Fine needle aspiration biopsy (FNAB) of breast lumps: comparison study between pre- and post-operative histological diagnosis

Fine-needle aspiration biopsy is recommended as first and most important step in the management of breast cancer. A retrospective study was realized on 420 patients that underwent fine-needle aspiration (FNAB) in comparison to 140 patients that underwent surgical management. The results of FNAB showed that 81% of the cases were benign with an accuracy of 93%, a specificity of 97% and a sensitivity of 92% compared to operative findings. The accuracy of FNAB depends on the expertise and experience of the cyto pathologist as well as the technical skills of the physician performing the biopsy. FNAB is showing to be a highly effective procedure which can obviate unnecessary surgery in breast suspected lumps, save time and money and patient anxiety. It is the effective method for distinguishing benign from malign breast lesions.     

Vibrant技术在磁共振双侧乳腺动态增强检查中的应用及优势

目的：探讨Vibrant 软件技术在磁共振双侧乳腺动态增强检查中的应用及优势。方法：回顾性分析我院经手术或穿刺病理证 实的乳腺疾病患者70 例,均为女性,按照Vibrant 动态增强检查扫描的时间不同,分为A、B 两组,每组35 例。两组病例均采用 1.5T MR 机行动态增强检查。A 组病例行Vibrant 动态增强的扫描时间为9 分24 秒,B组病例行Vibrant 动态增强的扫描时间为 7 分42 秒。结果：A 组病例动态增强MRI 诊断的敏感性为94.74%,特异性为85%,准确性为89.74%;B 组病例动态增强MRI诊 断的敏感性为91.3%,特异性为89.47%,准确性为90.48%。两组病例动态增强MRI对病灶诊断的敏感性、特异性和准确性无显著 性差异（P>0.05）。结论：Vibrant乳腺动态增强扫描技术在乳腺疾病的诊断中具有较高的诊断敏感性、特异性和准确性。Vibrant技 术在缩短增强扫描时间的情况下不降低其诊断效能。     

Fine needle aspiration biopsy with adjunct immunohistochemistry in intraocular tumor management

OBJECTIVE: To assess the effectiveness of fine needle aspiration biopsy (FNAB), with and without immunohistochemistry (IHC), in the management of solid intraocular tumors. STUDY DESIGN: Thirty-three consecutive adults undergoing FNAB of suspected intraocular tumors were studied. Clinical, cytologic and histologic diagnoses were correlated. The positive predictive value, sensitivity and specificity of FNAB for detecting malignancy, the effect of lHC on the final cytologic diagnosis and the number of patients in whom clinical management was altered as a result of cytologic evaluation were determined. RESULTS: The positive predictive value was 96% with and 93% without adjunct IHC. The sensitivity and specificity of FNAB for detecting malignancy were 96% and 83%, respectively, with IHC. Without IHC, the sensitivity was unaltered, but the specificity was 67%. IHC confirmed the morphologic diagnosis in 75% of cases, made a diagnosis in 12.5% and changed a malignant diagnosis from carcinoma to melanoma in 6% of cases. The planned management was changed by the FNAB findings in 24% of patients. In 3 patients (9%), IHC was essential for diagnosis and management. No patients exhibited local tumor dissemination or recurrence associated with the biopsy. CONCLUSION: FNAB is a safe, sensitive and specific method of establishing a tissue diagnosis in a subset of patients with solid intraocular tumors. The routine use of immunohistochemical stain ing increases the diagnostic utility of the technique and may change clinical management.     

Use of fine needle aspiration biopsy in radiofrequency ablation

OBJECTIVE: To demonstrate the utility of fine needle aspiration biopsy (FNAB) in radiofrequency ablation (RFA) of suspected metastatic tumors at various sites. STUDY DESIGN: Eighteen patients referred for RFA underwent 21 aspirations prior to the procedure. A radiologist performed the FNAB and RFA with radiographic guidance. On-site preliminary evaluation of Diff-Quik-stained smears were followed with Papanicolaou staining. A final diagnosis was rendered and compared to the preliminary diagnosis. RESULTS: Liver was aspirated in 17 cases, lung in 3 cases and pubic bone in 1. Fifteen aspirates were deemed on site as positive or suspicious for malignancy. A preliminary, on-site diagnosis of benign was given in one case and adequate with deferment for review of all slides in four others. One FNAB was unsatisfactory. All but one (patient with benign diagnosis) then immediately proceeded to RFA of the lesion. After review of additional slides, the final diagnosis confirmed metastatic adenocarcinoma in 16, hepatocellular carcinoma in 2 and metastatic squamous cell carcinoma in 1. One FNAB yielded benign hepatocytes, and one was unsatisfactory. CONCLUSION: FNAB is an accurate, safe and rapid method of confirming disease in patients just prior to undergoing RFA.     

