高频彩色多普勒超声对乳腺癌腋窝淋巴结性质的鉴别价值

目的:研究高频彩色多普勒超声对乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结的鉴别价值。方法:选择2015年2月~2016年6月在我院进行诊治的乳腺癌患者150例,应用高频二维超声结合彩色多普勒血流显像技术,观察腋窝肿大淋巴结的声像图及血流情况。结果:经二维超声发现,乳腺癌腋窝良性淋巴结的皮质多向心增厚(68.93%)、长短径比L/S多2.0(70.58%)、多不融合(93.14%)、多无钙化斑(97.06%);腋窝转移性淋巴结的皮质多偏心增厚(68.48%)、长短径比L/S多2.0(69.57%)、多融合(68.48%)、多有钙化斑(77.17%);两者相比有明显差异(P0.05);经彩色多普勒血流显像技术发现,乳腺癌腋窝良性淋巴结的血流信号分布多呈门型(63.17%),血流丰富程度多为Ⅱ级(54.35%);腋窝转移性淋巴结的血流信号分布多呈周边型(68.93%),血流丰富程度多为Ⅲ级(72.83%);两者相比有明显差异(P0.05)。结论:乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结在内部回声、形态、血流分布特点等方面有显著的差异,高频彩色多普勒超声对乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结具有较高的鉴别价值。     

超声弹性成像组织弥散定量分析诊断宫颈良恶性病变的临床效果

目的:探讨超声弹性成像组织弥散定量分析诊断宫颈良恶性病变中的临床效果。方法:选择2018年2月到2019年7月在我院诊治的宫颈病变患者88例,包括病理检查为良性病变68例(良性组)和恶性病变20例(恶性组)。所有患者都给予常规超声、多普勒血流超声与超声弹性成像组织弥散定量分析,记录影像学特征,分析诊断效果。结果:恶性组的超声血流分级2级和3级、超声弹性成像半定量评分4分和5分显著高于良性组(P0.05)。恶性组SR值显著高于良性组(P0.05)。超声弹性成像组织弥散定量诊断宫颈良恶性病变的敏感性与特异性分别为95.6%和95.0%。ROC曲线结果显示超声弹性成像组织弥散定量诊断宫颈良恶性病变的AUC值为0.914。结论:超声弹性成像组织弥散定量分析能有效诊断宫颈良恶性病变,敏感性与特异性均较高。     

乳腺良性肿块与乳腺癌患者的超声弹性成像对比

目的:对比乳腺良性肿块与乳腺癌患者的超声弹性成像,明确超声弹性成像的应用价值。方法:选取2014年5月-2016年1月我院乳腺肿块患者128人次共146例肿块,根据病理结果分为乳腺良性肿块和乳腺癌,比较超声弹性成像与病理结果。结果:128个患者共计肿块146例,99例结节为良性肿块,其中32例为乳腺纤维腺瘤,29例为乳腺增生结节,20例为乳腺脂肪瘤,6例为乳腺血管脂肪瘤,4例为乳腺导管腺瘤,8例为乳腺导管内乳头状瘤;47例肿块为恶性,其中37例肿块为浸润性导管癌,9例肿块为粘液腺癌,1例肿块为硬癌。乳腺良性肿块患者81人次共99例,其中1分43例(43.43%),2分34例(34.34%),3分18例(18.18%),4分4例(4.04%);乳腺癌患者47例,其中3分9例(19.15%),4分20例(42.55%),5分18例(38.30%)。超声弹性成像鉴别乳腺良性肿块与乳腺癌的灵敏度为95.96%,特异性为80.85%,准确度为91.10%,阴性预测值为90.48%,阳性预测值为91.35%。结论:超声弹性成像鉴别乳腺良性肿块与乳腺癌的灵敏度高达95.96%,具有较高准确度,可辅助诊断乳腺疾病。     

