超声引导下粗针穿刺活检在肺周围型肿块诊断中的临床应用价值

目的 探讨超声引导下粗针穿刺活检对肺周围型肿块的临床诊断价值.方法 选取88例肺周围型肿块患者,采用超声引导下粗针穿刺活检,所有取材标本进行病理组织学检查.结果 88例患者一次穿刺成功率为96.6%(85/88).穿刺组织用于病理诊断满意率为100.0%.并发症发生率为3.4%(3/88).行穿刺活检诊断病理88例,行免疫组化检查55例,行基因检测25例.82例均获得明确的病理诊断结果,诊断准确率93.2%.结论 对于超声能显示的肺周围型肿块,超声引导下粗针穿刺活检具有安全性高、操作简单、定位准确等优点,获得病理诊断的组织标本还可用于基因检测,为患者个性化治疗方案提供指导,有较高临床价值,值得推广应用.     

上尿路尿路上皮癌患者根治术前行输尿管镜活检的临床研究

  目的  探讨CT尿路造影（computed tomography urography,CTU）诊断明确的上尿路尿路上皮癌（upper tract urothelial carcino-ma,UTUC）患者行根治性肾输尿管切除（radical nephroureterectomy,RNU）术前是否有必要行输尿管镜活检。  方法  回顾性分析2011年9月至2020年5月郑州大学第一附属医院73例术后病理确诊为UTUC患者的病例资料,比较CTU与输尿管镜活检诊断UTUC的阳性率,并分析输尿管镜活检与根治术后肿瘤病理分级的不一致性。  结果  73例患者中70例行CTU检查者均提示异常,确诊阳性率为88.6%（62/70）,术后病理证实均为尿路上皮肿瘤。行CTU检查后又行输尿管镜活检患者为61例,确诊阳性率为91.8%（56/61）。输尿管镜活检为临床高级别、低级别肿瘤分别占39.3%（24/61）、52.5%（32/61）,术后病理诊断为高级别和低级别肿瘤分别占77.1%（47/61）和22.9%（14/61）。输尿管镜活检为临床低级别的肿瘤中,56.2%（18/32）术后病理升级为高级别肿瘤。CTU检查与输尿管镜活检诊断UTUC的阳性率无显著性差异（P=0.537）。  结论  输尿管镜活检为临床低级别肿瘤的患者术后病理有明显的升级风险。对于CTU诊断明确,拟行RNU的UTUC患者,术前不建议行输尿管镜活检。      

彩色多普勒高频超声诊断甲状腺肿瘤的效果及与病理检查的比较

目的探讨彩色多普勒高频超声诊断甲状腺肿瘤的超声图像特点及与病理检查的比较。方法选取2015年7月至2018年12月间陕西省西安高新医院收治的66例甲状腺肿瘤疑似患者,均采用彩色多普勒高频超声诊断和病理检查,比较两种检查结果,评价彩色多普勒高频超声诊断甲状腺肿瘤的敏感性和特异性和准确性。结果经彩色多普勒高频超声诊断后,结节性甲状腺肿患者16例,甲状腺肿瘤36例,甲状腺癌14例,经病理诊断后,结节性甲状腺肿11例,甲状腺肿瘤40例,甲状腺癌15例,差异无统计学意义(P> 0. 05)。与病理检查结果相比,彩色多普勒高频超声诊断的准确性为83. 3%,敏感性为90. 2%,特异性为60. 0%。结论彩色多普勒高频超声诊断甲状腺肿瘤患者,有较高的敏感性、准确性,但特异性略低,临床参考价值较高,可用于初步的临床诊断。     

乳腺癌的实时超声诊断与病理分型对照

乳腺癌为女性常见恶性肿瘤,及时发现和明确诊断对临床治疗、预后具有重要意义。乳腺肿瘤的实时超声诊断符合率为80.0%～88.4%[1～5]。我院自1995年4月～1998年12月对86例乳腺癌患者行超声诊断检查,通过分析图像并与术后病理比较,对乳腺癌的超声诊断与病理分型作初步探讨。1　材料和方法本组86例均为住院患者,全部为女性,年龄为23～74岁,左乳癌44例,右乳癌42例,均经手术和病理证实,全部病例术前行实时超声检查。检查仪器为日本ＡｌｏｋａＳＳＤ650实时超声显像仪及美国Ｅｎｖｉｓｉｏｎ5200型彩色超声检查仪,探头频率为7.5ＭＨｚ。患者取仰卧…     