乳腺MRI 与乳腺X线在导管原位癌临床诊断中应用的比较研究

目的:探讨乳腺MRI与乳腺X线检查在导管原位癌(DCIS)诊断中的应用价值。方法:选择2012年5月至2014年9月在我院接受诊治的乳腺DCIS患者52例(58个病灶)为研究对象,对所有患者进行乳腺MRI及X线检查,以病理检查结果作为金标准,比较乳腺MRI及X线检查在导管原位癌(DCIS)诊断中的应用价值。结果:58个病灶中,乳腺MRI共检查出阳性54例,阴性4例,其中误诊或漏诊4例;乳腺X线共检查出阳性49例,阴性9例,其中误诊或漏诊11例。乳腺MRI检查的灵敏度和准确度均显著高于乳腺X线,差异有统计学意义(P0.05)。此外,乳腺MRI检查的特异度、阳性预测值及阴性预测值均分别高于乳腺X线,但差异无统计学意义(P0.05)。结论:乳腺MRI检查对DCIS的诊断价值较高,具有广泛的应用前景,但亦存在少数误诊或漏诊。     

Fine needle aspiration biopsy of vertebral and paravertebral lesions: retrospective study of 124 cases

OBJECTIVE: To evaluate the diagnostic value of image-guided fine needle aspiration biopsy (FNAB) in the diagnosis and management of vertebral and paravertebral lesions and to review similar studies in the literature. STUDY DESIGN: One hundred twenty-four FNAB cases (113 [corrected] patients) of vertebral and paravertebral lesions occurring over a 10-year period were retrieved from the archives of the University of Mississippi Medical Center for review and clinico-radiologic correlation. Thirty-four of the cases included a concurrent core needle biopsy sample, 15 cases had subsequent surgical specimens, while 32 cases had previously established malignancy. The age range was 11 days to 91 years (mean, 46 years), with 57 male patients and 56 female. RESULTS: One hundred five cases were vertebral lesions, and 19 cases were paravertebral lesions. FNAB diagnosis were malignant in 33.87% of cases, benign in 5.64%, suspicious in 4.03%, infectious/inflammatory and degenerative in 12.91%, unsatisfactory in 16.13% and negative in 27.42%. The overall sensitivity of the procedure was 89.3% and the specificity, 93.8%. The positive predictive value was 95.7% and negative predictive value, 85.2%. CONCLUSION: FNAB is an effective means of establishing a definitive diagnosis of vertebral and paravertebral lesions, allowing appropriate patient management. Cell blocks, core biopsies and ancillary studies are useful adjuncts in rendering the diagnosis.     

Fine needle aspiration biopsy of vertebral lesions

OBJECTIVE: To evaluate the accuracy of fine needle aspiration biopsy (FNAB) in the diagnosis of vertebral lesions. STUDY DESIGN: Eighty-nine FNAB cases of vertebral lesions from January 1996 to December 2001 were retrieved from the Allegheny General Hospital laboratory information system. The cases were reviewed and correlated with clinical findings, including previous clinical history, primary site of malignancy and final pathologic diagnosis. RESULTS: ENAB diagnoses were malignant in 43 cases, benign in 35, suspicious in 1, unsatisfactory in 7 and false negative in 3. Previous clinical history included malignancy (37 patients), osteomyelitis and systemic disease (11), and nonspecific or no history (41). In 34 cases (38.2%) both aspirates and core biopsies were available, and the diagnoses correlated in 29/34 cases (85%). Surgical or core biopsies in the unsatisfactory/suspicious group showed malignancy in 4 cases (50%). The sensitivity of FNAB of vertebral lesions was 96%, specificity 100%, positive predictive value 100% and negative predictive value 92%, with no false positive cases. CONCLUSION: FNAB of vertebral lesions is an effective, sensitive and specific procedure in the diagnostic workup of a patient with or without a prior history of malignancy. Surgical pathology examination, including core biopsies of unsatisfactory or suspicious lesions, can further improve the diagnostic yield.     

