目的 采用回顾性研究的方法，分析B型超声引导下的细针穿刺活检能否提高对甲状腺结节诊断的准确性。方法 54例患者行B型超声引导下的细针穿刺活检，另76例患者采用触诊法行细针穿刺活检，并将54例B超引导下的细针穿刺活检结果与手术结果进行比较。结果 超声引导下细针穿刺活检对可触及的甲状腺结节诊断的敏感性为63%，特异性为71%，准确性为65%，阳性预告值为100%，阴性预告值为70%。标本取材不当率为18%； 触诊法细针穿刺活检的灵敏性为47%，特异性为51%，准确性为43%，阳性预告值是54%，取材不当率为28%。B超引导下的细针穿刺活检准确性显著高于触诊法细针穿刺活检。结论 B超引导下的细针穿刺活检能提高手术前甲状腺癌的诊断。
This study aims to compare the prostate cancer detection rate between magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) cognitive fusion targeted biopsy and systematic biopsy. A total of 614 patients who underwent transrectal prostate biopsy during 2016-2018 with multiparametric magnetic resonance imaging (mpMRI) were included. All patients with a PI-RADS V2 score ≥ 3 accepted both targeted biopsy and systematic biopsy, and those with a PI-RADS V2 score ≤ 2 only accepted systematic biopsy. Overall prostate cancer detection rate between the two biopsies was compared. MRI-TRUS cognitive fusion targeted biopsy identified 342 cases (75.7%) of prostate cancer while systematic biopsy identified 358 cases (79.2%). There was no significant difference in the detection rate between the two groups (χ2 = 1.621, P = 0.203). Targeted biopsy had significant fewer biopsy cores compared with systematic biopsy, reducing (9.3 ± 0.11) cores (P < 0.001) in average. Targeted biopsy had about 10.8% (P < 0.001) more tumor tissues in positive cores compared with systematic biopsy. The results show that both MRI-TRUS cognitive fusion targeted biopsy and systematic biopsy have good detection rate on prostate cancer. Cognitive targeted biopsy may reduce biopsy cores and provide more tumor tissues in positive cores.
目的 讨论多窗技术+凝血酶封闭在CT导向下经皮肺穿刺活检中的应用价值。 方法 2009年6月－2010年3月收集分析由同一工作组连续完成的CT导向下肺穿刺活检患者共128例，其中A组58例，采用双窗技术+注射生理盐水；B组70例，采用多窗技术+注射凝血酶）。比较两组患者的诊断阳性率、气胸及肺出血发生率的差异。 结果 128例均穿刺成功，A组的穿刺诊断阳性率、气胸发生率及肺出血发生率分别为87.9%、13.8%、17.5%。B组的穿刺诊断阳性率为92.9%，气胸发生率为8.6%，肺出血发生率为5.7%。两组穿刺诊断阳性率和气胸发生率的差异无统计学意义（P＞0.05）；B组肺出血的发生率均明显低于A组，两组间肺内出血的发生率差异有统计学意义（P＜0.05）。 结论 多窗技术+凝血酶针道封闭技术能有助于减少气胸、肺出血等肺穿刺活术的并发症，具有重要的临床应用价值。
目的 总结直肠超声引导下经会阴前列腺12点穿刺活检术围手术期的护理经验。 方法 对2010年6月－2012年10月行直肠超声引导下经会阴前列腺12点穿刺活检术932例患者围手术期护理措施及要点予以回顾分析。 结果 932例患者顺利完成穿刺活检，术后除1例患者出现迷走神经反射综合征、经及时抢救缓解外，无其他并发症发生。 结论 直肠超声引导下经会阴前列腺12点穿刺活检术具有安全简便、无需肠道准备、并发症少、准确率高等优点，充分的围手术期护理是该活检术顺利完成的重要因素与环节。
Objective To evaluate the diagnostic yield and safety of two biopsy methods, electromagnetic navigational bronchoscopy (ENB) and transthoracic needle biopsy (TTNB), in peripheral pulmonary lesions. To select a low-risk and high-benefit biopsy method based on the clinical characteristics of the lesions and patients. Methods A retrospective analysis was conducted on inpatients who underwent ENB and/or TTNB for peripheral pulmonary lesions in Huadong Hospital Affiliated to Fudan University. Propensity score matching was used to compare the diagnostic yield and safety of the two biopsy methods. Results A total of 126 patients were included in the ENB group, and 104 patients