the bile duct (IPNB) is a type of tumor that presents in the intra- or extrahepatic bile ducts. Cystic-type intrahepatic IPNB often mimics simple liver cysts, making the diagnosis difficult. Because the growth of IPNB is slow, careful follow-up and timely therapeutic intervention is recommended. There are few reports with a follow-up period longer than a decade;thus, we report the case of a patient with an IPNB that grew for over 13 years. CASE SUMMARY A 65-year-old man was diagnosed, 13 years prior with a cystic hepatic tumor with abnormal imaging findings. The targeted tumor biopsy results showed no malignancy. Biannual follow-up examinations were performed because of the potential for malignancy. The cystic lesions showed gradual enlargement over 11 years and a 4 mm papillary proliferation appeared on the cyst wall, which is compatible with IPNB. The tumor was observed for another 2 years because of the patient’s wishes. The imaging findings showed enlargement to 8 mm and a new 9 mm papillary proliferation of the cystic tumor. Contrast-enhanced ultrasonography showed hyperenhancement during the arterial phase in both cyst walls, indicating intraductal tumor progression in both tumors. Thus, liver segment 8 subsegmentectomy was performed. The pathological findings indicated that the tumors contained mucin, and high-grade atypia was observed in the papillary lesions, showing IPNB.CONCLUSION The development of IPNB should be monitored in patients with cystic lesions and ultrasonography are useful tool for the evaluation.

Pancreatic cancer screening in patients with presumed branch-duct intraductal papillary mucinous neoplasms

Because delayed diagnosis is one of the causes of poor prognosis in pancreatic ductal adenocarcinoma(PDAC), early detection is a key for overall improvement of prognosis. Towards this end, periodic screening is recommended for individuals considered high-risk for PDAC. Advances in diagnostic imaging modalities have increased the frequency of incidental findings of pancreatic cysts,including the intraductal papillary mucinous neoplasm(IPMN)-a major risk factor of PDAC, having 1% annual prevalence of concomitance with IPMN.Proper retainment of patients with IPMN and regular follow-up by routine imaging examination will likely improve early detection and better prognosis of PDAC. Unfortunately, current guidelines only address management of PDAC derived from IPMN and overlook PDAC concomitant with IPMN. Screening of patients with IPMN, by endoscopic ultrasonography(currently the most reliable modality for detecting small PDAC), may facilitate early detection of both IPMNderived and-concomitant PDAC. Prospective studies to evaluate the usefulness of endoscopic ultrasonography in screening of IPMN-concomitant PDAC will also help in determining the optimal surveillance strategy for more widespread applications.

Ultrasonographic Characteristics of Intraductal Papillary Mucinous Neoplasm of the Pancreas

Objective To analyze the clinical and ultrasonographic imaging features of intraductal papillary mucinous neoplasm(IPMN) of the pancreas.Methods Twelve patients with IPMN underwent surgery between May 2005 and December 2008,including 4(33.3%) with adenoma and 8(66.7%) with adenocarcinoma.IPMN was classified preoperatively into 3 types based on sonographic findings of different sites:main duct,branch duct,and combined type.All clinical presentations and ultrasonographic findings of those patients were reviewed and the correlation between ultrasonographic findings and histopathological results was analyzed.Results There were 9 men and 3 women with a mean age of 60.1±9.6 years(range,32-73).Of all the 12 patients with IPMN,9(75.0%) had experienced some symptoms of epigastric discomfort and/or pain as well as backache;7 cases were with medical history of acute pancreatitis,5 cases with diabetes,4 cases with elevated CA19-9,and 2 cases with steatorrhea.All lesions of IPMN have been revealed by transabdominal ultrasonography.The mean diameters of the lesions were 1.4±0.8 cm(range,0.5-2.0) and 6.3±6.0 cm(range,2.0-20.0) in adenomas and adenocarcinomas,respectively.And the mean diameters of the main duct in adenomas and adenocarcinomas were 1.0±0.8 cm and 1.6±1.0 cm,respectively.Among the 4 adnomas,3(75.0%) cases were classified as branch type based on sonographic findings,and 2 were demonstrated as mural nodules in which no color signals was detected.Among the 8 adenocarcinomas,5(62.5%) cases were classified as main duct type,and 3(37.5%) as combined type.In 7 of the 8 adenocarcinomas,mural nodules were detected within the dilated ducts or cysts of the lesions in which color flow signals were detected.Conclusions Transabdominal ultrasonography can reveal the pancreatic cystic lesions of IPMN as well as dilated pancreatic ducts.Some characteristics should be noticed as suggesting the possibility of malignancy:clinical symptoms of pancreatic insufficiency,large tumor size,and mural nodules with color Doppler flow signals.Transabdominal ultrasonography could be a useful tool to help diagnose and make appropriate management of IPMN.