23例原发性输尿管肿瘤的诊断与治疗

目的 探讨原发性输尿管肿瘤的临床特征、诊断和治疗方法 .方法 对23例原发性输尿管肿瘤患者的临床资料进行回顾性分析.结果 通过B超、静脉尿路造影(IVU)、逆行肾盂造影、CT、MRU及输尿管镜等检查,术前诊断符合率为91.3%(21/23).23例均行手术治疗,术后病理:1例内翻性乳头状瘤,1例乳头状瘤,21例移行细胞癌.结论 原发性输尿管肿瘤中输尿管癌多见.联合应用多种检查方法 可以提高原发性输尿管癌的诊断正确率,患侧肾、输尿管和膀胱袖状切除是治疗原发性输尿管癌的首要方法 .     

高频超声在诊断儿童甲状腺肿瘤中的应用价值

目的探讨高频超声在诊断儿童甲状腺肿瘤中的临床应用价值。方法选取51例儿童甲状腺肿瘤患者,均接受高频超声检查,分析超声检查和病理诊断结果的差异。结果超声诊断准确率为92.2%,良恶性准确率分别为97.0%与83.3%。良性肿瘤与恶性肿瘤在边界清晰度、形态规则度、有无微钙化、内部回声高低、有无颈部淋巴结肿大以及Ⅲ型肿块血流方面均存在明显差异(P<0.05)。联合指标评估比较中,形态不规则联合Ⅲ型血流表现的特异度和敏感度最佳。结论针对儿童甲状腺肿瘤患者开展高频超声检查能够有效发现结节,并能够依据不同表现判定肿瘤的性质,可作为儿童甲状腺肿瘤的首选诊断方法。     

卵巢肿瘤良恶性鉴别诊断初步探讨

B 型超声检查的临床应用不仅对妇科肿瘤的检出提供有价值诊断、而且对卵巢肿瘤良恶性改变,术前可提供可靠的诊断依据,我们就49例卵巢肿瘤的超声图象做进一步分析探讨:资料我们对49例患卵巢肿瘤患者术前进行超声检查,术后均经病理证实,年龄20-60岁。     

常规超声及介入性超声在诊断原发性卵巢癌腹膜转移中的应用价值

目的:探讨常规超声及介入性超声对卵巢癌腹膜转移的诊断价值.方法:对195例高度疑似卵巢癌患者行术前经腹式(transabdominal ultrasonography,TAUS)、经阴式(transvaginal ultrasonography,TVUS)的常规超声检查,扫查卵巢及腹膜、腹水等情况,对于异常腹膜进行超声引导下穿刺活检,与术后病理进行对比.结果:术后病理证实195例患者确诊为原发性卵巢癌,其中136例伴有腹膜转移.TAUS、TVUS以及TAUS+TVUS三种常规超声检查方式的诊断结果不同,其中以TAUS+TVUS的灵敏性、特异性、诊断准确率最高,分别为62.50%、94.92%、72.30%.腹水是常规超声对腹膜转移诊断的影响因素之一.TAUS+TVUS检查发现88例腹膜异常患者均行超声引导下穿刺活检,穿刺成功率为100%,与术后病理对比,灵敏性97.64%、特异性100%,诊断准确率为97.72%.结论:TAUS联合TVUS常规超声检查可在术前对卵巢癌腹膜转移情况进行较准确的影像学诊断,超声引导下穿刺活检可在术前为临床提供明确病理诊断,为卵巢癌的分期及治疗提供精确信息.     

超声造影对早期乳腺癌腋窝评估可行性的研究

目的 探讨早期乳腺癌患者腋窝超声造影检查对腋窝病理结果判断的准确性.方法 选取早期乳腺癌患者94例,术前均行腋窝超声造影检查,其诊断结果采用BI-RADS分级法表示,采用阳性率评估术前腋窝超声造影检查对腋窝病理情况预测价值的判定标准;同时分析不同病理类型状态下的预测价值.结果 94例患者中,Luminal A型23例(24.5%),Luminal B型44例(46.8%),HER2过表达型11例(11.7%),三阴型16例(17.0%).腋窝淋巴结BI-RADS-US 3级38例,阳性率为15.8%(6/38);BI-RADS-US 4级55例,阳性率为54.5%(30/55),其中BI-RADS-US 4c级阳性率最高,阳性率为92.8%(13/14);BI-RADS-US 5级1例,为假阳性.结论 超声造影检查是精准评估早期乳腺癌患者腋窝淋巴结状态的一种有价值的方法,可为临床选择合理的治疗方案提供参考.     