Endoscopic ultrasound-guided fine needle aspiration of the pancreas. Diagnostic utility and accuracy

OBJECTIVE: Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) is regarded as a safe and reliable procedure for diagnosing and staging of pancreatic neoplasms. This study retrospectively evaluated both the diagnostic utility and accuracy of pancreatic EUS-FNABs and potential cytologic pitfalls when using Diff-Quik stain for on-site evaluation. STUDY DESIGN: Pancreatic EUS-FNABs performed between 1995 and 1998 were identified from the files of the Department of Pathology. All patients were studied via a linear-array ultrasound endoscope with an FNAB device. Immediate evaluation of the specimen by a pathologist using air-dried slides and Diff-Quik stain was done on all cases. An average of five passes (range, three to nine) were performed. Five cytologic categories were identified: nondiagnostic, benign, atypical, suspicious and malignant. EUS disease staging, histologic correlation and clinical follow-up were reviewed. RESULTS: Sixty-nine consecutive pancreative FNABs were evaluated in the study period. The patients comprised 38 females and 31 males with a mean age of 65 years (range, 36-83). Histologic correlation was available on 40 patients, and follow-up was available on the remaining 29. The cytologic diagnoses included: 31 malignant, 8 suspicious, 6 atypical, 20 benign and 4 nondiagnostic. Forty-three cases were true positive, 9 were true negative, 2 were false positive, and 11 were false negative. The overall sensitivity was 80% and specificity was 82%. CONCLUSION: The study showed that cytologic evaluation of pancreatic EUS-FNABs has 80% sensitivity and 82% specificity. False negative diagnosis was usually due to sampling error. A nondiagnostic cytologic diagnosis should be rendered in the absence of adequate sampling of a lesion. On-site cytologic evaluation of EUS-FNABs aids in guaranteeing specimen adequacy, and the pathologist should be trained to evaluate Diff-Quik-stained samples.     

Accuracy of touch imprint cytology of image-directed breast core needle biopsies

OBJECTIVE: To evaluate the accuracy of touch imprint (TI) cytology of image-directed core needle biopsy (CNB) specimens of nonpalpable breast lesions. STUDY DESIGN: Fifty-two consecutive CNBs from 44 patients were performed under mammographic or ultrasound guidance. Air- dried TIs of CNBs were stained with Diff-Quik. TI cellularity was considered adequate if six or more ductal cell groups were identified. CNBs and TIs were interpreted in a blinded fashion. RESULTS: TI cellularity was adequate in 37/52 (71%) cases, including 17/20 carcinomas and 20/32 benign lesions. Among 17 carcinomas, TIs were positive in 12, suspicious in 4 and atypical in 1. One case of lactational change was suspicious on TI, and 5/8 fibroadenomas were atypical. No benign lesions were called "carcinoma" on cytology. When lesions categorized as "carcinoma" or "suspicious" were considered positive and those classified as "atypical" or "benign" were scored as negative, TI sensitivity and specificity were 94% and 95%, respectively. When the "atypical" cases were grouped with the positive cases, TI sensitivity was 100%, with 75% specificity. CONCLUSION: With satisfactory cellularity, TIs of CNBs are highly accurate. When immediate evaluation of CNB specimens is important, TIs can potentially decrease the number of biopsy passes required and provide preliminary diagnoses.     

FNAB thyroid gland: comparison study between pre- and post-operative histological diagnosis

Fine-needle aspiration biopsy is recommended as the first and most important step in the management of nodular thyroid disease. A retrospective study of 520 patients with nodular thyroid disease was done in the north of Jordan, between January 1998 and August 2001. We compared the results of fine-needle aspiration biopsy (FNAB) of thyroid gland with postoperative histological findings. The results are classified into three groups A)-benign, B)-malignant, and C)-suspicious as shown in table II. The results of the FNAB were benign in 96.4% of the cases which include benign colloid nodules (325 cases), multi-nodular goitre (70 cases), diffuse goitre (40 cases), thyroiditis (23 cases) and thyroid cysts (43 cases). A total of 52 patients underwent surgical management, 49 patients found to be accurate with the FNAB. The accuracy of FNAB was 94% (49 patients out of 52), with a specificity of 99% and a sensitivity of 93%. Ultrasound findings showed that 65% (338 patients) had solid nodules, 15% (78 patients) had cystic lesions and 20% (104 patients) had mixed echogenicity lesions. Histological confirmation of malignancy was 10 out of 11 patients with a 91% accuracy rate. FNAB was found to be a highly effective procedure, which can obviate a lot of unnecessary surgery in case of thyroid lesions, and avoid over treatment of benign disease. Surgery was recommended in all suspicious cases. FNAB under ultrasound guidance increases the sensitivity rate which can reach 100%. FNAB accuracy seems to be similar in cold and in hot nodules. Clinically, most of the patients with benign colloid nodules were having goitres suggesting the role played by iodine deficiency is which a prominent feature in that area in Jordan.     

