超声引导经皮穿刺活检诊断乳腺占位性病变的可行性及有效性分析

目的:探讨乳腺占位性病变诊断中超声引导经皮穿刺活检的可行性及有效性。方法:选取2017年1月—2018年11月我院收治的102例乳腺占位性病变患者,对患者进行超声引导经皮穿刺活检和超声活检诊断,并以病理诊断为参考依据。分析乳腺占位病变超声诊断价值和乳腺占位性病变超声经皮穿刺活检的诊断价值,比较超声活检诊断和乳腺占位性病变超声引导诊断价值。结果:超声诊断与病理诊断结果无明显差异(P>0.05),超声引导活检诊断与病理诊断结果无明显差异(P>0.05),超声活检诊断和乳腺占位性病变超声引导诊断在灵敏度、特异度、符合率、漏诊率和误诊率方面存在显著差别(P<0.05),超声引导经皮穿刺活检的诊断效能优于超声诊断。结论:对乳腺癌患者进行超声引导经皮穿刺活检,不仅诊断效果理想,而且大大降低了患者诊断过程的漏诊率和误诊率,提高了诊断准确度,降低了并发症的发生。     

超声造影引导经皮穿刺活检诊断胰腺占位性病变

目的探讨应用CEUS引导经皮穿刺活检对胰腺占位性病变的临床应用价值。方法对因胰腺占位性病变需行穿刺活检、但常规超声定位困难的49例患者行CEUS引导下经皮穿刺活检,以所取组织能够作出明确病理诊断为取材满意;随访至少6个月,以术后病理诊断或随访影像学检查结果为最终临床诊断。结果本组穿刺活检满意率为95.92%(47/49),取材满意者穿刺活检的诊断准确率为97.87%(46/47)。术后恶心呕吐、发热及胆汁性腹膜炎各1例(1/49,2.04%)。结论对于常规超声不能准确定位的胰腺占位性病变,以CEUS引导穿刺可以提高取材的准确性,降低并发症发生率。     

超声引导自动肝穿刺活检对AFP阴性肝占位病变的临床诊断价值

为探讨应用超声引导自动活检枪肝穿刺活检对血AFP阴性肝占位病变的临床诊断价值。笔者近3年来应用彩色超声引导下自动活检枪肝穿刺对２３例ＨＢsＡg及ＡＦＰ均为阴性的肝实性占位性病变患者行活组织病理检查。结果示23例患者均为B超、CT检查发现占位病变，无临床典型表现。肿瘤大小2~4cm，13例为单发结节,10例为多发结节。其中既往有肿瘤手术病史的11例，均无肝炎病史。经超声引导自动肝穿活检获得明确诊断。无腹壁针道肿瘤种植。提示彩超引导下自动活检枪肝穿刺活检病理检查对肝脏实性占位性病变，尤其是血AFP阴性、临床诊断有疑问的患者有确诊意义。     

CT引导下经皮穿刺活检在脊柱占位性病变诊断中的应用

目的探讨CT引导下经皮穿刺活检对脊柱占位性病变的诊断价值。方法 2008年5月～2010年8月对临床不能明确诊断的30例脊柱占位性病变行CT引导下椎体穿刺活检术,在CT扫描监控下,使用骨穿刺活检针,局麻下经椎弓根或椎弓根旁途径取脊柱占位性病变骨质适量,通过变换工作通道方向或用不同直径的骨活检针进行多向多点取材,将钻取标本立即置于10%福尔马林中保存,标本送病理检查及相应的病理细胞学检查。结果 30例均成功穿刺取材,其中28例获得明确诊断:原发恶性肿瘤7例,脊柱转移性肿瘤13例,化脓性脊柱炎2例,脊柱结核2例,嗜酸性肉芽肿1例,神经纤维瘤1例,椎体血管瘤1例,修复性肉芽肿1例;2例未能明确诊断,采取切除活检,术后病理检查结果为嗜酸性肉芽肿1例,转移性腺癌(肺源性)1例。穿刺活检总的诊断准确率93.3%(28/30)。结论 CT引导下穿刺活检术对于脊柱占位性病变诊断具有安全、活检阳性率高特点,是诊断脊柱占位性病变的理想方法,对指导治疗具有重要意义。     

