简介：无

简介：无

简介：AbstractBackground:Endometrial cancer is one of the most common malignancies of the reproductive system. Effective and cost-effective screening method for populations at high risk is not available. This study aimed to investigate specimen adequacy and the influencing factors in microscale endometrial sampling biopsy and to evaluate the diagnostic accuracy and medical cost of biopsy in endometrial cancer and atypical hyperplasia screenings in comparison with hysteroscopic endometrial biopsy.Methods:A total of 1551 patients at high risk for endometrial lesions who required hysteroscopic endometrial biopsy from November 2017 to August 2018 were included. Microscale endometrial sampling biopsy was performed, followed by hysteroscopic endometrial biopsy. We evaluated the specimen adequacy and influencing factors of microscale endometrial sampling. Diagnostic consistency between microscale endometrial sampling biopsy and hysteroscopic endometrial biopsy was evaluated. The sensitivity, specificity, positive predictive value, and negative predictive value of microscale endometrial sampling biopsy in screening for endometrial cancer and atypical hyperplasia were analyzed, and the medical costs of the two procedures were compared.Results:The specimen adequacy was 81.2%. Patient age, menopausal status, endometrial thickness, and endometrial lesion type were correlated with specimen adequacy. There was good consistency in distinguishing benign and malignant endometrial diseases between microscale endometrial sampling biopsy and hysteroscopic biopsy (kappa 0.950, 95% CI 0.925-0.975). The sensitivity, specificity, positive predictive value, and negative predictive value of microscale endometrial sampling biopsy were 91.7%, 100.0%, 100.0%, and 99.3% for endometrial cancer screening, respectively, and 82.0%, 100.0%, 100.0%, and 99.4% for atypical hyperplasia screening. The medical cost of endometrial sampling biopsy was only 22.1% of the cost of hysteroscopic biopsy.Conclusions:Microscale endometrial sampling biopsy is a minimally invasive alternative technique for obtaining adequate endometrial specimens for histopathological examination. It has the potential to be used in detecting endometrial cancer and atypical hyperplasia with high efficiency and low cost.

简介：

简介：AIM:Toinvestigatetheaccuracyofendoscopicorbiopsydiagnosesofsuperficialnonampullaryduodenalepithelialtumors(NADETs).METHODS:Clinicopathologicaldatawerereviewedfor84superficialNADETsfrom74patientswhounderwentsurgeryorendoscopicresectionbetweenSeptember2002andAugust2014atasingleprefecturalcancercenter.SuperficialNADETsweredefinedaslesionsconfinedtothemucosaorsubmucosa.Demographicandclinicopathologicaldatawereretrievedfromcharts,endoscopicandpathologicreports.Endoscopicreportsincludedendoscopicdiagnosis,location,grosstype,diameter,color,andpresenceorabsenceofbiopsy.Endoscopicdiagnosesweremadebyanendoscopistinchargeoftheexaminationbeforebiopsyspecimenswereobtained.Endoscopicimageswereobtainedusingroutine,front-view,high-resolutionvideoendoscopy,andchromoendoscopywithindigocarminewasperformedforalllesions.Endoscopicimageswerereviewedbyatleasttwoendoscopiststoassessendoscopicfindingsindicativeofcarcinoma.Preoperativediagnosesbasedonendoscopyandbiopsyfindingswerecomparedwithhistologicaldiagnosesofresectedspecimens.Sensitivity,specificity,andaccuracywereassessedforendoscopicdiagnosisandbiopsydiagnosis.RESULTS:Themajority(81%)ofthelesionswerelocatedinthesecondportionoftheduodenum.Themedianlesiondiameterwas14.5mmaccordingtofinalhistology.Surgerywasperformedfor49lesionsfrom39patients,and35lesionsfrom35patientswereendoscopicallyresected.Finalhistologyconfirmed65carcinomas,15adenomas,and3hyperplasias.Afinaldiagnosisofduodenalcarcinomawasmadefor91%(52/57)ofthelesionsdiagnosedascarcinomabyendoscopyand93%(42/45)ofthelesionsdiagnosedascarcinomabybiopsy.Thesensitivity,specificity,andaccuracyofendoscopicdiagnoseswere80%,72%,and78%,respectively,whereasthoseofbiopsydiagnoseswere72%,80%,and74%,respectively.Preoperativediagnosesofcarcinomasweremadein88%(57/65)ofthecarcinomalesionsviaendoscopyorbiopsy.En