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。     

Thyroid neoplasms. Can we do any better with quantitative cytology?

The differential diagnosis of thyroid neoplasms by routine cytology presents major difficulties. We therefore looked for measurable nuclear parameters that could be generated from Feulgen-stained smears obtained by fine needle aspiration biopsy (FNAB). These parameters would then be used to differentiate between benign and malignant lesions. Seventy-six patients whose cold thyroid nodule was surgically excised after FNAB and examined by a pathologist were used in this study: 56 benign, 18 malignant and 2 atypical adenomas. A set of 3,662 cells from the 33 benign cases was compared with the set of 1,712 cells from the 11 malignant nodules. Discrimination between the two populations was based on four nuclear features ranked according to their discriminating power. The first ranked was a textural parameter, followed by a densitometric and finally two other textural parameters. The rate of nuclei that could be regarded as benign was computed for each case using the ranked parameters. The average rate for the 33 benign cases was 85% (50.2 = 100%, set at the 95% confidence interval). In a prospective study of the 32 remaining patients, sensitivity and specificity were, respectively, 92% and 88%, which were higher than those obtained by conventional cytology.     

乳腺影像报告数据系统对乳腺疾病的诊断价值

目的:探讨BI-RADS(breast imaging reporting and data system)乳腺影像报告数据系统对乳腺疾病的诊断价值。方法:采用彩色多普勒超声对75例乳腺占位性病变患者(均为女性)进行双侧乳腺探查,并采用BI-RADS乳腺影像报告数据系统进行评价。选取患者BI-RADS 3类、4类、5类的94枚病灶进行研究,以组织病理学诊断结果为金标准,来探讨其关系。结果:在94个病灶中BI-RADS诊断为3类32枚,病理学结果证明良性30枚(93.75%),恶性2枚(6.25%);BI-RADS诊断为4类的36枚,病理学结果证明良性24枚(66.67%),恶性12枚(33.33%);BI-RADS诊断为5类的26枚,病理学结果证明良性2枚(7.69%),恶性24枚(92.31%)。结论:BI-RADS乳腺影像报告数据系统可用来对各级病灶进行描述、评估,有利于提高乳腺病变影像诊断的特异性,为临床医生提供了明确的病变信息,为其进行下一步治疗措施起着重要的指导价值。     

超声造影联合HE4、CA125、CA153在子宫内膜癌诊断中的价值研究

摘要 目的：为提高对子宫内膜癌的早期诊断,本研究对超声造影联合肿瘤标志物人附睾蛋白4（human epididymis protein-4,HE4）血清糖类抗原125（carbohydrate antigen 125,CA125）及153（CA153）在子宫内膜癌中的诊断价值进行研究。方法：以80例疑似子宫内膜癌患者为研究组,另以80例于本院体检的健康女性为对照组。对患者进行超声造影检查,比较两组血清HE4、CA125以及CA153水平,考察超声造影联合HE4、CA125及CA153对子宫内膜癌的诊断作用。结果：本研究中80例疑似患者中,子宫内膜癌患者有49例,子宫内膜良性病变患者31例,而超声造影检查显示子宫内膜癌患者有41例,良性病变39例,与金标准检查结果有一定的差异,单纯的超声造影检查对子宫内膜癌的诊断有局限性。子宫内膜癌和良性病变患者的病变区灌注的时间、增强强度以及增强均度都有显著差异（P<0.05）。对照组血清HE4、CA125及CA153水平分别为82.31±15.45 pmol/mL、22.31±6.21 U/mL、16.45±4.91 U/mL,研究组血清HE4、CA125及CA153水平分别为159.28±24.01 pmol/mL、42.88±5.73 U/mL、28.30±3.76 U/mL,经统计,研究组各项指标均显著高于对照组（P<0.05）。超声造影的灵敏度为79.3 %、特异度为67.34 %、阳性似然比为2.54、阴性似然比为0.25、阳性预测值为84.63 %、阴性预测值为60.51 %及符合率为72.19 %;联合检测的灵敏度为86.58 %、特异度为78.92 %、阳性似然比为3.11、阴性似然比为0.23、阳性预测值为93.19 %、阴性预测值为67.42 %及符合率为77.90 %。结论：超声造影联合HE4、CA125及CA153检测对子宫内膜癌诊断价值更高,HE4、CA125及CA153能辅助提高超声造影的诊断效果。     