原发性小肠肿瘤的影像诊断(附26例报告)

目的　分析原发性小肠肿瘤的影像特点 ,探讨螺旋CT及DSA检查应用价值。方法　回顾分析 2 6例小肠原发性肿瘤的影像表现。 2 6例均行口服钡剂造影 ,11例超声检查 ,6例螺旋CT检查 ,4例DSA检查。结果　口服钡剂造影主要表现为充盈缺损、管腔狭窄 ,螺旋CT主要表现为肠壁增厚、软组织肿块 ,DSA主要表现为肿瘤染色、出血。CT诊断 6例 ,与病理相符 5例 ;DSA诊断 4例 ,与病理相符 3例。结论　小肠原发性肿瘤具有一定的影像特点 ,结合临床可提高诊断 ,螺旋CT与DSA检查明显提高肿瘤的定性诊断率。     

Increased risk of esophageal cancer after breast cancer.

BACKGROUND: Adjuvant radiation therapy for breast cancer has been related to excess esophageal cancer risk, but population-based data are scanty. PATIENTS AND METHODS: We considered esophageal cancer risk among 11 130 breast cancer patients diagnosed between 1974 and 2002 in the Swiss cantons of Vaud and Neuchatel, and followed-up to the end of 2002, for a total of 75 900 women-years at risk. RESULTS: Overall, 18 cases were observed compared with 8.9 expected, corresponding to a standardised incidence ratio (SIR) of 2.0 [95% confidence interval (CI) 1.2-3.2]. The SIR was 1.6 in the first 10 years after diagnosis and 3.3 for >/=10 years after diagnosis, 2.3 for cases diagnosed between 1974 and 1988 and 1.5 for those diagnosed after 1988, 2.3 (based on 15 cases) for squamous cell cancer and 1.3 (based on three cases) for adenocarcinomas, and 2.9 for the upper third, 2.3 for the middle third and 1.9 for the lower third of the esophagus. CONCLUSIONS: These data confirm an excess esophageal cancer risk following treatment for breast cancer which could not be explained by confounding of tobacco or alcohol alone. The excess risk tended to decrease for cases diagnosed after 1988, leaving open the issue of the risk of modern radiotherapy for breast cancer on esophageal cancer.     

Treatment outcome of recurrent cervical cancer

A total of 85 patients with recurrent cervical cancer were reviewed: 17 patients with recurrences were treated by radical surgery, 18 by radiotherapy, 29 by chemotherapy, and 21 cases received no further treatment. Survival was presented according to the site of recurrence and the mode of therapy. All patients were followed for a minimum of 24 months after recurrence. Of the total group, 14% are living without evidence of disease, 29% died of metastatic disease with no involvement in the pelvis, and 45% died of pelvic cancer. Overall, 22% were living more than 2 years, and only 2% lived over 5 years after recurrence. The NED (no evidence of disease) rate for radical surgery group was 47 and 44% for the radiotherapy group. There were no significant differences in median survival between the chemotherapy group and the no-treatment group (6.8 versus 4.8 months). New chemotherapy agents and adjuvant systemic therapy are discussed.     

乳腺癌术后肺栓塞27例临床特征分析

目的探讨乳腺癌外科术后肺栓塞的临床特征。 方法选取2008年1月1日至2020年1月1日在北京大学肿瘤医院行乳腺癌手术后出现肺栓塞的患者27例，收集并分析其临床资料、诊断结果、治疗及预后等。 结果入组的27例肺栓塞患者的临床表现无特异性，均通过肺动脉CT血管造影（CTPA）显示动脉充盈缺损确诊，其中双侧肺栓塞18例，单侧肺栓塞9例。超声检查显示伴下肢深静脉血栓14例，伴上肢深静脉血栓4例。18例早期予以足量低分子肝素（0.1 ml/10 kg，2次/d）抗凝治疗，9例予以减量低分子肝素（0.05 ml/10 kg，2次/d）抗凝治疗，患者均好转。在治疗过程中出现大出血1例，抗凝减量并予以输血治疗后好转。随访3个月无失访及死亡患者。 结论乳腺癌术后肺栓塞的临床表现无特异性，早期诊断和治疗可降低病死率。     

Therapeutic impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose positron emission tomography in the pre- and postoperative staging of patients with clinically intermediate or high-risk breast cancer.

