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Objective:To investigate the value of Breast Ultrasound Report and Data System (BI-RADS) classification in diagnosis of special types of breast cancer.Methods:A total of 112 patients with special type of breast cancer (112 breast lesions) confirmed by pathology were analyzed by using BI-RADS ultrasound category in the Second Affiliated Hospital, Zhejiang University School of Medicine from August 2009 to August 2020. All patients underwent ultrasound before surgery. The breast lesions were evaluated by senior attending and junior resident according to BI-RADS ultrasound category respectively. Taking histopathological result as the gold standard, the sensitivity and accuracy of BI-RADS classification in the diagnosis of special types of breast cancer were calculated.The differences between different special types of breast cancer in terms of ultrasound characteristics and pathological features were analyzed. Kappa consistency test was used to evaluated the consistency of the results of two physicians.Results:In the 112 patients, pathological results showed that there were 20 cases of metaplastic carcinoma, 19 cases of invasive carcinoma with medullary features, 16 cases of differentiated carcinoma of apocrine gland, 12 cases of mucinous carcinoma, 12 cases of invasive micropapillary carcinoma, 10 cases of invasive papillary carcinoma, 6 cases of invasive lobular carcinoma and 17 cases of other special types of carcinoma. Among them, 4 cases (3.5%) were BI-RADS 3, 13 cases (11.6%) were BI-RADS 4a, 42 cases (37.5%) were BI-RADS 4b, 47 cases (42.0%) were BI-RADS 4c and 6 cases (5.4%) were BI-RADS 5. The accuracy and sensitivity of BI-RADS classification in diagnosis of special types of breast cancer was 96.43% and 96.43%, respectively. There was significant difference in BI-RADS grade among different special types of breast cancer ( P<0.05). Most lesions were characterized by hypoechoic with irregular shape and angular or microlobulated margin. The nodule size, boundary, echo and posterior echo in breast cancer with different special types showed significant differences (all P<0.05). There was a good consistency between the two physicians (Kappa=0.789). Conclusions:The ultrasonography features of different special types of breast cancer are different. BI-RADS classification has great value in diagnosis of special types of breast cancer.
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Clinical trial is an important step of in vitro diagnostic reagents research and development. Based on the Guiding Principles and the key points of inspect on the spot, combined with the actual work experience, the article focuses on the prominent problems in the whole process of in vitro diagnostic reagent clinical trials. It is helpful to improve the level of hospital drug clinical trial centre and the quality of in vitro diagnostic reagent clinical trials by analyzing the issues.
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Clinical Trials as Topic , Indicators and Reagents/administration & dosage , Reagent Kits, DiagnosticABSTRACT
Objective To explore the safety and clinical value of percutaneous ultrasound‐guided core needle biopsy( PUS‐CNB) and endoscopic ultrasound‐guided fine needle aspiration( EUS‐FNA ) in pancreas mass . Methods Ultrasound‐guided biopsy were performed in 109 cases who were difficult to diagnose to get specimens from the highly suspicious parts of the lesions by avoiding vessels . PUS‐CNB were performed in 82 cases , EUS‐FNA in 19 cases and both in 8 cases . T he site and size of lesions were recorded preopeartion . Specimens with clear pathological diagnosis were considered as satisfactory materials . Specimens that were impossible to puncture due to the existence of high risk factors in the process of puncture were considered as unsuccessful biopsy . All patients were followed up after biopsy and complications were recorded . Results The satisfaction rate and success rate of PUS‐CNB were 98 .89% and 100% ,the diagnostic accuracy and false negative rate were 97 .78% and 2 .22% . T he satisfaction rate and success rate of EUS‐FNA were 96 .15% and 96 .30% ,the diagnostic accuracy and false negative rate were 80 .77% and 23 .81% . T here were no serious complications such as pancreatic fistula ,hemorrhage and needle transfer at the needle site after puncture . Conclusions Both PUS‐CNB and EUS‐FNA are safe and effective methods for the diagnosis of benign and malignant pancreatic lesions and have high clinical values . Reasonable selection of EUS‐FNA and PUS‐CNB can safely and reliably identify and diffentiate the benign and malignant pancreatic lesions .