简介：Nonalcoholicfattyliverdisease(NAFLD),definedasabnormalaccumulation(>5%)ofhepatictriglyceridewithoutexcessalcoholintake,isthemostcommonformofchronicliverdiseaseinadultsandchildrenintheUnitedStates.NAFLDencompassesaspectrumofhistologicfindingsincludinguncomplicatedsteatosis,steatosiswithinflammationandsteatohepatitis[nonalcoholicsteatohepatitis(NASH)];thelattercanadvancetocirrhosisandhepatocellularcarcinoma.NASHiscurrentlyacceptedasthehepaticmanifestationofthesetofcardiovascularriskfactorscollectivelyknownasmetabolicsyndrome.In1999asystemforhistologicgradingandstagingforNASHwasproposed;thiswasrevisedbytheNASHClinicalResearchNetworkin2005fortheentirespectrumoflesionsinNAFLD,includingthelesionsandpatternsofpediatricNAFLD,andforapplicationinclinicalresearchtrials.Diagnosisremainsdistinctfromgradeandstage.ArecentEuropeanproposalseparatessteatosisfromactivitytoderiveanumericdiagnosisofNASH.Eventhoughtherehavebeenpromisingadvancementsinnon-invasivetesting,thesetestsarenotyetdetailedenoughtoreplacethefullrangeoffindingsprovidedbyliverbiopsyevaluation.Limitationsofbiopsyareacknowledged,butliverbiopsyremainsthe'goldstandard'fordiagnosisanddeterminationofamountsofnecroinflammatoryactivity,andlocationoffibrosis,aswellasremodelingoftheparenchymainNASH.ThisreviewfocusesonthespecifichistologiclesionsofNAFLDandNASH,gradingandstaging,differentialdiagnosestobeconsidered,andthecontinuingroleoftheliverbiopsyinthisimportantliverdisease.

简介：无

简介：Increasedabdominalimaginghasledtoanincreaseinthedetectionoftheincidentalsmallrenalmass(SRM).WithincreasingrecognitionthatthemalignantpotentialofSRMsisheterogeneous,rangingfrombenign(15%-20%)toaggressive(20%),enthusiasmformoreconservativemanagementstrategiesintheelderlyandinfirmed,suchasactivesurveillance(AS),havegrownconsiderably.AsthemanagementoftheSRMevolvestoincorporateablativetechniquesandASforlowriskdisease,theroleofrenalmassbiopsy(RMB)tohelpguideindividualizedtherapyisevolving.Historically,theroleofRMBwaslimitedtotheevaluationofsuspectedmetastaticdisease,renalabscess,orlymphoma.However,inthecontemporaryera,theroleofbiopsyhasgrown,mostnotablytoidentifypatientswhoharborbenignlesionsandforwhomtreatment,particularlytheelderlyorfrail,maybeavoided.WhenperformingaRMBtoguideinitialclinicaldecisionmakingforsmall,localizedtumors,themostrelevantquestionsareoftenrelegatedtoproofofmalignancyanddocumentation(ifpossible)ofgrade.However,significantintratumoralheterogeneityhasbeenidentifiedinclearcellrenalcellcarcinoma(ccRCC)thatmayleadtoanunderestimationofthegeneticcomplexityofatumorwhensingle-biopsyproceduresareused.HeterogeneousgenomiclandscapesandbranchedparallelevolutionofccRCCswithspatiallyseparatedsubclonescreatesanillusionofclonaldominancewhenassessedbysinglebiopsiesandraisesimportantquestionsregardinghowtumorscanbeoptimallysampledandwhetherfutureevolutionarytumorbranchesmightbepredictableandultimatelytargetable.Thisworkraisesprofoundquestionsconcerningthegeneticlandscapeofcancerandhowtumorheterogeneitymayaffect,andpossiblyconfound,targeteddiagnosticandtherapeuticinterventions.Inthisreview,wediscussthecurrentroleofRMB,theimplicationsoftumorheterogeneityondiagnosticaccuracy,andhighlightpromisingfuturedirections.