弹性定量参数法对甲状腺良恶性结节诊断的应用

目的:探讨弹性成像评分法及弹性应变率比值法在甲状腺结节良恶性诊断中最佳诊断界点.方法:对78例共122个甲状腺结节术前行弹性成像检查并获得应变率比值(SR),根据病理结果分为良性组90个结节和恶性组32个结节.结果:(1)弹性成像评分法:78例122个结节术前超声弹性评分为1-3分有90个结节,与病理诊断符合74个结节弹性评分为4分和5分有32个结节,与病理诊断符合24个结节,对应的诊断敏感度为75％,特异度为82％,准确率为80％;(2)弹性应变率比值:良性组结节90个,SR平均值为2.34+1.02:恶性组结节32个,SR平均值为4.15+1.09;(3)通过ROC曲线确定SR最佳诊断点为3.30,对应的应变率比值法诊断敏感度为81％,特异度为90％,准确率为87％,ROC曲线下面积(AUC)为0.831.结论:弹性应变率比值法可用于甲状腺结节良恶性的判断,为甲状腺弹性成像检查提供了一项新的诊断指标.     

超微血流显像联合剪切波弹性成像在最大径≤2 cm乳腺癌诊断与病理评估中的应用价值

摘要 目的：探讨超微血流显像（SMI）联合剪切波弹性成像（SWE）在最大径≤2 cm乳腺癌诊断与病理评估中的应用价值。方法：选取成都市第三人民医院2018年6月至2021年6月收治的最大径≤2 cm疑似乳腺癌患者125例,以手术病理结果为金标准,分为良性组49例与恶性组76例,比较两组SMI Alder分级、SWE检查参数[最大弹性值（Emax）、平均弹性值（Emean）、最小弹性值（Emin）],分析SMI Alder分级与SWE检查参数的相关性及对乳腺癌的诊断价值,并对比不同临床病理特征乳腺癌患者的Alder分级、Emax、Emean、Emin。结果：恶性组与良性组SMI Alder分级比较差异有统计学意义（P＜0.05）;恶性组Emax、Emean、Emin高于良性组（P＜0.05）;恶性组SMI Alder分级与SWE检查参数Emax、Emean、Emin呈正相关（P＜0.05）;SMI Alder分级、Emax、Emean、Emin联合诊断最大径≤2 cm乳腺癌的AUC为0.917（95%CI：0.870～0.963）,优于各指标单独诊断;恶性组不同肿瘤直径、组织学分级、有无腋窝淋巴结转移患者SMI Alder分级、Emax、Emean、Emin比较差异有统计学意义（P＜0.05）。结论：SMI联合SWE检查在最大径≤2 cm乳腺癌中具有较为可靠的诊断价值,且各参数与肿瘤直径、组织学分级、腋窝淋巴结转移密切相关,可为临床评估病理进展提供有效信息。     

经直肠实时组织超声弹性成像诊断前列腺良恶性病灶的价值

目的:探索经直肠实时组织超声弹性成像技术在前列腺良恶性病灶诊断中的应用价值。方法:选取2013年12月至2014年5月我科疑似前列腺癌(PCa)并拟行穿刺活检的患者49例,以病例活检结果作为金标准,对比经直肠实时组织超声弹性成像技术、经直肠超声(TRUS)及直肠指诊(DRE)在疑似PCa患者中的诊出结果,并对直肠超声进行弹性图像评分及应变指数分析。结果:弹性图像评分≥4分时,其对PCa的敏感性、特异性及准确性分别为92.3%、91.3%和93.9%;良性病灶的应变指数为2.84±4.72,恶性病灶的应变指数为32.12±15.05,差异有统计学意义(P0.05)。结论:经直肠实时组织超声弹性成像技术可提高PCa的诊出率,在前列腺良恶性病灶的鉴别及指导治疗与预后方面有重要价值。     