Fine-needle aspiration biopsy cytology of cutaneous calcinosis in a 74-year-old woman with dermatomyositis on methotrexate therapy: a case report

BACKGROUND: Cutaneous calcinosis (CC) occurs in a variety of rheumatic diseases. Fine needle aspiration biopsy (FNAB) may be used in the office setting to evaluate such soft tissue lesions. For patients on methotrexate (MTX) therapy, methotrexate nodulosis (MN) should be considered in the differential diagnosis. CASE: A 74-year-old Caucasian woman with adult-onset dermatomyositis (ADM) on MTX therapy presented for evaluation of a right breast mass and multiple soft tissue nodules. FNABs of the right breast mass and a left upper extremity nodule both demonstrated benign calcified material. Six months later, the patient returned for evaluation of the persistent right breast mass and repeat FNAB revealed adenocarcinoma. Concurrently, a right hip soft tissue nodule was aspirated, demonstrating benign crystalline debris. MTX therapy was discontinued, and the patient subsequently underwent a lumpectomy of the right breast 1 month after FNAB diagnosis, displaying infiltrative ductal carcinoma. Of note, 2 months after her lumpectomy, MTX therapy was restarted and the patient continues to have adequate control of ADM symptoms with persistent, clinically benign soft tissue calcifications. CONCLUSION: Performing FNAB on soft tissue lesions can obviate needless tissue biopsies of CC in appropriate rheumatology patients, thus avoiding the risks and complications associated with more invasive procedures.     

An audit of the accuracy of fine needle aspiration using a liquid-based cytology system in the setting of a rapid access breast clinic

We have assessed the effectiveness and accuracy of reporting fine needle aspirates of the breast (FNAB) using a liquid-based cytology (LBC) system (the Cytospin) method) in the pressure situation of a rapid access clinic (RAC). We have reviewed every case from the RAC from June 1997 to February 2001 inclusive. There were 1322 cases, which accounted for 26% of the total FNAB received in our department over the period. There were 323 cancers and 999 benign cases in the group. The inadequate/nondiagnostic rate (C1) was 18%. The absolute sensitivity, including C1 cases, was 73% with the complete sensitivity being 90%. The groups of 'atypical, probably benign' (C3) and 'suspicious, probably malignant' (C4) accounted for a total of 6.2%. There were 28 false negative cases and 1 false positive case (a borderline phyllodes tumour). Comparing our results with the standards recommended by the NHSBSP has shown that the diagnosis of FNAB using this LBC method is feasible, accurate and reliable even in the pressure situation of a RAC.     

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。     

阴道镜及宫颈活组织检查对早期宫颈上皮内瘤变诊断价值分析

目的:探究阴道镜及宫颈活组织检查对早期宫颈上皮内瘤变(cervicalintraepithelialneoplasia,CIN)的诊断价值。方法:选择2015年3月至2018年5月于我院接受诊治的543例疑似宫颈上皮瘤变患者,分别对其实施阴道镜及宫颈活组织检查,以病理学检测结果为金标准,分别评估两种方式单独检测及联合检测对早期CIN的诊断一致性、灵敏度和特异度,并进行组间对比。结果:(1)543例疑似CIN患者病理诊断早期CIN阳性患者168例,阴性患者375例,诊断率为30.94%;阴道镜对早期CIN诊断发现阳性患者有143例,良性患者有400例,诊断率为26.34%;宫颈活组织检测对早期CIN诊断发现阳性患者有159例,良性患者有384例,诊断率为29.28%;阴道镜联合颈活组织检测对早期CIN诊断发现阳性患者有163例,良性患者有380例,诊断率为30.02%。(2)检测发现,阴道镜对早期CIN诊断一致性为81.77%,灵敏度为60.12%,特异度为91.47%。(3)宫颈活组织对早期CIN诊断一致性为91.71%,灵敏度为83.33%,特异度为95.47%。(4)阴道镜联合宫颈活组织对早期CIN诊断一致性为96.50%,灵敏度为92.86%,特异度为98.13%。(5)联合检测对早期CIN诊断的一致性、灵敏度和特异度均明显优于阴道镜及宫颈活组织单独检测。结论:阴道镜及宫颈活组织检测对早期CIN具有较好的诊断效果,但联合检测诊断准确率更高,适用于早期CIN临床筛查中。     