简介：当前transrectal指导超声的前列腺活体检视(TRUS-Bx)是最普通的urological过程之一，在经历TRUS-Bx的病人之中在欧洲和统一States.1每年与超过100万表现了，约三分之一个将收到前列腺癌症(PCa)的诊断，当三分之二在起始的活体检视上收到否定结果时。否定活体检视病人在1年维持12%的重复活体检视的估计的风险并且38%在5years.2标准TRUS-Bx是可能的系统地错过重要肿瘤，特别地在gland.3的前面、顶端的部分，在下一十年的泌尿科医师的一个关键目的是增加过程的精确性并且避免不恰当的活体检视的使用。

简介：Standardizedapproachtopolypectomyofdiminutivecolorectalpolyps(DCPs)islackingsincecoldbiopsyforcepshavebeenassociatedwithhighlevelsofrecurrence,hotbiopsyforcepsareconsideredinadequateandriskyandcoldsnaringiscurrentlyunderinvestigationforitsefficacyandsafety.Thishasledtoconfusionandagapinclinicalpractice.ThisarticlediscussestheusefulnessandcontemporarypracticalapplicabilityofhotbiopsyforcepsandprovideswellintentionedcriticismofthenewEuropeanguidelinesforthetreatmentofDCPs.Diminutivecolorectalpolypsareasourceoffrustrationfortheendoscopistsincetheirsmallsizeisaccompaniedbyaconsiderableriskofpremalignantneoplasiaandasmallbutnonnegligibleriskofadvancedneoplasiaandevencancer.Sincetheproportionofdiminutivecolorectalpolypsissubstantialandexceedsthatoflargerpolyps,theireffectiveremovalposesaconsiderableworkloadandatherapeuticchallenge.Duringthelastdecade,theintroductionofcoldsnaringtoroutineendoscopypracticehasattemptedtoovercometheuseofpriortechniques,suchashotbiopsyforceps.Itisimportanttorecognizethatwiththeexceptionofendoscopicmethodsthatareobviouslyunsafeandinadequatetoservetheirpurpose,allotherinterventionalendoscopicmethodsareoperator-dependentinthesensethatspecificexpertiseandtrainingareobligatoryforthesuccessofanytherapeuticintervention.Sincerelevantpublicationsonhotbiopsyforcepsarestillinfavorofitscarefuluse,asithasnotyetdemonstratedinferioritycomparedwithnewertechniques,itwouldbeprudentforanymedicalpractitionertoevaluatetheavailabletoolsandjudgeanynewproposedtechniquebasedontheevidencebeforeitisadopted.

简介：AbstractBackground:Glomerular disease is the leading cause of chronic kidney disease globally. No scoping review reports have focused on China's spectrum of glomerular diseases in children. This study aimed to systematically identify and describe retrospective studies on pediatric glomerular disease based on available data on sex, age, study period, and region.Methods:Six databases were systematically searched for relevant studies from initiation to December 2021 in PubMed, Embase, Web of Science, Global Health Library, Wangfang Database, and CNKI.Results:Thirty-four studies were identified in the scoping review, including 40,430 patients with biopsy-proven diagnoses. The proportion of boys was significantly higher than that of girls. In this study, 28,280 (70%) cases were primary glomerular disease, 10,547 (26.1%) cases were diagnosed as secondary glomerular disease, and 1146 (2.8%) cases were hereditary glomerular disease. Minimal change disease is the most common glomerular disease among children in China, followed by mesangial proliferative glomerulonephritis, IgA nephropathy, and purpura nephritis. We observed increments in glomerular diseases in periods 2 (2001–2010) and 3 (2011–2021). The proportion of major glomerular diseases varies significantly in the different regions of China.Conclusion:The spectrum of pediatric glomerular diseases varied across sex, age groups, study periods, and regions, and has changed considerably over the past 30 years.

简介：瞄准：为了评估胰腺的织物的组织学的评估的诊断精确性，一个修改方法为恢复并且处理内视镜的超声(EUS)获得的样品指导了好针渴望(FNA)在胰腺的固体的鉴别诊断的材料集中。方法：有胰腺的群众的62个连续病人有希望地被学习。EUS被线性扫描PentaxFG-38UX回响内诊镜执行。三FNA(22G针)在每个过程期间被执行。与第一和第二根刺获得的材料为cytological学习被处理。第三根刺的材料被盐溶液的小心的注射通过针为摩尔答案恢复进10%，并且为组织学的学习处理了。结果：一些为组织学的分析获得的核心标本是6.5+/-5.3公里(范围1-22公里)。Cytological和组织学的样品在51被看作足够(82.3%)并且52个盒子(83.9%)分别地。为恶意的诊断的胰腺的细胞学和组织学的全面敏感是68.4%。与细胞学相反，组织学能诊断除煽动性的群众的腺癌，和所有情况以外的瘤。细胞学和组织学的联合允许在56种情况(90.3%)中获得一件足够的样品，与84.21%的全球敏感，100%的特性和90.32%的全面精确性。复杂并发症率是1.6%。结论：为组织学的检查的足够的胰腺的核心标本能被指导EUS的FNA获得。这种技术为胰腺的瘤的不同类型和良性的疾病的评估的诊断主要是有用的。