超声弹性成像联合血清TSH、TT3、TT4在甲状腺结节良恶性诊断的临床价值研究

目的:探讨超声弹性成像联合血清促甲状腺激素(TSH)、总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)在甲状腺结节良恶性诊断的临床价值。方法:选择2018年1月至2019年12月我院收治的甲状腺结节患者80例,根据病理检查结果分为良性结节组(48例),恶性结节组(32例),所有患者术前进行血清TSH、TT3、TT4及超声弹性成像检查,比较各组血清TSH、TT3、TT4水平及超声弹性成像评分,分析甲状腺结节患者血清TSH、TT3、TT4水平与超声弹性成像评分的相关性,超声弹性成像联合血清TSH、TT3、TT4在甲状腺恶性结节诊断的临床价值。结果:恶性结节组血清TSH、TT3、TT4水平显著高于良性结节组,超声弹性成像评分高分比例显著高于良性结节组(P<0.05),经Pearson相关分析显示,甲状腺结节患者血清TSH、TT3、TT4水平与超声弹性成像评分呈正相关(P<0.05)。以病理诊断为金标准,超声弹性成像联合血清TSH、TT3、TT4诊断甲状腺恶性结节的灵敏度为96.88%,特异度为93.75%,准确度为95.00%,灵敏度、特异度和准确度优于单独血清TSH、TT3、TT4检测和单独超声弹性成像检测。结论:超声弹性成像联合血清TSH、TT3、TT4对甲状腺结节良恶性的鉴别诊断具有较好的临床价值。     

动态增强磁共振扫描与超声弹性成像对乳腺癌的诊断价值探讨

目的:探讨动态增强磁共振成像扫描与超声弹性成像对乳腺癌良恶性肿瘤的诊断价值,为临床诊断提供影像学依据。方法:回顾性分析2009年10月至2013年5月在我院经穿刺或手术病理证实为乳腺癌的59例患者的临床资料,患者术前均行超声与动态增强MR检查。依据病理组织活检和临床随访分别评价动态增强MR和UE对乳腺癌诊断的准确性。结果:DCE-MRI检测共发现病灶59个,55个初步诊断乳腺恶性肿瘤(BI-RADS 4-5),4个诊断为良性(BI-RADS 3),诊断准确率为93.22%(55/59)。UE对59个病灶进行评分,54个评分为乳腺恶性肿瘤,5个评分为良性,诊断率为91.53%(54/59)。UE检测乳腺癌的敏感性明显低于DCE-MRI及DCE-MRI+UE,DCE-MRI检测乳腺癌的特异性明显低于UE及DCE-MRI+UE,差异具有统计学意义(P0.05)。DCE-MRI+UE诊断乳腺癌的准确率为96.61%(57/59),明显高于DCE-MRI或UE单独检测的准确率(P0.05)。结论:动态增强MR诊断乳腺癌的敏感性较高,而超声弹性成像的特异性较好,两者联合可提高诊断准确率,对乳腺癌的早期诊断具有重要的临床应用价值。     

彩色多普勒超声对临床触诊阴性乳腺癌的诊断价值

目的:探讨超声对临床触诊阴性乳腺癌的诊断价值。方法:回顾性分析135个临床触诊阴性乳腺肿块(恶性33个,良性102个)超声直接和间接征象图特征,并与病理结果对照分析,计算超声诊断触诊阴性乳腺肿块灵敏性、特异性、阳性预测值、阴性预测值及准确性。结果:直接征象中微钙化、Ⅱ～Ⅲ级血流、穿支血管、阻力指数RI≥0.7和间接征象中浅筋膜的改变、腋窝淋巴结肿大具有较高诊断价值,良恶性组比较差异有统计学意义(P均<0.01)。超声诊断临床触诊阴性乳腺癌的灵敏性81.82%、特异性93.14%、阳性预测值79.41%、阴性预测值94.06%、准确性90.37%。结论:超声对临床触诊阴性乳腺癌的早期诊断具有重要价值。     