in the TTNB group. After propensity score matching, 83 matched pairs were obtained. The TTNB group exhibited a significantly higher diagnostic yield compared with the ENB group (90.4% vs. 48.2%, P<0.001), but it was also associated with a higher incidence of pneumothorax (1.2% vs. 21.7%, P<0.001). In the ENB group, the diagnostic efficacy was correlated with lesion diameter (P<0.001, OR=0.183, 95%CI 0.071 - 0.470), but there was no statistically significant difference in the diagnostic yield among different lung segments (P>0.05). In the TTNB group, lesion characteristics did not significantly affect the diagnostic yield, but a lesion diameter ≤30 mm (P=0.019, OR=5.359, 95%CI 1.320 - 21.753) and a distance from the pleura ≥20mm (P=0.030, OR=6.399, 95%CI 1.192 - 34.360) increased the risk of pneumothorax. When stratified based on lesion and patient blood characteristics, no significant difference was found in the diagnostic yield between the two groups for characteristics such as left upper lobe (P=0.195), right middle lobe (P=0.333), solid with cavity (P=0.567), or abnormal serum white blood cell count (P=0.077). However, the incidence of pneumothorax in the TTNB group was higher than that in the ENB group. Conclusions The diagnostic yield of ENB is affected by the size of the lesion, while the incidence of pneumothorax in TTNB is influenced by both lesion size and distance from the pleura. In cases with lesions located in the left upper lobe, right middle lobe, solid with cavity, or with abnormal serum white blood cell count, selecting ENB for biopsy is considered preferable to TTNB.
ObjectiveTo evaluate the diagnostic value of BRAFV600E mutation test in high-risk thyroid nodules with easily underdiagnosed fine-needle aspiration biopsy (FNAB) results.MethodsRetrospectively collected 122 cases of thyroid nodule who treated in the Hebei Petrochina Central Hospital between January 2017 and December 2018, all the cases admitted preoperative ultrasound and FNAB detection. All of the patients had the non-positive cytological results of FNAB and the high-risk features of ultrasound. Contrasted the postoperative pathological coincidence rate of combination of FNAB and BRAFV600E test with FNAB alone.ResultsThe BRAFV600E mutation rate was 27.0% (33/122). The positive rate of BRAFV600E mutation increased with the increase of ultrasound thyroid imaging reporting and data system(TI-RADS) grade (P<0.05), which was independent of patients’ age, gender, number of nodules, diameter of nodules, and FNAB results (P>0.05). The coincidence rate of FNAB combined with BRAFV600E mutation detection was higher than that of FNAB alone ［86.9% (106/122) vs. 69.7% (85/122), P<0.05).ConclusionsThe BRAFV600E mutation test can detect papillary thyroid carcinoma that might be missed by FNAB. We recommend that FNAB should be routinely accompanied by the BRAFV600E mutation test in the high-risk thyroid nodules.
