Objective To investigate clinical significance of serum VEGF-C level and C-erbB-2 protein expression in patients with breast cancer. Methods Sixty-two female patients with breast invasive ductal cancer and breast benign lesion were respectively selected. Serum VEGF-C level was detected by enzyme-linked immunosorbent assay (ELISA) before operation and at one month after operation, and C-erbB-2 protein expression in tissues of breast cancer was detected by immunohistochemistry. Then, the relationship between serum VEGF-C level and clinicopathologic characteristics and C-erbB-2 protein expressions wereas analyzed. Results The serum VEGF-C level before operation in breast cancer patients〔(279.65±17.34) pg/ml〕 was significantly higher than that in breast benign lesions patients 〔(167.26±12.15) pg/ml〕, P＜0.01. In breast cancer patients, the serum VEGF-C level before operation was higher than that at one month after operation 〔(209.45±15.23) pg/ml〕, P＜0.01. The serum VEGF level was related to tumor stage (P＜0.05) but not to patient age, tumor size, menopause status , lymph node metastasis or not and ER and PR expression (Pgt;0.05). The positive expression rate of C-erbB-2 protein in breast cancer patients (54.84%, 34/62) was significantly higher than that in breast benign lesion patients (11.29%, 7/62), P＜0.01. Moreover, the positive expression rate of C-erbB-2 protein in breast cancer patients with axilla lymph node metastasis (69.44%) was significantly higher than that without axilla lymph node metastases (34.62%), P＜0.05. The serum VEGF level increased with increasing expression intensity of C-erbB-2 protein and there was positive correlation between them (r=0.813，P＜0.05). Conclusions The serum VEGF-C level in breast cancer may be conducted as an assisted marker to differential diagnosis of breast tumor. C-erbB-2 is related to lymph node metastasis of breast cancer patients. There is synergistic effect between VEGF-C and C-erbB-2 in the lymph node metastasis way of breast cancer.
Objective To determine feasibility of texture analysis of CT images for the discrimination of nonhypervascular pancreatic neuroendocrine tumor (PNET) from pancreatic ductal adenocarcinoma (PDAC). Methods CT images of 15 pathologically proved as PNETs and 30 PDACs in West China Hospital of Sichuan University from January 2009 to January 2017 were retrospectively analyzed. Results Thirty best texture parameters were automatically selected by the combination of Fisher coefficient (Fisher)+classification error probability combined with average correlation coefficients (PA)+mutual information (MI). The 30 texture parameters of arterial phase (AP) CT images were distributed in co-occurrence matrix (18 parameters), run-length matrix (10 parameters), and autoregressive model (2 parameters). The distribution of parameters in portal venous phase (PVP) were co-occurrence matrix (15 parameters), run-length matrix (10 parameters), histogram (1 parameter), absolute gradient (1 parameter), and autoregressive model (3 parameters). In AP and PVP, the parameter with the highest diagnostic performance were both Teta2, and the area under curve (AUC) value was 0.829 and 0.740 (P<0.001,P=0.009), respectively. By the B11 of MaZda, the misclassification rate of raw data analysis (RDA)/K nearest neighbor classification (KNN), principal component analysis (PCA)/KNN, linear discriminant analysis (LDA)/KNN, and nonlinear discriminant analysis (NDA)/artificial neural network (ANN) was 28.89% (13/45), 28.89% (13/45), 0 (0/45), and 4.44% (2/45), respectively. In PVP, the misclassification rate of RDA/KNN, PCA/KNN, LDA/KNN, and NDA/ANN was 35.56% (16/45), 33.33% (15/45), 4.44% (2/45), and 11.11% (5/45), respectively. Conclusions CT texture analysis is feasible in the discrimination of nonhypervascular PNET and PDAC. Teta2 is the parameter with the highest diagnostic performance, and in AP, LDA/KNN modality has the lowest misclassification rate.