超声造影和超声弹性成像在甲状腺良恶性结节鉴别诊断中的临床价值

目的:探讨超声造影与超声弹性成像鉴别诊断甲状腺良恶性结节的临床价值。方法:回顾性分析2011年1月-2013年6月我院经病理证实的128例甲状腺占位性病变患者(160个结节)的超声影像学资料,其中恶性结节68个,良性占位92个,评估实时超声造影与超声弹性成像诊断甲状腺良性与恶性结节的敏感性、特异性、准确率、阳性预测值及阴性预测值。结果:甲状腺良性结节超声造影检查以快进慢出、高增强为主;恶性结节以慢进快出、低增强为主。超声造影诊断甲状腺良、恶性结节的灵敏度、特异度与阳性预测值、阴性预测值及其诊断符合率分别为91.18%、92.39%、91.18%、93.41%、91.88%;超声弹性成像分别为89.71%、90.22%、87.14%、92.22%、90.00%,联合检查分别为94.12%、95.65%、94.12%、95.65%、95.00%,均高于常规超声的57.35%、72.83%、60.94%、69.79%、65.63%,比较差异有统计学意义(P0.05);联合检查灵敏度、符合率明显高于超声造影与超声弹性成像单一检查,比较差异有统计学意义(P0.05)。结论:超声造影与超声弹性成像在鉴别诊断甲状腺良恶性结节中均具有较高的应用价值,两种方法联合检查灵敏度及准确性更高。     

Initial axillary staging of breast cancer using ultrasound‐guided fine needle aspiration: a liquid‐based cytology study

A. Schiettecatte, C. Bourgain, C. Breucq, N. Buls, V. De Wilde and J. de Mey
Initial axillary staging of breast cancer using ultrasound‐guided fine needle aspiration: a liquid‐based cytology study Objective: To evaluate the preoperative detection of axillary metastasis combining ultrasound (US)‐guided fine needle aspiration cytology (FNAC) and liquid‐based cytology (Surepath^®) to reduce sentinel node procedures. Methods: In total, 148 patients with clinically negative lymph nodes and no preoperative therapy were included. All patients underwent preoperative ultrasound of the axilla with FNAC if suspicious lymph nodes were found. Complete axillary lymph node dissection was performed at primary surgery when FNAC was positive. All other patients underwent a sentinel node procedure. Results: US‐guided FNAC of the axilla revealed metastasis in 34 (23.0%) of the 148 patients. These 34 patients were 53.1% of all patients (n = 64) with proven axillary lymph node involvement. In 66 patients (44.6%), both ultrasound and histopathology were negative. Overall sensitivity of US‐guided FNAC was 50.0%, specificity 100%, positive predictive value 100% and negative predictive value 70.2%. In T1 tumours, all patients referred for sentinel node procedure were node‐negative. The correlation between malignant FNAC and histopathology was 100%. US‐guided liquid‐based FNAC in patients with no clinically positive lymph nodes reduced the necessity for a sentinel node procedure by 23.0%. Conclusions: We advocate that US‐guided fine needle aspiration (FNA) combined with liquid‐based cytology of axillary lymph nodes should be included in the preoperative staging of breast cancer.     

初诊腋窝淋巴结阳性乳腺癌新辅助化疗后对腋窝淋巴结转阴性前哨活检的影响分析

摘要 目的：探究对初诊腋窝淋巴结阳性乳腺癌行新辅助化疗患者开展腋窝前哨淋巴结活检的临床意义。方法：选择2017年1月至2020年10月于我院接受改良根治术或保乳术治疗的100例初诊腋窝淋巴结阳性乳腺癌患者,将其中50例病理检测II B、III期行4~8个疗程新辅助化疗后实施前哨淋巴结活检患者设为研究组,将50例I、II A期直接行前哨淋巴结活检患者设为对照组,对比两组患者前哨淋巴结检出率、准确率、假阴性率和灵敏度,同时就患者病理特征与前哨淋巴结检出率的相关性开展分析。结果：（1）比较显示研究组患者与对照组患者在前哨淋巴结检出数、前哨淋巴结检出率以及前哨淋巴结假阴性率方面组间差异不大（P>0.05）;（2）病理学特征分析显示肿瘤直径以及临床N分期同新辅助化疗后患者前哨淋巴结检出阳性率密切相关（P<0.05）。结论：对初诊腋窝淋巴结阳性行新辅助化疗乳腺癌患者实施前哨淋巴结活检具有较显示的临床意义,能够较好的预测患者腋窝淋巴结状况,同时化疗前肿瘤直径、临床N分期是影响前哨淋巴结检出率的重要影响因素。     