简介：Preoperativestagingoftheaxillainwomenwithinvasivebreastcancerusingultrasound-guidedneedlebiopsy(UNB)identifiesapproximately50%ofpatientswithaxillarynodalmetastasespriortosurgicalintervention.Althoughmoderatelysensitive,itisahighlyspecificstagingstrategythatisrarelyfalsely-positive,henceapositiveUNBallowspatientstobetriagedtoaxillarylymph-nodedissection(ALND)avoidingpotentiallyunnecessarysentinelnodebiopsy(SNB).Inthisreview,weextendourpreviousworkthroughanupdatedliteraturesearch,focusingonstudiesthatreportdataonUNButility.Basedondatafor10,934breastcancerpatients,sourcedfrom35studies,apositiveUNBallowedtriageof1,745cases(simpleproportion16%)toaxillarysurgicaltreatment:theutilityofUNBwasamedian19.8%[interquartilerange(IQR)11.6%-26.7%]acrossthesestudies.Wealsomodelleddatafromasubgroupofstudies,andestimatedthatamongstpatientswithmetastasestoaxillarynodes,theoddsratio(OR)forhighnodaldiseaseburdenforapositiveUNBversusanegativeUNBwas4.38[95%confidenceinterval(95%CI):3.13,6.13],P<0.001.Fromthismodel,theestimatedproportionwithhighnodaldiseaseburdenwas58.9%(95%CI:50.2%,67.0%)forapositiveUNB,whereastheestimatedproportionwithhighnodaldiseaseburdenwas24.6%(95%CI:17.7%,33.2%)ifUNBwasnegative.Overall,axillaryUNBhasgoodclinicalutilityandapositiveUNBcaneffectivelytriagetoALND.However,theevolvinglandscapeofaxillarysurgicaltreatmentmeansthatUNBwillhaverelativelylessutilitywheresurgeonshavemodifiedtheirpracticetoomissionofALNDforminimalnodalmetastaticdisease.

简介：镇静可以在指导的transrectal超声(TRUS)期间疼痛地导致减小前列腺活体检视。我们试图在在护理费用的指导TRUS的前列腺活体检视和相关增加期间评估propofol和remifentanil注入的联合的功效和安全。从1月到2010年9月，经历transrectal前列腺活体检视的100个人被使随机化进二个组。在组1，50个病人收到了propofol和remifentanil的联合注入；在组2，50个病人收到了lidocaine果冻。在指导TRUS的活体检视被执行以后，疼痛和耐心的满足被一个10点评估视觉模拟规模(管)，和一张费用相关的耐心的满足问询表被所有病人完成。病人们也被问他们是否将愿意由一样的方法经历重复活体检视。在1看了显著地更低的管的组的病人在组2比那些得分(吝啬的管分数：0.9±；1.1对6.3±；2.5；P<；0.001)。另外，耐心的满足规模在组1是显著地更高的(P=0.002)。尽管全面费用在组1是显著地更高的(P=0.006)，就费用而言的耐心的满足规模在这个组(P=0.009)也是更高的。propofol和remifentanil的联合在指导TRUS的前列腺活体检视期间是到减少病人疼痛和增加病人满足的一条安全、有效的路。尽管费用在收到了镇静，期望的组是更高的，病人展出了提高的满足和心甘情愿由一样的方法重复活体检视。

简介：ＣＴＧＵＩＤＥＤＰＥＲＣＵＴＡＮＥＯＵＳＴＲＡＮＳＴＨＯＲＡＣＩＣＦＩＮＥＮＥＥＤＬＥＡＳＰＩＲＡＴＩＯＮＢＩＯＰＳＹＯＦＳＭＡＬＬＰＥＲＩＰＨＥＲＡＬＰＵＬＭＯＮＡＲＹＬＥＳＩＯＮＳＺｈａｎｇＪｕｎ张军ＺｈａｏＨｕｉｒｕ赵惠儒ＦｕＺｈｉｍｉｎ付...