目的:明确肌钙蛋白Ⅰ(cTnI)在心源性呼吸困难的鉴别诊断中有无应用价值。方法:比较急性心衰与急性肺源性呼吸困难时cTnI的变化情况,并观察一定的cTnI临界值辅助诊断心衰的敏感性和特异性。结果:总共156例患者,最后确诊为急性心衰的患者69例,而肺源性呼吸困难患者87例。急性心衰组的平均cTnI值为076±085ng/dL,而肺源性呼吸困难组为025±032ng/dL,两组间有显著性差异(Plt;0001)。根据ROC曲线计算肌钙蛋白Ⅰ的临界值(截点值)为042ng/dL,其鉴别心衰的敏感度为7153%,特异度为9036%,准确度为8014%。结论:检测肌钙蛋白Ⅰ水平并与其它临床信息相结合,有助于快速准确地诊断充血性心力衰竭。
ObjectiveTo investigate the clinicopathological features, diagnosis and differential diagnosis of villoglandular carcinoma of the uterine cervix. MethodsThe clinical data of a 34-year-old patient diagnosed with villoglandular carcinoma of cervix on April 6, 2010 was retrospectively analyzed. Surgical excision samples were analyzed by means of hematoxylin-eosin and immunohistochemical staining. ResultsThe gross appearance of the tumor mass showed cauliflower-like pattern of growth. Histologically, it was similar to colorectal villoglandular adenoma, and was composed of branching papillae shaped like villous glandular tube structure, and the surface was coated with pseudostratified or stratified columnar cells which showed mild atypia and uncommon mitotic figures. Immunohistochemically, tumor cells were positive for carcinoma embryonic antigen, CK7 and CA125, and negative for estrogen receptor, progesterone receptor, P16, p53 and vimentin. This patient was subjected to a follow-up of 48 months, and was alive without recurrence or metastasis. ConclusionsVilloglandular carcinoma of the uterine cervix is rare and has a favorable prognosis. The diagnosis of villoglandular carcinoma depends on pathological morphology, and meanwhile, it is necessary to distinguish villoglandular carcinoma from other benign and malignant tumors which exhibited papillary growth pattern.
【Abstract】ObjectiveBy using multidetector row spiral CT (MDCT) to investigate the CT imaging findings of gallbladder abnormalities caused by hepatic parenchymal diseases and those of inflammatory cholecystitis. MethodsCT and clinical data of 80 patients with gallbladder abnormalities were retrospectively reviewed. Fifty patients were in hepatic disease group, including 20 chronic hepatitis, 25 liver cirrhosis, and 5 cirrhosis with hepatocellular carcinoma. Thirty patients were in inflammatory group, including 19 chronic cholecystitis, 6 acute cholecystitis, 3 cholecystitis with acute pancreatitis, 1 gangrenous cholecystitis, and 1 xanthogranulomatous cholecystitis. All patients underwent MDCT plain scan and contrastenhanced dualphase scanning of upper abdomen. ResultsIn hepatic disease group, 48 cases had evenly thickened gallbladder wall (96%) with mean thickness of (3.67±0.49) mm; 38 cases had clear gallbladder outlines (76%); 38 cases had gallbladder wall enhancement of various degree (76%); 14 cases had gallbladder bed edema and localized nondependant pericholecystic fluid collection (28%). In inflammatory cholecystitis group, 28 cases had obscuring gallbladder outlines (93%) ; 26 cases had gallbladder wall evenly thickened (87%), 4 cases showed unevenly thicked wall (13%), the mean thickness being (4.54±1.14) mm; 30 cases had inhomogenous enhancement of the gallbladder wall (100%); 9 cases had highattenuation bile (30%); 4 cases had dependant pericholecystic fluid collection (13%); 5 cases had transient enhancement of adjacent hepatic bed in arterial phase (17%); microabscess and gas in the gallbladder wall was observed in 1 case respectively. ConclusionMDCT can offer imaging findings useful for differentiating abnormal gallbladder changes caused by hepatic parenchymal diseases from those due to inflammatory cholecystitis.
ObjectiveTo systematically review the clinical value of ultrasonographic elastography (UE) for the differential diagnosis of benign/malignant thyroid nodules. MethodsWe comprehensively searched the databases including The Cochrane Library (Issue2, 2013), PubMed, EMbase, CNKI, WanFang Data, Medalink, VIP and CBM from inception to the December of 2013, for including clinical research reports of determining thyroid nodules using ultrasonographic elastography. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment were completed by two reviewers independently. Then Meta-DiSc software (version 1.4) was used for pooling analysis. ResultsA total of 35 studies including 4 127 patients were included. The results of metaanalysis showed that, specificity, sensitivity, positive likelihood radio, negative likelihood radio and diagnostic odds ratio (DOR) were 0.89 (0.88 to 0.90), 0.88 (0.86 to 0.90), 6.37 (5.44 to7.47), 0.13 (0.11 to 0.16) and 58.72 (43.12 to 79.98), respectively; and the area under SROC curve (AUC) was 0.936 9. ConclusionCurrent evidence shows that ultrasonographic elastography has fairly high sensitivity (88%) and specificity (89%) in differential diagnosis of benign/malignant thyroid nodules. The positive rate in the malignant thyroid group is 58.72 times higher that in benign thyroid cancer with better efficacy in differential diagnosis, so ultrasonographic elastography is of effective and feasible diagnostic value for thyroid benign/malignant nodules.