Diagnostic value of fine needle aspirates processed by ThinPrep® for the assessment of axillary lymph node status in patients with invasive carcinoma of the breast

X. Jing, E. Wey and C. W. Michael Diagnostic value of fine needle aspirates processed by ThinPrep® for the assessment of axillary lymph node status in patients with invasive carcinoma of the breast Objective: To evaluate the utility of ThinPrep® as an optional specimen processing method for the detection of axillary lymph node metastasis of invasive breast carcinoma. Methods: A computer SNOMED search from the file at our institution between January 2003 and August 2011 retrieved a total of 209 fine needle aspiration (FNA) specimens of axillary lymph nodes prepared by ThinPrep and followed by axillary lymph node biopsy and/or dissection. Original cytological diagnoses and corresponding histological diagnoses were documented. Using the histological diagnoses as the gold standard, the diagnostic parameters including sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and diagnostic accuracy were calculated. Both cytology and histology slides from cyto‐histologically discrepant cases were reviewed. Results: Out of a total of 209 specimens, 193 (92%) had adequate diagnostic material while the remaining 16 specimens (8%) were inadequate for cytological assessment. The diagnostic specimens included 168 invasive ductal carcinomas (IDC), 15 invasive lobular carcinomas (ILC) and 10 mixed carcinomas (IDC and ILC). Excluding 19 cases with malignant cells on FNA in which no residual tumour was found in fibrotic lymph nodes after neoadjuvant therapy (cytology and histology confirmed on review) ThinPrep detected nodal metastasis with an overall sensitivity of 77.5%, specificity of 100%, PPV of 100% and NPV of 53.7%. Diagnostic accuracy was 82.2%. There was no difference in Bloom–Richardson grade or the number or size of metastases between tumours with true‐positive and false‐negative cytology. Sampling error was the sole factor contributing to cyto‐histological discrepancy. Conclusions: ThinPrep is a good alternative to the conventional smear for cytological assessment of axillary lymph node status in patients with invasive breast carcinoma, particularly when specimens are collected at remote sites or when cytologists are not available for assistance during FNA.     

Sentinel node biopsy should be supplemented by axillary sampling in patients with small breast cancers

Axillary clearance provides important prognostic information but is associated with significant morbidity. Sentinel node biopsy can provide staging .141 patients with node negative early breast cancers-tumour size less than 1.5 cm measured clinically or by imaging had guided axillary sampling (sentinel lymph node biopsy in combination with axillary sampling). Four node axillary sampling improved the detection rate of axillary node metastases by 13.6% as compared to blue dye sentinel node biopsy alone. Positive sampled nodes strongly indicated the likelihood of further metastatic being revealed by axillary dissection (67%). Negative sampled nodes in combination with a positive sentinel node biopsy were associated with a much lower rate of further nodal involvement in the axillary clearance (8%).     

Quantitative Molecular Analysis of Sentinel Lymph Node May Be Predictive of Axillary Node Status in Breast Cancer Classified by Molecular Subtypes

To determine the performance of intraoperative one-step nucleic acid amplification (OSNA) assay in detecting sentinel lymph node metastases compared to postoperative histology taking into account breast cancer molecular classification and to evaluate whether the level of cytokeratin 19 mRNA copy number may be useful in predicting the likelihood of a positive axillary lymph node dissection. OSNA assay was performed in a prospective series of 903 consecutive sentinel lymph nodes from 709 breast cancer patients using 2 alternate slices of each sentinel lymph node. The remaining 2 slices were investigated by histology. Cytokeratin 19 mRNA copy number, which distinguishes negative cases (<250 copies), micrometastases (+, ≥250≤5000 copies) and macrometastases (++, >5000 copies), was compared to axillary lymph node dissection status and to the biological tumor profile. Concordance between OSNA and histopathology was 95%, specificity 95% and sensitivity 93%. Multiple Corresponce Analysis and logistic regression evidenced that positive axillary lymph node dissection was significantly associated with a higher cytokeratin 19 mRNA copy number (>5000; p<0.0001), HER2 subtype (p = 0.007) and lymphovascular invasion (p<0.0001). Conversely, breast cancer patients with cytokeratin 19 mRNA copy number <2000 mostly presented a luminal subtype and a negative axillary lymph node dissection. We confirmed that OSNA assay can provide standardized and reproducible results and that it represents a fast and quantitative tool for intraoperative evaluation of sentinel lymph node. Omission of axillary lymph node dissection could be proposed in patients presenting a sentinel lymph node with a cytokeratin 19 mRNA copy number <2000 and a Luminal tumor phenotype.     