Image analysis of low magnification images of fine needle aspirates of the breast produces useful discrimination between benign and malignant cases

Image analysis of low magnification images of fine needle aspirates of the breast produces useful discrimination between benign and malignant cases
Fine needle aspirates of the breast (FNAB) ( n =362; 204 malignant, 158 benign), prepared by cytocentrifuge methods and stained by the Papanicolaou technique, were analysed using a semi‐automated image analysis system at a low magnification which precluded resolution of nuclear detail. The measured parameters were integrated optical density, fractal textural dimension, number of cellular objects (single cells and contiguous groups of cells), distance between cellular objects (mean, s.d., skewness and kurtosis), area of cellular objects (mean, s.d., skewness, kurtosis) and the nearest neighbour statistic. The cases were divided into a 200‐case training set and a 162‐case test set. Analysis was performed by logistic regression and the multi‐layer Perceptron type of artificial neural network. Logistic regression and the neural network produced similar performances with a sensitivity of 82–83%, specificity 85% and a positive predictive value for a malignant result of 85%. A non‐parametric analysis of all the predictor variables showed that all except the mean area of cellular objects and the s.d. of this measurement were significant discriminants ( P <0.05), but most were highly interrelated and this was reflected in the selection of only three predictor variables by forward and backward conditional logistic regression. This study shows that much diagnostic information is present in low power views of FNAB, and that image analysis could form the basis of a semi‐automated decision‐support aid.     

肿块型乳腺癌的超声造影特征及定量参数与sE-cad、sTNFR-P55的相关性及其诊断价值分析

摘要 目的：探讨肿块型乳腺癌的超声造影（CEUS）特征及定量参数与可溶性E-钙黏蛋白（sE-cad）、可溶性肿瘤坏死因子受体P55（sTNFR-P55）相关性研究,并探讨其对肿块型乳腺癌的诊断价值。方法：选取2019年1月至2021年1月于本院诊治并行CEUS检查的162例乳腺肿块患者,根据病理结果分为肿块型乳腺癌组（82例）和良性组（80例）,另选取本院体检健康的80例女性作为对照组。三组均行血清sE-cad、sTNFR-P55水平检测。比较肿块型乳腺癌组与良性组CEUS特征及定量参数的差异,采用Pearson相关分析肿块型乳腺癌患者CEUS定量参数与血清sE-cad、sTNFR-P55水平的相关性。对CEUS、血清sE-cad、sTNFR-P55水平单独或三者联合诊断的方式采用敏感度、特异度、准确性、阳性预测值、阴性预测值指标表达。结果：肿块型乳腺癌组大部分表现为增强后形态不规则、高增强、向心性灌注、造影剂分布不均匀以及呈慢出型的强化方式,且所占比例显著高于良性组（P<0.05）。与良性组相比,肿块型乳腺癌组CEUS定量参数TTP、G显著降低（P<0.05）,而PI、K显著升高（P<0.05）。肿块型乳腺癌组血清sE-cad、sTNFR-P55水平显著高于良性组、对照组（P<0.05）,且良性组血清sE-cad、sTNFR-P55水平还显著高于对照组（P<0.05）。肿块型乳腺癌患者的CEUS定量参数TTP、G与血清sE-cad、sTNFR-P55水平呈负相关（P<0.05）;而PI、k与血清sE-cad、sTNFR-P55水平呈正相关（P<0.05）。CEUS联合血清sE-cad、sTNFR-P55水平诊断肿块型乳腺癌的准确度、敏感度、特异度、阳性预测值、阴性预测值最高。结论：CEUS特征及定量参数对肿块型乳腺癌具有一定的鉴别诊断价值,而且CEUS定量参数与血清sE-cad、sTNFR-P55水平具有一定的相关性,说明CEUS定量参数可在一定程度上可反映乳腺癌的恶性生物学行为;同时CEUS联合血清sE-cad、sTNFR-P55水平检测有助于提高对肿块型乳腺癌的鉴别诊断价值,进一步为临床医生的定性判断提供更加科学的影像学依据。