目的:探讨胸膜活检对胸腔积液病因诊断的价值。方法:对127例胸腔积液患者行首次胸膜活检术。结果:127例患者获取胸膜组织125例, 穿刺成功率98.4%,经病理检查有41例为正常胸膜组织,特异性病理诊断84例,病理诊断阳性率(67.2%)。恶性胸腔积液胸膜活检阳性38例(45.2%),结核性胸腔积液胸膜活检阳性31例(36.9%),非特异性炎15例(17.9%)。38例恶性肿瘤经免疫组织化学和特殊染色分类,腺癌27例,小细胞肺癌2例,鳞癌2例,恶性间皮瘤2例,转移癌3例,淋巴瘤1例,未分化癌1例。发生并发症者4例(3.1%),全部为气胸,肺压缩均小于15%,未做特殊处理数日后自行吸收。结论:胸膜活检是一项安全、简单、有效的胸膜疾病的重要的内科确诊手段。
ObjectiveTo analyze the value of internal mammary lymph node biopsy via intercostal space in staging and adjuvant therapy of breast cancer. MethodsThe clinical data of 305 breast cancer patients received any kind of radical mastectomy from may 2003 to January 2014 in the Jinan Military General Hospital of PLA were analyzed retrospectively. The patient age, axillary lymph node, and internal mammary lymph node status were integrated to investigate the changing of staging and postoperative adjuvant therapy of the breast cancer. ResultsThese 305 patients were divided into neoadjuvant chemotherapy group and non-neoadjuvant therapy group. There were 67 patients in the neoadjuvant chemotherapy group, including 45(67.2%) patients with axillary lymph node positive, 23(34.3%) patients with internal mammary lymph node positive. There were 23(34.3%) patients who had a change of pathology lympy node (pN) staging and 8(11.9%) patients who had a change of the pTNM staging. Meanwhile, there were 238 patients in the non-neoadjuvant chemotherapy group, including 155(65.1%) patients with axillary lymph node positive, 30(12.6%) patients with internal mammary node positive. There were 30(12.6%) patients who had a change of the pN staging and 23(9.66%) patients who had a change of the pTNM staging. There was a significant difference in the metastasis rate of the internal mammary lymph node (χ2=15.7, P < 0.05) or the changing ratio of the pTNM staging (χ2=5.3, P < 0.05) in two groups. ConclusionsInternal mammary lymph node status could affect pN staging of breast cancer, so do the pTNM staging (TNM, pathology tumor, lymph node, metastasis). The internal mammary lymph node status could guide the postoperative adjuvant radiative therapy by reducing excessive treatment of the internal mammary lymph node area, also could enhance the individual accurate therapy.
ObjectiveTo explore the influence of sentinel lymph node (SLN) status on the prognosis of elderly breast cancer patients ≥70 years old, and to screen patients who may be exempted from sentinel lymph node biopsy (SLNB), so as to guide clinical individualized treatment for such patients. MethodsA retrospective analysis was made on 270 breast cancer patients aged ≥70 years old who underwent SLNB in the Affiliated Hospital of Southwest Medical University from 2012 to 2021. The clinicopathological characteristics of the total cases were compared according to the status of SLN. Kaplan-Meier method was used to draw the survival curve, and the influence of SLN status on the overall survival (OS) time, local recurrence (LR) and distant metastasis (DM) of patients were analyzed, and used log-rank to compare between groups. At the same time, the patients with hormone receptor (HR) positive were analyzed by subgroup. The differences between groups were compared by single factor χ2 test, and multivariate Cox regression model was used to analyze and determine the factors affecting OS, LR and DM of patients. ResultsThe age of 270 patients ranged from 70 to 95 years, with a median age of 74 years. One hundred and sixty-nine (62.6%) patients’ tumor were T2 stage. Invasive ductal carcinoma accounted for 83.0%, histological gradeⅡ accounted for 74.4%, estrogen receptor positive accounted for 78.1%, progesterone receptor positive accounted for 71.9%, and human epidermal growth factor receptor 2 negative accounted for 83.3%. The number of SLNs obtained by SLNB were 1-9, and the median was 3. SLN was negative in 202 cases (74.8%) and positive in 68 cases (25.2%). Thirty-five patients (13.0%) received axillary lymph node dissection. There was no significant difference in LR between the SLN positive group and the SLN negative group (P>0.05), but the SLN negative group had fewer occurrences of DM (P=0.001) and longer OS time (P=0.009) compared to the SLN positive group. The results of univariate and multivariate analysis suggest that the older the patient, the shorter the OS time and the greater the risk of DM. Analysis of HR positive subgroups showed that SLN status did not affect patient survival and prognosis, but age was still associated with poor OS time and DM. ConclusionsFor patients with invasive ductal carcinoma of breast in T1-T2 stage, HR positive, clinical axillary lymph nodes negative, and age ≥70 years old, SLNB may be exempted. According to the patient’s performance or tumor biological characteristics, patients who need systemic adjuvant chemotherapy may still consider SLNB.