Diagnostic value of needle aspiration cytology in the assessment of palpable axillary lymph nodes. A study of 336 cases

OBJECTIVE: To evaluate the diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable axillary lymph nodes and determine whether ancillary procedures can be useful in enhancing the diagnosis. STUDY DESIGN: The material was analyzed in 336 cases with enlarged axillary lymph nodes in which NAC were performed by the conventional method. In all cases cytologic examination was done on site after staining the smears with the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The NAC diagnosis was supported by examining cell blocks, which showed the reliability of histologic architecture; further support was obtained with tissue biopsy and/or comparison with the primary tumor in some of the cases. RESULTS: Twelve cases were diagnosed as inflammatory lesions, and 64 were unsatisfactory due to scanty/acellular samples (despite 2-3 repeat samplings). However, in 6 of these, malignant tumors were later found on a biopsy done due to persistent and continued enlargement of an axillary lymph node or nodes. One hundred twenty-two cases were regarded as negative (normal cellular elements, n = 52; reactive elements, n = 70), and 4 cases were suspicious for malignancy. In 124 cases a variety of metastatic tumors were diagnosed (breast, n = 63; melanoma, n = 22; others, n = 39), and in 10 cases a diagnosis of lymphoma was made. CONCLUSION: NAC of palpable axillary lymph nodes as a first-line of investigation is a cost-effective procedure and is not only useful in the diagnosis of various lesions but can also help in deciding on management. Also, histologic architecture from cell blocks can be correlated with cytology, and such material can be used for histochemical and immunomarker studies.     

乳腺癌腋窝淋巴结转移患者应用多普勒超声与CT的诊断价值比较

摘要 目的：探讨乳腺癌腋窝淋巴结转移患者应用多普勒超声与CT的诊断价值比较。方法：回顾性分析2017年3月至2019年3月我院接诊的60例经过手术病理证实的乳腺癌患者。比较多普勒超声与128排螺旋CT在乳腺癌腋窝淋巴结转移中的检出率、声像特征比较及两组灵敏度、特异度、准确度。结果：在术后经过病理证实的60例乳腺癌手术患者中,有38例为腋窝淋巴结转移,有22例未腋窝淋巴结转移,在多普勒超声诊断结果对乳腺癌腋窝淋巴结转移诊断中,36例得到确诊,在128排螺旋CT诊断中,30例得到确诊;多普勒超声皮质向心性生长、淋巴结内钙化灶、淋巴结横直径比值及淋巴结边界模糊检出率均显著高于128排螺旋CT检出率,差异显著（P＜0.05）;将病理结果作为金标准。多普勒超声灵敏度、特异度、准确度均比128排螺旋CT结果高,两组方式比较具有显著差异（P＜0.05）。结论：多普勒超声在乳腺癌腋窝淋巴结转移中诊断价值高,可帮助临床提供正确诊断,以选择合适的治疗方案。     

Cystic Lymph Nodes in the Lateral Neck As Indicators of Metastatic Papillary Thyroid Cancer