BACKGROUND: Positron emission tomography with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG-PET) is an accurate imaging modality for the staging of breast cancer. The aim of this study was to determine the potential therapeutic impact of pre- and postoperative FDG-PET in patients with clinically intermediate or high-risk breast cancer. PATIENTS AND METHODS: One hundred and fourteen patients with newly diagnosed breast cancer were examined before (73) or after (41) surgery. Patient data were translated into three scoring sheets corresponding to information available before positron emission tomography (PET), after PET and after further diagnostic tests. Three medical oncologists independently reviewed the retrospectively acquired patient data and prospectively made decisions on the theoretically planed treatment for each time point, according to the recommendations of St Gallen Consensus Guidelines 2005. RESULTS: FDG-PET changed the planed treatment in 32% of 114 patients. In 20% of cases, therapeutic intention (curative versus palliative) was modified. Radiation treatment planning was changed in 27%, surgical planning in 9%, chemotherapy in 11% and intended therapy with bisphosphonates in 13% of all patients. CONCLUSION: Based on current treatment guidelines, FDG-PET, as a staging procedure in patients with newly diagnosed clinically intermediate or high-risk breast cancer examined pre- and postoperatively, may have a substantial therapeutic impact on treatment planning.     

Omitting axillary lymph node dissection in sentinel node negative breast cancer patients is safe: a long term follow-up analysis

PURPOSE: To evaluate the rate of axillary recurrences in sentinel node (SN) negative breast cancer patients without further axillary lymph node dissection (ALND). PATIENTS AND METHODS: Between October 1994 and November 1999, all SN negative breast cancer patients who did not underwent complete ALND were enrolled in this prospective study. SN biopsy was performed by using the triple technique which combines preoperative lymphoscintigraphy, intraoperative use of blue dye, and a handheld gamma probe to visualize and localize the SN. SNs were examined by standard hematoxylin and eosin (H&E) staining and immunohistochemistry (IHC). During the first year after surgery all patients underwent clinical examination at 3 monthly intervals. This follow-up interval was prolonged to 6 month after the first year. RESULTS: From the 104 patients, 93 (89%) underwent breast-conserving therapy; all remaining patients were treated by modified radical mastectomy. In 91 cases a ductal carcinoma and in 13 cases a lobular carcinoma was diagnosed. One SN was removed in 80, two SNs in 18, and three SNs in 2 patients. Twenty patients received systemic therapy based on age and primary tumor characteristics. After a median follow-up of 57 month only one axillary recurrence was observed. During follow-up three patients developed distant metastases. One of these patient with metastases to the bone is alive with evidence of disease. The remaining two patients died 9 and 19 month after surgery. CONCLUSIONS: Our long term follow-up results indicate that survival is excellent (98%) and local axillary control is adequate (99%) after omitting ALND in a group of 104 SN negative breast cancer patients.     

18F-FDG PET/CT显像在胰腺癌诊断中的应用价值

[目的]评价18F-脱氧葡萄糖(148F-FDG)PET/CT显像在胰腺癌诊断中的应用价值.[方法]回顾性分析46例疑似胰腺癌患者的全身18F-FDG PET/CT及CT平扫加增强的影像学资料,比较两者对胰腺癌的诊断价值.[结果] 46例疑似胰腺癌患者中,44例经手术、腹腔镜取病理确诊,其中胰腺癌38例,慢性胰腺炎6例,另2例PET/CT发现多处肝转移或肺转移,因而放弃手术,经临床随访1年后确诊为胰腺癌.18F-FDG PET/CT检查阳性37例,灵敏度92.5％,特异性83.3％,准确率为91.3％;CT平扫加增强检查,灵敏度75.0％,特异性66.7％,准确率为73.9％.PET/CT对胰腺癌诊断的灵敏度、特异性、准确率均明显高于CT,两者差异有统计学意义(P＜0.05).[结论] 18F-FDG PET/CT对胰腺癌的诊断与分期有较高的临床应用价值.     