Objective To identify the feasibility of the lymphatic mapping and sentinel node biopsy (SLNB) in patients with breast cancer and to examine whether the characteristics of the sentinel lymph node (SLN) accurately predict the status of axillary lymph node.MethodsFrom March to October 2000, 32 patients with breast cancer were evaluated at the Sichuan Provincial People’s Hospital. Lymphatic mapping was performed using Methlene Blue. A SLN was defined as any blue node. Thirtytwo patients, with breast cancer underwent a complete axillary lymph node resection (ALNR) following SLN biopsy. Subsequently, all SLNs and ALNs were examined by both Hamp;E staining as well as immunohistochemical staining for cytokeratin. ResultsLymphatic mapping was successful in identifying the SLN in 26/32(81.25%) cases of nodes at level Ⅰ. Of the 26 patients mapped successfully, 10 had metastasis to the SLNs.In 3 cases that SLNs were positive, but other axillary lymph nodes were negative. In 2 cases that the SLNs were negative, but other axillary lymph nodes were positive. The sensitivity of SLNB using Methlene Blue in this study was 77.78%(7/9), accuracy 80.77%(21/26), specificity 82.35%(14/17), and false negative rate 22.22%(2/9). ConclusionSLN can predict the status of the axillary lymph nodes reliably. However, the efficacy of SLNB in the setting of randomized, prospective trials must be tested first before abandoning axillary lymph node resection as the standard of care.
Objective To evaluate the diagnostic value and safety of surgical lung biopsies ( SLB)in patients with interstitial lung disease ( ILD) . Methods A retrospective analysis was performed on patients undergoing SLB, who were obtained from Chinese literatures through searching PubMed, CBM,Wanfang database, VIP information and CHKD from 2000 to 2010. The data from Affiliated Drum Tower Hospital, Nanjing University Medical College from2000 to 2010 was also reviewed. Results A total of 398cases underwent SLB, including open lung biopsy ( OLB) in 221 cases and video-assisted thoracoscopic lung biopsy ( VATLB) in 177 cases. SLB yielded a specific diagnosis for 386 cases. The total postoperative complication rate was 12. 1% and mortality rate was 2. 0% . The diagnostic yield, post-operative complication rate, and mortality rate between VATLB and OLB had no significant difference. Conclusion SLB is a useful and relatively safe procedure for diagnosis of ILD.
ObjectiveTo introduce the current status of clinical application, value and perspective of fiberoptic ductoscopy.MethodsThe related literatures on advances in clinical application of fiberoptic ductoscopy were reviewed.ResultsFiberoptic ductoscopy is now widely used in breast diseases, especially complicated with nipple discharge, and it has a higher accuracy rate than routine examinations. With ductoscopy, ductal lavage,location, biopsy and treatment can be carried out.ConclusionFiberoptic ductoscopy has a greater value in diagnosis and treatment, we believe it will be better applied and further developed.
ObjectiveTo investigate whether liquid-based cytology (LBC) can improve diagnostic value of cytological assessment of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MethodsA cohort of 600 cases who underwent EBUS-TBNA from June 2012 to September 2013 was enrolled in this prospective study in West China Hospital. EBUS-TBNA was carried out under local anesthesia and moderate sedation. The procedure was performed with echobronchoscopes. Histological tissues were stained with hematoxylin and eosin for further study. Additional immunohistological analysis was performed for establishing a reliable diagnosis as necessary. Aspirates were smeared on glass slides and separate aspirates were processed by the monolayer SurePath method. ResultsIn total, 480 cases of malignant tumors and 120 cases of benign lesions were confirmed by histological examination. The sensitivity of SurePath liquid-based preparations and conventional smears was 82.1% and 56.0%, and the specificity was 87.5% and 82.5%, respectively. The combined specificity was 100.0%. The positive predictive value of two methods combined was 96.3% and 92.8%, whereas the negative predictive value was 54.9% and 31.9%, respectively. The difference between the two methods was significant (P < 0.05). ConclusionsLBC preparation can improve cytological assessment of EBUS-TBNA. Histological study is necessary when the cytological diagnosis is obscure.
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。