ObjectiveTo determine whether radiographic findings portend to metastatic disease in patients with papillary thyroid carcinoma (PTC) and whether cystic lymph node metastasis can be recognized by preoperative, ultrasound-guided fine-needle aspiration (FNA).MethodsWe performed a retrospective review of patients with cystic lymph nodes in the lateral neck identified on preoperative ultrasonography between March 1996 and December 2009. Factors examined included demographic information; stage; cytologic and final pathologic findings; and imaging characteristics including location, size, and presence of vascularity and calcifications. Time of cystic node identification in relationship to initial diagnosis was also recorded.ResultsThirty patients had cystic lymph nodes in the lateral neck on cervical ultrasonography during the study period. Among this group, 28 (93%) had PTC, 1 (3%) had papillary serous carcinoma of the ovary, and 1 (3%) had poorly differentiated thyroid cancer. Median age at initial cancer diagnosis was 41 years (range, 16-64 years). Twenty-one patients (70%) were women, and median lymph node size was 1.8 cm (range, 0.6-4.8 cm). Twenty-three patients (77%) had a solitary cystic lymph node, and the remainder had more than 1 cystic lymph node. Cystic lymph nodes were identified at initial presentation in 11 patients (37%), while cystic lymph nodes were discovered in 19 patients (63%) after the initial operation. FNA was performed on the cystic lymph nodes of 23 patients (77%). Cytologic findings were positive for metastatic disease in 18 of 23 patients (78%). Among the 5 of 23 patients with negative cytologic findings, thyroglobulin aspirate was obtained in 1 patient, confirming metastatic PTC. Final pathologic review after surgical resection of cystic lymph nodes with negative cytologic findings from FNA was consistent with metastatic disease in 4 of 5 patients (80%).ConclusionsIn patients with PTC, the presence of a cystic lymph node by ultrasonographic examination is highly suggestive of locally metastatic disease. Confirmation of metastatic PTC may sometimes be achieved with thyroglobulin aspirate from cystic lymph nodes when cytologic findings are negative. Clinicians should strongly consider surgical lymph node resection of cystic lymph nodes regardless of the preoperative cytologic findings by FNA. (Endocr Pract. 2011;17:240-244)     

术前血清促甲状腺激素水平与甲状腺结节相关性的研究

目的:探讨术前血清促甲状腺激素(TSH)水平与甲状腺结节良恶性的关系。方法:回顾性分析了1499例甲状腺结节手术切除患者术前血清TSH、甲状腺B超,手术记录、术后病理诊断报告。根据术后病理报告判定甲状腺结节良恶性,分析术前血清TSH水平在甲状腺良恶性结节中的不同分布。结果:分化型甲状腺癌(DTC)患者术前血清TSH水平明显高于甲状腺良性结节组(2.179±2.017vs1.259±0.884μIU/mL),P<0.001;在DTC患者中,有淋巴结转移较无淋巴结转移、TNM分期III、IV期较I、II期以及肿瘤直径≥1cm较<1cm的患者术前血清TSH明显升高(均P<0.001)。结论:术前血清TSH水平是预测甲状腺结节良恶性的重要指标。     

P-gp、MMP-2、C-erbB-2在乳腺癌原发灶和转移淋巴结中的表达对比研究

目的：探讨乳腺癌侵袭转移和多药耐药之间的关系,为治疗方案的个体化提供依据。方法：采用免疫组化方法检测46例乳腺浸润性导管癌患者乳腺原发灶及相应腋淋巴结转移灶中P-gp、MMP-2、c-erbB-2的表达,结合临床表现、病理学指标,分析其相关性。结果：46例原发灶P-gp阳性表达35例（76.1%）,MMP-2阳性表达25例（54.3%）,c-erbB-2高表达18例（39.1%）;相应腋淋巴结转移灶P-gp阳性表达28例（60.9%）,MMP-2阳性表达16例（34.8%）,c-erbB-2高表达16例（34.8%）;P-gp、MMP-2蛋白表达水平与肿块大小、淋巴结转移数目均呈正相关（P〈0.05）,c-erbB-2蛋白表达水平与腋窝淋巴结转移数量呈正相关,与ER、PR表达呈负相关,P-gp阳性表达与MMP-2和c-erbB-2的表达呈正相关（P〈0.05）。结论：肿瘤原发灶与转移灶存在异质性,P-gp、MMP-2、c-erbB-2的表达与乳腺癌的多药耐药和侵袭转移有关,检测上述基因在原发灶与转移灶的表达,为乳腺癌选择个体化的化疗、内分泌治疗及分子靶向治疗提供了分子生物学依据。