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.
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。
摘要:目的:探讨接受超声引导下经直肠前列腺穿刺活检术(transretal prostatic biopsy,TPB)检查的临床护理相关问题,为前列腺穿刺活检临床护理提供参考。方法:通过心理疏导接解除者术前对TPB的恐惧心理,明确TPB是比较安全、可靠的、不可替代的检查方法,了解手术过程、护理方法和一般并发症,提高TPB的检查效果及护理质量。结果:71例患者进行TPB检查,全部患者均能主动配合检查操作,检查术中并发迷走神经心血管反射1例,术后并发血尿4例,短期内疼痛5例,均早期发现,给与相应的护理与治疗后治愈。结论:TPB是前列腺占位性病变患者有效的定性有创性检查方法,对行TPB检察患者患者应采取针对性的护理措施,提高护理质量及检查安全性。 Abstract: Objective: To investigate correlative nursing measure of patients with transretal prostatic biopsy (TPB) guided by ultrasound, provide reference for clinical nursing of TPB. Methods: We dismissed patient’s fear by psychological nursing, and explained that TPB was a safe, reliable and nosubstitutive checking, and help them understand procedure of operation, nursing measure and common complication, so as to improve effect of checking and quality of care. Results: Seventyone patients received checking with TPB, all patients could initiativiy go with checking, one patient took place pneumogastric nerve reflect, 4 patients take place hematuria postoperation, 5 patients feel soreness in shortterm. All complications were found in morning, and were cure by nursing and treatment. Conclusion: TPB is valid checking method to occupy lesion of prostate for qualitation. Because TPB is a traumatic operation, homologous nursing measure must be take to improve safety of TPB and quality of care.
Objective To systematically review the value of rapid on-site evaluation (ROSE) for diagnosing pulmonary and mediastinal lesions with endobronchial ultrasound (EBUS). MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases were searched by computer to collect the studies of ROSE and EBUS in the diagnosis of pulmonary and mediastinal lesions from inception to August 2022. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. Meta-analysis was implemented by RevMan 5.4 and Stata 12.0 software. ResultsA total of 15 studies (9 retrospective studies and 6 prospective studies) with 3 577 patients were included. The meta-analysis results of main outcomes showed that the adequacy of the sample (RD=0.10, 95%CI 0.05 to 0.15, P<0.000 1), overall diagnosis rate (RD=0.07, 95%CI 0.04 to 0.10, P<0.000 1) and the diagnosis rate of the malignant lesion (RD=0.06, 95%CI 0.02 to 0.09, P=0.004) of the ROSE combined with EBUS group were significantly higher than those of the EBUS group. Subgroup analysis showed that the diagnosis rates of pulmonary lesions (RD=0.12, 95%CI 0.08 to 0.17, P<0.000 01) and mediastinal lesions (RD=0.06, 95%CI 0.01 to 0.12, P=0.02) in the ROSE group was significantly higher than those in the EBUS group. The overall diagnosis rate and malignant diagnosis rate of ROSE combined with EBUS were 90% and 92%. The meta-analysis results of secondary outcomes showed that the number of lesions punctures (MD=–1.16, 95%CI –1.89 to –0.43, P=0.002) in the ROSE combined with EBUS group were significantly less than that in the EBUS group; there was no statistical difference in operation time (MD=0.09, 95%CI –5.22 to 5.39, P=0.97) or incidence of complications (RD=–0.06, 95%CI –0.13 to 0.01, P=0.1) between the two groups. Conclusion ROSE can improve the diagnostic efficiency of EBUS in pulmonary and mediastinal lesions, and has the value of the clinical application.
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.
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 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。