锥体束CT引导下纵隔占位性病变穿刺活检的临床应用

目的探讨锥体束CT(CBCT)引导下穿刺活检纵隔占位性病变的可行性及安全性。方法回顾性分析31例纵隔占位性病变患者的资料。与临床最终诊断结果对照,评价CBCT引导下纵隔占位性病变穿刺活检的诊断效能,并分析穿刺相关并发症情况。结果对31例患者共行穿刺活检31次,技术成功率100%(31/31)。30例穿刺病理结果与临床最终诊断结果一致,1例穿刺病理检查未能定性。CBCT引导下穿刺活检的诊断敏感度、特异度及准确率分别为96.30%(26/27)、100%(4/4)和96.77%(30/31)。本组出现气胸、血胸各1例,并发症发生率为6.45%(2/31)。结论 CBCT引导下穿刺活检定性诊断纵隔占位性病变准确率较高,且并发症较少。     

超声引导下经皮细针穿刺抽吸与粗针穿刺活检在胰腺占位性病变中的应用价值分析

目的 研究超声引导下经皮细针穿刺抽吸与超声引导经皮粗针穿刺活检（CNB）在胰腺占位中的应用价值。方法 回顾性分析本院2020年1月至2023年1月收治的72例胰腺占位性病变患者的临床资料,按照穿刺方式不同,分为A组（n=31）和B组（n=41）,A组应用超声引导下经皮细针穿刺抽吸,B组应用超声引导下CNB。以最终手术病理作为金标准,观察并比较两组患者诊断及穿刺效能差异情形,评价超声引导下经皮细针穿刺抽吸与CNB的价值。结果 B组患者轻微并发症发生率为64.52%,其中轻度疼痛15例,中度疼痛3例,一过性晕厥2例,A组为26.83%,其中轻度疼痛8例,中度疼痛3例,未见一过性晕厥,B组患者轻微并发症发生率明显高于A组患者,差异有统计学意义（P<0.05）。A组患者敏感度、准确率明显低于B组患者,差异有统计学意义（P<0.05）。结论 超声引导下经皮细针穿刺抽吸与CNB在胰腺占位性病变中均具有良好的诊断价值,其中超声引导下经皮细针穿刺抽吸并发症发生率较低,CNB诊断敏感度和准确率较高。     

超声引导徒手穿刺活检在乳腺癌诊断中的应用

目的探讨高频超声引导徒手穿刺活检在乳腺癌诊断中的应用价值。方法回顾性分析36例乳腺癌经高频超声引导自动活检枪徒手穿刺活检情况。结果36例可疑乳腺癌经超声引导徒手穿刺活检均取得满意的病理材料,病理诊断为乳腺癌,与术后病理结果一致,诊断率100%,其中1例未明确病理组织学分型,对组织学分型诊断率为97.2%。所有穿刺活检病例均未出现严重并发症。结论乳腺癌应用高频超声定位徒手穿刺活检可以获得明确的病理诊断,操作简单方便、安全可靠。     

超声定位穿刺活检诊断肺周围型占位性病变的临床应用价值

目的分析超声定位穿刺活检在肺周围型占位性病变中的应用价值。方法对105例胸部超声诊断为肺周围型占位性病变的患者,使用超声定位穿刺活检取标本行病理学检查。与术后病理结果比较,记录穿刺活检成功率、诊断正确率、良恶性肿瘤率、良恶性肿瘤最大直径和超声定位活检术后并发症发生率。结果本组100例(95.24%)穿刺活检成功并获取到满意标本。其中恶性病变为68例(68.00%),良性病变32例(32.00%)。与术后病理结果比较,诊断正确率为96.00%。术后并发症率为5.71%。结论超声定位穿刺活检诊断肺周围型占位性病变,具有创伤小、确诊率高、安全、操作简便、并发症少等优点。     

超声引导下胃肠道病变穿刺活检

目的探讨超声引导下胃肠道病变穿刺活检的临床应用价值。方法对30例经肠镜、CT或MRI检查发现但未能明确诊断的胃肠道病变(胃来源2例、小肠4例、结肠4例、直肠18例、肛管2例)进行超声引导下穿刺活检,总结活检方法、成功率及相关并发症。结果 30例中,经腹穿刺10例,经直肠穿刺16例,经肛周穿刺4例。标本取材满意29例,目标病灶穿刺成功率96.67%(29/30)。29例取材成功者中,活检病理提示良性病变11例,恶性病变18例,其中7例手术切除,6例活检病理与手术病理相符,1例活检病理不能鉴别未分化癌与间皮瘤,手术病理证实为未分化癌,其余病例与随访结果相符。穿刺后随访1~18个月,所有患者均未出现穿刺相关并发症。结论对于胃肠道病变,尤其是内镜活检困难或无效的病变,超声引导穿刺活检是安全、有效的诊断方法。     