经腹超声引导下经皮穿刺活检对内镜超声引导下穿刺活检诊断胰腺肿瘤的补充价值

目的 观察经腹超声引导下经皮穿刺活检对内镜超声(EUS)引导下穿刺活检诊断胰腺肿瘤的补充价值。方法 回顾性分析30例因EUS引导下穿刺活检诊断结果不满意(未见肿瘤细胞20例、可见异常细胞但无法明确诊断10例)而接受经腹超声引导下经皮穿刺活检的胰腺肿瘤患者,评价后者的补充诊断价值。结果 20例EUS引导下穿刺活检未见肿瘤细胞患者中,经腹超声引导下穿刺活检明确诊断11例肿瘤及其病理类型,7例可见异常细胞但未能明确诊断,2例仍未见肿瘤细胞;10例EUS引导下穿刺结果无法明确诊断患者中,经腹超声引导下穿刺活检明确诊断9例肿瘤及其病理类型,1例为非典型细胞。结论 经腹超声引导下经皮穿刺活检对EUS引导下穿刺活检诊断胰腺肿瘤具有较高补充价值。

超声人工智能辅助诊断系统用于甲状腺髓样癌

目的 以甲状腺乳头状癌(PTC)为对照,对比超声甲状腺人工智能(AI)辅助诊断系统(AI辅助诊断系统)与不同年资超声医师诊断甲状腺髓样癌(MTC)的效果。方法 纳入经病理证实的63枚MTC、70枚PTC和62枚良性结节。以AI辅助诊断系统分析并识别结节,将恶性概率值≥0.40者诊断为恶性结节;由高、中及初级职称医师各1名利用我国甲状腺影像报告和数据系统(C-TIRADS)对甲状腺结节进行分类;对比两种方法诊断MTC及PTC的效能。结果 AI辅助诊断系统诊断MTC和PTC的敏感度、特异度、阳性预测值、阴性预测值、准确率及曲线下面积(AUC)均低于3名医师;高、中级职称医师与AI辅助诊断系统诊断MTC和PTC的AUC差异均有统计学意义(P均<0.01),初级职称医师与AI辅助诊断系统AUC差异均无统计学意义(P均>0.05)。AI辅助诊断系统诊断MTC的敏感度、特异度、阳性预测值、阴性预测值、准确率及AUC均低于其诊断PTC,但AUC差异无统计学意义(P>0.05)。结论 超声甲状腺AI辅助诊断系统诊断MTC效能较高。

高频超声在乳腺乳头腺瘤中的诊断价值

目的:探讨高频超声在乳腺乳头腺瘤(NA)中的诊断价值。方法:回顾性分析2012年1月-2022年12月我院55例经病理确诊为乳腺NA的术前超声表现,观察病变部位、内部回声、形态、边界、血流信号、与周边的毗邻关系,以及有无伴随其他乳腺病变。结果:NA超声表现呈现多样化,超声声像图分为:①结节型18例(32.7%):乳头内或乳头根部结节,结节直径3.7~22mm,实性低回声17例,囊实性1例,边界清,椭圆形,血流不丰富;②乳头肿大型16例(29.1%):乳头肿大、回声减低伴丰富血流;③中央导管扩张型7例(12.7%):中央区导管扩张,内径约2.0~4.5mm;④无特殊表现型14例(25.5%)。单纯NA组36例,NA伴良性病变组14例,NA伴恶性病变组5例。NA伴恶性病变组年龄>50岁(60%)明显多于单纯NA组(16.7%),差异具有统计学意义(P=0.028)。结论:NA可单独发生,也可与良性病变或恶性病变伴发,高频超声可显示NA的典型声像图特征,为临床诊疗提供影像学支持。