ObjectiveTo explore the application and effect of clinical nursing pathway based on information-knowledge-attitude-practice (IKPA) theory in percutaneous renal needle biopsy.MethodsThis is a historical control study. A total of 460 patients who underwent percutaneous renal biopsy in West China Hospital of Sichuan University between April and December 2020 were prospectively recruited as the pathway group, and a clinical nursing pathway based on IKAP theory was implemented. By contrast, the data of 617 patients who underwent percutaneous renal biopsy and received routine care in the same hospital between April and December 2019 were retrospectively collected as the control group. The length of hospital stay, hospitalization expenses, the incidences of postoperative complications (macroscopic haematuria, perirenal hematoma, and acute urinary retention), the incidence of postoperative postural hypotension, and the management enrollment rate of chronic kidney disease patients were compared between the two groups.ResultsThe length of hospital stay [median (lower quartile, upper quartile): 8 (7, 11) vs. 8 (7, 12) d] and the hospitalization expenses [median (lower quartile, upper quartile): 7380.50 (6401.86, 8789.21) vs. 8167.00 (6816.50, 10044.50) yuan] were less in the pathway group than those in the control group, the incidences of postoperative macroscopic haematuria (1.52% vs. 6.97%) and perirenal hematoma (2.61% vs. 5.02%) were lower in the pathway group than those in the control group, the management enrollment rate of chronic kidney disease patients was higher in the pathway group than that in the control group (26.09% vs. 6.16%), and the differences between the two groups were statistically significant (P<0.05). The differences in the incidences of acute urinary retention (8.26% vs. 11.18%) and postoperative postural hypotension (0.00% vs. 0.81%) between the two groups were not statistically significant (P>0.05).ConclusionThe application of clinical nursing pathway in percutaneous renal needle biopsy can effectively reduce the length of hospital stay and hospitalization expenses, and improve the management enrollment rate of chronic kidney disease patients.
ObjectiveTo explore the diagnostic value of CT-guided percutaneous needle aspiration biopsy (PTNB) for ground-glass opacity (GGO) pulmonary lesions. MethodsA retrospective design was used to collect clinical data of patients with GGO lesions admitted in the Affiliated Hospital of North Sichuan Medical College between Jan. 2009 to Jan 2015. Patients were divided into groups according the lesion size (≤10 mm, 10-20 mm,≥20 mm), length of needle path (≤5 cm, 5-9 cm,≥9 cm) and percentage of GGO component (50%-90%, >90%), respectively. The total and subgroups of sensitivity, specificity, and diagnostic accuracy of CT guided PTNB for diagnosing GGO were calculated and the differences among subgroups were compared using Fisher's exact test. Statistical analysis was conducted by using SPSS 17.0 software. ResultsA total of 60 patients involving 48 malignant and 12 benign lesions were included. The total sensitivity, specificity, and accuracy of CT guided PTNB for diagnosing GGO were 87.5%, 100% and 90%, respectively. There were no significant differences among the subgroups based on the lesion size, length of needle path, and percentage of GGO component (all P values >0.05). ConclusionCT-guided PTNB can be used as one of the diagnostic modalities for lung GGO lesions with a moderate diagnostic value.
ObjectiveTo systematically review the diagnostic accuracy of C-arm cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) for lung nodules. MethodsWe electronically searched databases including PubMed, EMbase, EBSCO, Ovid, CBM, VIP, WanFang Data and CNKI from inception to Feb 28th, 2015, to collect diagnostic studies of CBCT-guided PTNB for lung nodules. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies by QUADAS-1 tool. Then, meta-analysis was performed by Stata 12.0 and Meta-DiSc 1.4 softwares for calculating pooled sensitivity (Sen), specificity (Spe), positive likelihood ration (+LR), negative likelihood ration (-LR), and diagnostic odds ratio (DOR), drawing summary receiver operating characteristic (SROC) curve and estimating area under the curve (AUC). ResultsA total of 9 studies involving 1 815 patients were included. The results of meta-analysis showed that the pooled Sen, Spe, +LR,-LR, and DOR were 0.95 (95%CI 0.92 to 0.96), 1.00 (95%CI 0.66 to 1.00), 2 076.58 (95%CI 1.8 to 2.3e+0.6), 0.05 (95%CI 0.04 to 0.08), and 39 443.88 (95%CI 30.53 to 5.1e+0.7), respectively. The AUC of SROC was 0.97 (95%CI 0.95 to 0.98). ConclusionCBCT-guided PTNB can be used as one of the primary examination approaches for lung nodules with relatively high diagnostic accuracy. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.