CT引导下经皮穿刺活检食管占位性病变的有效性及安全性

目的 观察CT引导下经皮穿刺活检食管占位性病变的有效性及安全性。方法 回顾性分析37例接受CT引导下经皮穿刺活检的食管占位性病变患者（37个病灶）,统计取材成功率、穿刺病理诊断率及诊断准确率（以术后病理诊断或随访诊断为最终诊断）和术中、术后并发症。结果 37个病灶均穿刺取材成功并获明确病理诊断,32个病理结果为阳性（肿瘤性病变）、5个为阴性（炎性病变或正常组织）,穿刺病理诊断率100%。32个阳性病变穿刺病理诊断与最终诊断结果均一致;5个穿刺阴性病变中,3个与最终诊断一致,2个术后病理均为胃肠间质瘤,穿刺诊断准确率为94.59%（35/37）,假阴性率40.00%（2/5）。术后2例出现少量气胸、3例穿刺针道少量出血,1周后均自然吸收,并发症发生率13.51%（5/37）。结论 CT引导下经皮穿刺食管占位性病变安全、有效。     

超声引导下负压吸引旋切术治疗乳腺肿瘤

目的探讨超声引导下负压吸引旋切术治疗乳腺肿瘤的治疗效果。方法回顾性分析2010年9月-2011年4月在我院接受超声引导下乳腺肿瘤旋切术的26例患者（38个病灶）的临床资料及术后病理检查与随访情况。结果采用EnCor真空辅助旋切系统全部切除38个病灶,术后肿瘤无残留、复发,无明显血肿、感染,穿刺点无明显瘢痕。结论超声引导下乳腺旋切术是诊断和治疗乳腺肿瘤、特别是不易触及的乳腺小病灶的有效方法。     

Vacuum-assisted complete excision of solid intraductal/intracystic masses and complex cysts: Is follow-up necessary?

IntroductionManagement of complex cysts and benign intraductal/intracystic masses is controversial. The aim of this study was to determine if the complete removal of the complex cyst lesions with ultrasound-guided vacuum-assisted excision (US-VAE) is sufficient for their safe management when the histological diagnosis obtained at biopsy is benign.Subjects and methodsThis is a single institution retrospective study performed on patients who underwent breast biopsy between April 2007 and September 2013. Patients with complete removal of complex cyst lesion of a BIRADS 4 lesion by US-VAE that obtained a benign diagnosis were included. Size, morphology, histological diagnosis, and surgical or imaging follow-up of the lesions were analyzed.ResultsDuring the study period, 131 lesions met the inclusion criteria. Benign papilloma represented 32% (42/131) of the lesions; the remaining lesions had various benign diagnoses. Mean size of the solid mass or the cysts' thickest septum was 7 mm (range, 2–24). Mean imaging follow-up was 34.9 months (24–99 months) in 115 lesions. No recurrence or malignancy in the post-biopsy bed were observed during follow-up. Eleven lesions (8.4%) underwent surgery as follow-up: no cancer was found, but two lesions demonstrated atypia.ConclusionsComplex cyst lesion image completely excised with US-VAE and with a benign histology at biopsy might not require further imaging follow-up or surgery and a return to routine screening can be safely recommended. In a world where healthcare delivery and accessibility is important, elimination of unnecessary follow-ups is pertinent given its lower cost and lesser social impact.     

超声造影引导前纵隔病变穿刺活检

目的评价CEUS引导下前纵隔病变穿刺活检的可行性。方法收集CT或MRI提示为前纵隔病变的患者71例,比较常规超声(n=33)与CEUS引导下(n=38)穿刺活检的取材成功率、病理诊断率、病变内坏死显示率、取材次数和并发症。结果常规超声和CEUS引导穿刺活检取材成功率、病理诊断率分别为84.84%(28/33)、75.76%(25/33)和100%(38/38)、97.37%(37/38),两种方法差异均有统计学意义(P均0.05)。接受CEUS引导穿刺的38例患者中,病灶内液化坏死显示率常规超声为23.68%(9/38),CEUS为65.79%(25/38),差异有统计学意义(P0.05)。常规超声和CEUS引导穿刺活检的取材次数为(2.45±0.55)次和(2.03±0.20)次,差异有统计学意义(P0.05)。无严重并发症发生。结论 CEUS可清晰显示前纵隔病灶内坏死区域,以其引导穿刺活检,可提高取材成功率与病理诊断率。     