简介：无

简介：无

简介：AbstractBackground:Endoscopic biopsy can underestimate gastric malignancies as low-grade intraepithelial neoplasia (LGIN). Definitively diagnosed LGIN would progress. This study aimed to evaluate predictive factors to identify malignancies misdiagnosed as LGIN by biopsy and LGIN at high risk of progression.Methods:The clinical records of patients diagnosed with gastric LGIN by endoscopic biopsy who underwent at least two endoscopies during the first year of follow-up between 2007 and 2017 were retrospectively collected. Three endoscopists reviewed photographs of the initial endoscopy, described lesion characteristics, and made endoscopic diagnoses. Logistic regression was used to analyze predictors to identify malignancies underestimated as LGIN. A receiver operating characteristic curve was used to evaluate the diagnostic accuracy of these predictors. Patient clinical outcomes of follow-up >1 year were collected. Kaplan-Meier estimates with log-rank tests and Cox proportional hazards regression were used to analyze predictors of progression.Results:Overall, 48 of 182 (26.4%) patients were proven to have malignancies. A single lesion, a large lesion size, and marked intestinal metaplasia (IM) were independent predictors of initially misdiagnosed malignancies. The area under the curve of these predictors was 0.871, with a sensitivity of 68.7% and specificity of 92.5%. Twelve of 98 patients (12.2%) progressed during the 33-month median follow-up period. A whitish appearance, irregular margins, marked IM, and histological diagnosis of LGIN more than twice within the first year were predictors for progression.Conclusions:Lesions diagnosed as LGIN by biopsy with marked IM and other predictors above should be prudently treated for high potential to be malignancies or progress. Endoscopic follow-up with repeated biopsies within the first year is recommended.

简介：AbstractBackground:Methylene blue is the most commonly used tracer for sentinel lymph node (SLN) biopsy (SLNB) in China. This study aimed to investigate the feasibility of clinical application of SLNB using methylene blue dye (MBD) for early breast cancer and the prognosis of patients with different SLN and non-SLN statuses.Methods:We retrospectively analyzed the clinicopathological data of patients with early breast cancer treated at the Peking University First Hospital between 2013 and 2018. We calculated the SLN identification rate (IR) in SLNB with MBD and the false-negative rate (FNR), and analyzed the prognosis of patients with different SLN and non-SLN statuses using Kaplan-Meier curves.Results:Between January 2013 and December 2018, 1603 patients with early breast cancer underwent SLNB with MBD. The SLN IR was 95.8% (1536/1603). Two SLNs (median) were detected per patient. There were significant differences in FNR between patients with SLN micrometastasis and macrometastasis (19.0% vs. 4.5%, χ2 = 12.771, P < 0.001). Chi-square test showed that there were significant differences in SLN successful detection rates among patients with different vascular tumor embolism status (96.3% vs. 90.8%, χ2 = 9.013, P = 0.003) and tumor (T) stages (96.6% vs. 94.1%, χ2 = 5.189, P = 0.023). Multivariate analysis showed that vascular tumor embolism was the only independent factor for SLN successful detection (odds ratio: 0.440, 95% confidence interval: 0.224-0.862, P = 0.017). Survival analysis showed a significant difference in disease-free survival (DFS) between patients with non-SLN metastasis and patients without non-SLN metastasis (P = 0.006).Conclusion:Our single-center data show that, as a commonly used tracer in SLNB in China, MBD has an acceptable SLN IR and a low FNR in frozen sections. This finding is consistent with reports of dual tracer-guided SLNB. Positive SLNs with non-SLN metastasis are associated with DFS.

简介：Transperineal前列腺活体检视是能被用来从前列腺获得组织学的样品的一个过程。两个都改进活体检视核心样品和前列腺癌症察觉的质量，我们当前正在执行比较用18G针获得到用16G针获得的那些的前列腺活体检视样品的未来的、使随机化的试用。这初步的研究的目的是在两个组评估疼痛和复杂并发症率以便估计与一根更大的口径针执行前列腺活体检视是否是一个可行过程。经历transperineal前列腺活体检视的187个病人有希望地被评估并且把组划分了成二。第一个组(94个病人，组织A)用16G针和第二个组收到了transperineal前列腺活体检视(93个病人，组织B)与18G针经历了transperineal前列腺活体检视。麻醉在所有题目在prostatic顶与单个会阴的注射被获得。视觉类似物规模(管)和面部表情规模(FES)被用来在每个组在过程的多重步期间估计疼痛。因为它能潜在地影响病人们经历了的疼痛和复杂并发症，一张详细问询表被用来关于药使用获得信息。在过程以后的二个星期，早、迟了的复杂并发症被评估。统计分析用非参量的测试被执行。前列腺特定的抗原(PSA)和药使用在在二个组之间的基线是类似的。疼痛没在18-和16个G针组之间显著地在前列腺活体检视，与VAS和FES仪器一起被测量，期间不同，并且没有重要差别处于在这些组之间的早或迟了的复杂并发症率被发现。有16G针的Transperineal前列腺活体检视以疼痛和复杂并发症率是一个可行过程。有更大的耐心的人口的进一步的研究被要求估计这个过程是否能改进前列腺癌症察觉率。