附睾多发炎性肌纤维母细胞瘤一例

附睾炎性肌纤维母细胞瘤(inflammatory myofibroblastic tumor,IMT)国内外仅报道数例,并且都是单发的肿瘤。报告1例附睾多发性IMT病例,患者自行发现右侧阴囊内肿物1年,肿物进行性增大。超声检查提示右侧阴囊内多发实性结节,行右侧阴囊探查术+肿物切除术,术中发现右侧附睾多发类圆形质韧肿物,术后肿物病理证实为IMT,术后随访6个月,未见肿物复发。通过回顾相关文献,认为附睾IMT与发生在附睾的其他肿物临床症状类似,术前一般难以诊断,该肿瘤会进行性增大,有低度恶性潜能,故建议手术切除肿物,术后患者无需特殊治疗,一般不会复发,但需定期复查。

超声造影联合剪切波弹性成像技术对肝脏良恶性肿瘤诊断价值的Meta分析

目的 研究超声造影(CEUS)联合剪切波弹性成像(SWE)对肝脏肿瘤的诊断价值。方法 本研究根据PRISMA指南完成,PROSPERO注册号:CRD42023491288。检索Pub Med、Embase、Cochrane Library、中国知网、维普、万方数据库关于CEUS联合SWE诊断肝脏肿瘤的文献,检索时限为2000年1月—2023年10月,经筛选共纳入12篇文献,包含1 328例患者。以QUADAS-2工具对纳入的文献进行质量评估。采用Stata 15.0软件计算合并灵敏度、特异度、阳性似然比、阴性似然比、诊断比值比及异质性,绘制综合受试者工作特征曲线(SROC)并计算曲线下面积(AUC)。结果 纳入病例中,包含病灶1 457个,其中恶性病灶764个,良性病灶693个,阳性率为52.44%,阴性率为47.56%,计算得到合并灵敏度、特异度、阳性似然比、阴性似然比、诊断比值比分别为0.94(95%CI:0.91~0.96)、0.92(95%CI:0.87~0.95)、12.00(95%CI:7.40~19.40)、0.06(95%CI:0.04~0.10)、191(95%CI:87~417),异质性检验结果为Q=54.78,df=11.00,P<0.001,I2=79.92%,95%CI:69.18%~90.66%,AUC为0.98。结论 CEUS联合SWE技术对于肝脏良恶性肿瘤具有较高的诊断价值,值得临床推广使用。

超声乳腺影像报告和数据系统联合患者年龄鉴别良性与交界性/恶性乳腺叶状肿瘤

目的观察超声乳腺影像报告和数据系统(BI-RADS)联合患者年龄鉴别良性与交界性/恶性乳腺叶状肿瘤(PTB)的价值。方法回顾性分析74例经乳腺超声检查及术后病理证实的PTB女性患者共76个病灶,包括良性57个、交界性14个及恶性5个,比较3种病变患者年龄及其超声BI-RADS分类,观察以单一年龄、超声BI-RADS及其联合鉴别诊断价值。结果良性、交界性及恶性PTB之间,患者年龄及超声BI-RADS分类差异均有统计学意义(P=0.026、0.015)。以44.5岁、超声BI-RADS 4B类及其联合鉴别良性与交界性/恶性PTB的敏感度分别为94.74%、36.84%及73.68%,特异度分别为56.36%、87.27%及72.73%,曲线下面积分别为0.769、0.649及0.780。结论超声BI-RADS分类联合患者年龄有助于鉴别良性与交界性/恶性PTB。

高频超声联合超微血流成像技术在甲状腺乳头状癌颈部淋巴结转移中的诊断价值

【目的】探讨高频超声联合超微血流成像在甲状腺乳头状癌颈部淋巴结转移中的诊断价值。【方法】回顾性分析2020年1月至2023年6月在本院接受甲状腺乳头状癌切除术和颈部淋巴结清扫术治疗的60例患者的临床资料,术前均行高频超声、超微血流成像技术检查,比较高频超声联合超微血流成像检查与单纯高频超声及超微血流成像诊断转移性淋巴结的准确率。【结果】60例患者共计90个颈部淋巴结发生转移,65个淋巴结发生颈中央区转移,25个淋巴结发生颈侧区转移。高频超声和超微血流成像联合检查诊断颈部淋巴结转移的准确率显著高于高频超声检查和超微血流成像检查(P<0.05)。高频超声检查显示,44例甲状腺乳头状癌患者病灶内部或周边呈短棒状、点状血流信号,5例患者病灶内部呈分支状血流信号。超微血流成像技术检查显示,40例患者病灶内部或周边呈短棒状、点状血流信号,14例患者病灶内呈分支状血流信号。【结论】高频超声联合超微血流成像技术诊断甲状腺乳头状癌颈部淋巴结转移患者的价值高,值得临床借鉴。