单孔腹腔镜手术探查并诊治子宫切除术后盆腔包块53例临床分析

目的:总结单孔腹腔镜手术诊治子宫切除术后盆腔包块的应用价值及手术方法。方法:回顾分析5年间采用单孔腹腔镜手术诊治53例子宫切除术后盆腔包块患者的临床资料。结果:53例中10例患者行术中冰冻;38例患者获得标本,行常规病理检查。结合探查及病理47例诊断为卵巢瘤样病变,5例为卵巢良性肿瘤(1例畸胎瘤,2例浆液性囊腺瘤,2例粘液性囊腺瘤),1例为恶性肿瘤。41例直接行单孔腹腔镜手术,11例因腹腔粘连严重中转三孔法腹腔镜手术,1例恶性肿瘤患者中转开腹。结论:单孔腹腔镜探查术对子宫切除术后盆腔包块的诊治具有较高的临床应用价值。     

Can preoperative renal mass biopsy change clinical practice and reduce surgical intervention for small renal masses?

IntroductionThe role of renal biopsy prior to surgical intervention for a renal mass remains controversial despite the fact that for all other urological organs except the testicle, biopsy inevitably precedes treatment as is true for all other specialties dealing with solid masses (e.g. thyroid, breast, colon, liver, etc.). Accordingly, we sought to determine the impact of a routine biopsy regimen on the course of patients with cT1a lesions in comparison with a contemporary series of cT1a individuals who went directly to treatment without a preoperative biopsy.MethodsWe analyzed a multi-institutional, prospectively maintained database of patients who underwent an office-based, ultrasound-guided, renal mass biopsy (RMB) for a cT1a renal mass (i.e. ≤4cm in largest dimension). Controls were selected from all patients in the database who had a cT1a renal lesion but did not undergo RMB. Both groups were analyzed for differences in treatment modality and surgical pathology results.ResultsA total of 72 RMB and 73 control patients were analyzed. The groups were similar in regards to their baseline characteristics. Overall RMB diagnostic rate was 75%. Surgical pathology revealed that excision of benign tumors was eight-fold less in the RMB cohort compared to the control group (3% vs. 23%; P < 0.001). Additionally, the rate of active surveillance in the RMB cohort was nearly three times higher at 35% vs. 14% for the controls (P < 0.001). Biopsy was concordant with surgical pathology in 97% of cases for primary histology (i.e. benign vs. malignant), 97% for histologic subtype, and 46% for low (I or II) vs. high (III or IV) grade. On multivariate analysis patients who underwent surgical intervention without preoperative RMB were 6.7 times more likely to have benign histopathology compared to patients who underwent preoperative RMB (OR 6.7, 95% CI = 0.714 – 63.626, P = 0.096). There were no procedural or post-procedural RMB complications.ConclusionsFor patients with cT1a lesions, the implementation of routine office-based RMB led to a significant decrease in the rate of surgical intervention for benign tumors. This practice also resulted in a higher rate of active surveillance for the management of renal cortical neoplasms with benign histopathology compared to a control group.     

CT引导下肺结节热消融联合术中即时活检的可行性

目的 观察CT引导下热消融肺结节联合术中即时活检的可行性。方法 回顾性分析331例接受CT引导下经皮肺穿刺活检和/或热消融肺结节患者的资料,共373个病灶。其中102例（102个病灶）仅接受CT引导下经皮肺穿刺活检（单纯活检组）,132例（174个病灶）仅接受CT引导下热消融（单纯消融组）,97例（97个病灶）接受CT引导下热消融联合术中即时活检（消融联合活检组）。计算技术成功率,记录并发症;评价活检标本病理诊断阳性率（所取组织标本可获得明确病理诊断判定为阳性）及基因检测标本质量。结果 对331例均顺利完成操作,技术成功率为100%（331/331）。单纯活检组术后6例（6/102,5.88%）咯血,单纯消融组及消融联合活检组术中及术后均未见咯血。单纯活检组5例、单纯消融组11例、消融联合活检组13例发生气胸,3组间差异无统计学意义（P=0.10）;均予CT引导下经皮置管引流。单纯活检组活检组织病理诊断阳性率为73.53%（75/102）,消融联合活检组为82.47%（80/97）,组间差异无统计学意义（P=0.13）。消融联合活检组共16例接受基因检测分析,活检组织标本均达到质控合格标准。结论 CT引导下热消融肺结节联合术中活检可行,可降低出血发生风险,且能满足病理检查及基因检测要求。     