ObjectiveTo explore the differential diagnosis value of airspace consolidation in thoracic CT between organizing pneumonia (OP) and acquired community pneumonia (CAP).MethodsA retrospective study was taken by retrieving the patients CT database from October 2010 to August 2016. Fifty-six consecutive patients with OP and 99 consecutive patients with CAP whose CT showed airspace consolidation were enrolled and their clinical characteristics and radiological characteristics were analyzed.ResultsThe percentage of patients whose CT image showed various amount of air bronchogram (ABG) with different shapes is higher in OP group than that in CAP group (87.5% and 72.7% respectively, χ2=4.558, P=0.033). The median and interquartile range amount of ABG in the OP patients were significantly higher than those in CAP group [4 (ranged from 2 to 8) and 2 (ranged from 0 to 4) respectively, z=3.640, P=0.000]. Morphologically, 58.9% of the OP patients showed entire air bronchogram (EABG) on the thoracic CT, significantly higher than that in CAP group (21.2%) (χ2=22.413, P=0.000). Interrupted ABG was found in 26.3% of CAP patients, while 16.1% of OP patients shared same features and the difference was not statistically significant (χ2=2.125, P=0.148). Traction bronchiectasis and ground glass opacity (GGO) were more likely to be found in the OP patients rather than CAP patients with 26.8% and 39.3% respectively, while they were found in 1.0% and 11.1% in the CAP patients (P<0.05). Reversed halo sign was found only 1.0% of the CAP patients, significantly lower than that in OP group, 26.8% (χ2=25.671, P=0.000). Pleural effusion and bronchial wall thickening were more commonly found in the CAP group with 56.6% and 35.4% respectively. By multivariate logistic analysis, EABG (OR=5.526, P=0.000), traction bronchiectasis (OR=21.564, P=0.010), GGO (OR=4.657, P=0.007) and reversed halo sign (OR=13.304, P=0.023) were significantly associated with OP, while pleural effusion (OR=0.380, P=0.049) and bronchial wall thickening (OR=0.073, P=0.008) were significantly associated with CAP. Other features in thoracic CT coexisting with ABG all reach significance statistically between the OP and CAP group (all P<0.05).ConclusionsAirspace consolidation in thoracic CT may be valuable for the differential diagnosis between OP and CAP. EABG is more commonly found in OP patients than in CAP patients. When EABG exists or ABG coexists with traction bronchiectasis, GGO and reversed halo sign, a diagnose of OP should be considered.
ObjectiveTo investigate the research progress of etiology, pathogenesis, diagnosis, differential diagnosis, and treatment of granulomatous lobular mastitis (GLM). MethodA comprehensive analysis was conducted by reviewing the domestic and foreign literatures on GLM and combining with clinical experience. ResultsGLM was a relatively rare chronic inflammatory disease of the breast, and the number of patients had been increasing in recent years. It mainly occured in multiparous women of childbearing age. Clinically, it was characterized by a hard breast mass with or without redness and pain, and severe cases might be accompanied by nodular erythema and arthritis. Bacterial infection, especially Corynebacterium kroppenstedtii and autoimmunity were considered to be the main causes of GLM. The diagnosis of GLM needed to combine with medical history, clinical manifestations, histopathological findings, imaging findings, and laboratory tests. A multidisciplinary team for diagnosis and treatment of GLM should be established to improve the diagnostic accuracy and reduce misdiagnosis. At present, the treatment methods for GLM were mainly conservative treatment and surgical treatment, including follow-up observation, antibiotic treatment, glucocorticoid treatment, immunosuppressive therapy, surgical treatment, traditional Chinese medicine treatment, and combined treatment. ConclusionsAt present, the incidence of GLM is on the rise, but its etiology and pathogenesis are still unclear. The diagnosis needs to combine with many aspects, and it is recommended that the multidisciplinary team could improve the accuracy of diagnosis. There is still no unified standard for the selection and timing of treatment. Clinicians’ experience and patients’ wishes should be taken into account when choosing treatment options in clinical practice. Prospective and high-quality multicenter clinical trials and evidence-based medicine practice are still needed to further improve diagnosis and treatment of GLM.