多种超声影像技术在乳腺癌诊断中的研究进展

乳腺癌是我国女性发病率最高的恶性肿瘤,常规超声是乳腺癌筛查常用的影像检查方法。弹性成像、超声造影、自动乳腺超声成像系统、S-detect技术及超声引导下穿刺活检等新技术正在飞速发展并逐渐应用于临床,为乳腺癌的诊断提供了更有价值的信息。本文就多种超声影像技术诊断乳腺癌的临床应用进展进行综述。

多模态超声诊断甲状腺肿瘤

超声是诊断甲状腺疾病首选的影像学工具。基于常规超声的甲状腺影像报告和数据系统的建立在甲状腺肿瘤诊断中发挥着举足轻重的作用。近年来,弹性成像、超微血流成像、超声造影及人工智能等新技术广泛应用于甲状腺疾病超声诊断。多模态超声技术的应用大幅度提升了甲状腺恶性肿瘤的诊断准确度,为甲状腺癌患者个体化诊疗方案的制订提供了理论依据。

多模态超声联合细针抽吸活组织检查对直径≤5 mm甲状腺微小癌诊断分析

目的 分析多模态超声联合细针抽吸活组织检查(fine needle aspiration, FNA)对直径≤5 mm甲状腺微小癌(thyroid microcarcinoma, TMC)的诊断准确性。方法 回顾性分析2019年9月-2021年3月行多模态超声(二维超声、超声造影、超声弹性成像)联合FNA检查,且经手术病理证实为直径≤5 mm甲状腺微小结节120例(结节132个)的临床资料,分析多模态超声和FNA及联合检测与病理诊断结果的一致性,并采用受试者工作特征(ROC)曲线分析单项和联合检测的诊断价值。结果 132个直径≤5 mm甲状腺微小结节经术后病理结果分析,良性结节36个,TMC 96个。与病理结果比较,二维超声诊断符合率为85.60%(113/132),Kappa值0.646;超声造影诊断符合率为90.15%(119/132),Kappa值0.758;超声弹性成像诊断符合率为90.15%(119/132),Kappa值0.754;多模态超声诊断符合率为90.91%(120/132),Kappa值0.771;FNA诊断符合率为92.42%(122/132),Kappa值0.806;多模态超声联合FNA诊断符合率为94.70%(125/132),Kappa值0.860。ROC曲线分析结果显示,多模态超声与FNA单项诊断曲线下面积比较无差异(P>0.05);多模态超声与FNA联合诊断TMC的曲线下面积大于单项诊断(P<0.05)。结论 多模态超声和FNA对直径≤5 mm TMC均具有较好的临床诊断价值,二者联合更能提高临床诊断准确率。

超声引导下经皮穿刺活检诊断胰腺实性病变

目的 观察超声引导下经皮穿刺活检诊断胰腺实性病变的效能,探讨诊断准确率影响因素。方法 回顾性分析746例因胰腺实性病变接受经皮超声引导下粗针穿刺活检(US-CNB)患者,记录临床及影像学资料、胰腺穿刺相关资料和病理诊断;以穿刺12个月后临床随访结果为最终诊断,评估US-CNB诊断胰腺实性病变的效能。以单因素分析及logistic回归分析筛选影响US-CNB诊断准确率的因素。结果 742穿刺活检成功,技术成功率99.46%(742/746)。US-CNB准确诊断706例(准确组)、不准确36例(不准确组),其诊断胰腺实性病变的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为95.25%(702/737)、80.00%(4/5)、95.15%(706/742)、99.86%(702/703)和10.26%(4/39)。31例(31/742,4.18%)发生轻度并发症,4例(4/742,0.54%)发生严重并发症。组间患者年龄,胰腺病灶最大径<2 cm、病灶边界不清晰及病灶位于胰头部占比差异均有统计学意义(P均<0.1)。回归分析显示,病灶最大径<2 cm是US-CNB诊断准确率的独立影响因素(OR=3.054,P=0.030)。结论 超声引导下经皮胰腺病变穿刺活检安全、可靠,但病灶体积小可能影响其准确性。