超声引导下细针穿刺抽吸活检对甲状腺床病灶的应用价值

目的探讨超声引导下细针穿刺抽吸活检(US-FNAB)对甲状腺癌术后甲状腺床新生病灶的临床应用价值。方法回顾性分析于我院接受US-FNAB的63例次甲状腺癌患者术后新生甲状腺床病灶,分别评估病灶大小及超声引导下细针穿刺细胞学结果,并与手术病理结果及临床随访结果进行对照分析。结果 63例次患者的69个病灶中,细胞学结果满意60个,诊断为恶性38个,可疑恶性4个,良性18个;细胞学结果不满意9个。与最终临床诊断结果对照,USFNAB诊断甲状腺床病灶的敏感度为97.62%(41/42)、特异度为94.44%(17/18)、阳性预测值为97.62%(41/42)、阴性预测值为94.44%(17/18)、准确率为96.67%(58/60)。结论 US-FNAB对甲状腺癌术后甲状腺床新生病灶具有较高的诊断价值。     

Extracapsular extension on multiparametric magnetic resonance imaging better predicts pT3 disease at radical prostatectomy compared to perineural invasion on biopsy

IntroductionRisk assessment for non-organ-confined prostate cancer (PCa) is important in the surgical planning for radical prostatectomy (RP). Perineural invasion (PNI) on prostate biopsy has been associated with adverse pathological outcomes at prostatectomy. Similarly, the identification of suspected extracapsular extension (ECE) on multiparametric magnetic resonance imaging (mpMRI) has been shown to predict non-organ-confined disease. However, no prior study has compared these factors in predicting adverse pathology at prostatectomy. We evaluated mpMRI ECE and prostate biopsy PNI on multivariable analysis to determine their ability to predict pathological stage at time of RP.MethodsWe retrospectively investigated the prostatectomy database at our institution to identify men who underwent prostate biopsy with pre-biopsy mpMRI and subsequent RP from 2013–2017. Multivariable regression analysis was performed to compare the association of mpMRI ECE (mECE) and PNI on prostate biopsy on the likelihood of finding pT3 disease on pathology post-prostatectomy.ResultsOf a total 454 RP between 2013 and 2017, 191 patients met our inclusion criteria. Stage pT2 and pT3+ were found in 120 (62.8%) and 71 (37.2%) patients, respectively. Patients with mECE had 4.84 cumulative odds of worse pathological stage on RP (p=0.045) compared to PNI on biopsy, which showed cumulative odds of 2.25 (p=0.048). When controlling only for those patients without PNI, mECE was still found to be a significant predictor of pT3 disease at RP (p=0.030); however, in patients without mECE, PNI was not significant (p=0.062).ConclusionsWhile mECE and biopsy PNI were both associated with worse pathological stage on RP, mECE had significantly higher cumulative odds compared to PNI. The significant predictive ability of mECE adds further clinical value to the use of mpMRI in PCa management. While validation in a larger cohort is required, these factors have important clinical implications with regards to early diagnosis of advanced disease and surgical planning.     

Diagnosis and management of cystic dysplasia of the seminal vesicle

Introduction and objectivesCystic dysplasia of the seminal vesicle represents a rare congenital urologic anomaly of which elective treatment is controversial. We present our experience in the diagnosis and management of this uncommon pathology.Patients and methodDuring the last twelve years we have managed eight patients affected by this pathology. The diagnosis was incidental in the three asymptomatic patients, while the other five consulted because of low urinary tract sympthoms. Ectopic drainage of the ureter in the pathological seminal vesicle was found in three of the patients. Two of these patients presented large pelvic and ureteral ectasy. Other five patients presented renal agenesis.ResultsIn asymptomatic patients we adopted an expectant attitude, while the other five patients underwent surgical treatment. We performed open surgery in the two cases presenting ureterohydronephrosis, whereas in the other three we performed transurethral incision of the seminal vesicle. We obtained excellent results in all of them, with no evidence of symptomatic pseudodiverticulum.ConclusionsTransurethral incision of the seminal vesicle cyst is a minimal invasive procedure with low morbidity. We have proved in all of our cases that the retraction of the cyst was practically complete, this has led us into believing that transurethral incision is the elective treatment. Therefore, open surgery would only be indicated in cases of failure of the procedure due to existence of symptomatic pseudodiverticulum, or in patients presenting renoureteral ectasy associated.