Sentinel lymph node biopsy in clinically detected ductal carcinoma in situ

AIM: To study the indications for sentinel lymph node biopsy (SLNB) in clinically-detected ductal carcinoma in situ (CD-DCIS). METHODS: A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy (CNB) between June 2006 and June 2012 was conducted at King Faisal Specialist Hospital. The accuracy of performing SLNB in CD-DCIS, the rate of sentinel and non-sentinel nodal metastasis, and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed. The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion. We excluded any patient with evidence of microinvasion or invasion. There were two cases of mammographically detected DCIS and 18 cases of CD-DCIS. All our patients were diagnosed by an image-guided CNB except two patients who were diagnosed by fine needle aspiration (FNA). All patients underwent breast surgery, SLNB, and axillary lymph node dissection (ALND) if the SLN was positive. RESULTS: Twenty patients with an initial diagnosis of pure DCIS underwent SLNB, 2 of whom had an ALND. The mean age of the patients was 49.7 years (range, 35-70). Twelve patients (60%) were premenopausal and 8 (40%) were postmenopausal. CNB was the diagnostic procedure for 18 patients, and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate. Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis. Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%. The false negative rate was 0%. Only 2 patients had a positive SLNB (10%) and neither had additional metastasis following an ALND. After definitive surgery, 3 patients were upstaged to invasive ductal carcinoma (3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion (3/18 = 16.6%). Therefore the histologic underestimation rate of invasive disease was 33%. CONCLUSION: SLNB in CD-DCIS is technically feasible and highly accurate. We recommend limiting SLNB to patients undergoing a mastectomy.     

Metachronous malignancies in men with previous prostate cancer in Umbria, Italy, 1994-2003

Data about second primary tumors after prostate carcinoma are controversial. Some authors emphasize an increased incidence of some cancer sites, others an overall diminution. With the aim to provide further information to define the issue, we have analyzed the frequency of second metachronous primary malignancies in patients with diagnosed prostate cancer in the Umbria region of Italy. A total of 410 metachronous cancers among 4528 prostate cancer patients were abstracted from incident cases of the RTUP, over the period 1994-2003. This cohort was compared with all cases (except prostate cancers) recorded in the RTUP archive. The expected number of cases was obtained from indirect standardization with regional incidence rates of several sites. The significance of the observed/expected ratios and the corresponding 95% confidence intervals were based on the Poisson distribution. A significant standardized incidence ratio was found for all sites but prostate, with 410/351 observed/expected cases. The significance disappears considering all sites except prostate and skin non-melanomas. Among several sites, significant standardized incidence ratios were found for skin non-melanomas, for bladder, for rectum, but not for colon cancers. Kidney, ureter and urethra showed a nonsignificant standardized incidence ratio. Nasopharynx showed a significant standardized incidence ratio, but the result was based on a very small number of cases. In our data, the increase in urinary bladder and rectal cancers, after prostate cancer diagnosis, seems to be real: it is plausible that the number of second cancers may be due to increased urologist surveillance, which, in our Region, does not seem to be reduced in elderly men.     

National Cancer Database trends in surgical resection of the breast primary for stage IV breast cancer

BackgroundSurvival benefit after resection of the breast primary for women with metastatic breast cancer reported in retrospective studies has not been uniformly confirmed by randomized controlled trials. To assess the need for dissemination of trial results by the ACS Cancer Research Program Dissemination and Implementation (ACS CRP D&I) committee, we analyzed trends and predictors of surgery and other therapies for stage IV breast cancer.MethodsThe National Cancer Database (NCDB) was queried to identify women diagnosed with clinical stage IV breast cancer of ductal, lobular, or metaplastic histology between 2004 and 2017. Trends in utilization of breast surgery and other treatments and possible predictors of breast surgery were examined in univariable and multivariable analyses.ResultsWe identified 87,331 cases meeting inclusion criteria. Rates of surgical resection rose until 2009, peaking at 37%, then declined to a rate of 18% in 2017. The largest decline was seen in the hormone receptor positive (HR+), HER2 negative (HER2-) subgroup with up to 70% of patients undergoing surgery in 2007, down to 15% in 2017. In 2004, the rate of systemic therapy alone was slightly more common than locoregional therapy (surgery and/or radiation) with or without systemic therapy (48% vs 37%). However, by 2017, systemic therapy alone was by far more common (69% vs 20%).ConclusionRates of surgical resection of the breast primary for stage IV breast cancer have been on the decline in recent years, suggesting that providers at Commission on Cancer accredited hospitals are becoming more selective about who will be offered surgical resection.