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Objective@#To explore the safety and clinical value of percutaneous ultrasound-guided core needle biopsy(PUS-CNB) and endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) in pancreas mass.@*Methods@#Ultrasound-guided biopsy were performed in 109 cases who were difficult to diagnose to get specimens from the highly suspicious parts of the lesions by avoiding vessels. PUS-CNB were performed in 82 cases, EUS-FNA in 19 cases and both in 8 cases. The site and size of lesions were recorded preopeartion. Specimens with clear pathological diagnosis were considered as satisfactory materials. Specimens that were impossible to puncture due to the existence of high risk factors in the process of puncture were considered as unsuccessful biopsy. All patients were followed up after biopsy and complications were recorded.@*Results@#The satisfaction rate and success rate of PUS-CNB were 98.89% and 100%, the diagnostic accuracy and false negative rate were 97.78% and 2.22%. The satisfaction rate and success rate of EUS-FNA were 96.15% and 96.30%, the diagnostic accuracy and false negative rate were 80.77% and 23.81%. There were no serious complications such as pancreatic fistula, hemorrhage and needle transfer at the needle site after puncture.@*Conclusions@#Both PUS-CNB and EUS-FNA are safe and effective methods for the diagnosis of benign and malignant pancreatic lesions and have high clinical values. Reasonable selection of EUS-FNA and PUS-CNB can safely and reliably identify and diffentiate the benign and malignant pancreatic lesions.
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Objective@#To evaluate the diagnostic value of BRAF V600E mutation combined with shear wave elastography(SWE) for thyroid nodules of Bethesda Ⅲ diagnosed by fine-neddle aspiration(FNAC).@*Methods@#One hundred and seventeen thyroid nodules diagnosed as Bethesda Ⅲ in the department of ultrasound and confirmed by BRAF V600E gene detection, SWE examination and surgery were collected. BRAF V600E detection, SWE examination and both combined with pathological results were using to retrospective analysis.@*Results@#There were 75 benign nodules and 42 malignant nodules according to pathology. Sensitivity and negative predictive value of BRAF V600E combined with SWE were higher than single BRAF V600E mutation detection and SWE with statistically significant(P=0.01, 0.001; P=0.029, 0.01, respectively). There were no statistically differences between single BRAF V600E mutation detection and SWE for Bethesda Ⅲ nodules(P=0.483, 0.645).@*Conclusions@#BRAF V600E mutation detection combined with SWE can improve the sensitivity and negative predictive value in the diagnosis of Bethesda Ⅲ thyroid nodules.
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Objective To assess the therapeutic efficacy of subcutaneous transplantation pancreatic cancer in nude mice model with different size microbubbles. Methods Eighteen Balb/C nude mice with subcutaneous pancreatic carcinoma xenografts were divided into three groups:group A( 6 mice) did not received microbubbles and ultrasonic irradiation;group B(6 mice) received standard microbubbles and ultrasonic cavitation treatment;group C(6 mice) received up-sized microbubbles and ultrasonic cavitation treatment.Body weight and tumor size of nude mice were measured respectively at the time points of 0,7, 14,21 days after three times ultrasound radiation and before ultrasound treatment. Tumor volumes were calculated.Then the mice were sacrificed finally. Results There was no significant difference in tumor volumes among three groups before treatment( P > 0.05). Tumor volume continued to increase in all groups.Compared with group A,growth rate in group B and group C were lower,growth rate in group B was higher than that in group C,the difference was statistically significant( P < 0.05). There was no significant difference in the parameters of regional blood volume(RBV) and regional blood flow(RBF)among three groups before treatment( P > 0.05). RBV and RBF were decreased significantly after 3 days treatment in group B and group C( P <0.05),the RBV and RBF in group C were lower than those in group B,the differences were statistically significant( P <0.05).There was no significant difference in the body weight of nude mice before and after radiation among three groups during the follow-up period( P >0.05). Conclusions The cavitation effect of up-sized microbubbles is more efficient for mice subcutaneous pancreatic cancer xenograft tumor inhibition compared with standard microbubbles.
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Objective To evaluate the diagnostic value of combined scoring of contrast enhanced ultrasound(CEUS) and ultrasonic elastography(UE) for thyroid imaging reporting and date system(TI RADS) 4 type nodules.Methods The CEUS and UE features of 520 TI RADS 4 type nodules were analyzed retrospectively.The scores of each nodule were evaluated and compared with pathological results and fine-needle aspiration cytology(FNAC).ROC curve was used to compare the diagnostic value of CEUS combined with UE or alone in the differential diagnosis of TI-RADS 4 nodules.Results The sensitivity,specificity,accuracy and area under the curve(AUC) of UE were 82.34％,82.25％,82.31％ and 0.841,respectively,when the cut off value of UE score was 4.The sensitivity,specificity,accuracy and AUC of CEUS were 78.63％,65.68％,74.42％ and 0.750,respectively,when the cut-off value of CEUS score was 4.The sensitivity,specificity,accuracy and AUC of CEUS combined with UE were 92.31 ％,75.74％,86.92％ and 0.885,respectively,when the cut-off value of combined score was 6.The sensitivity and accuracy of combined score were higher than those of two other methods,the difference was statistically significant (all P ＜ 0.05),the AUC of combined score was the biggest,it had the highest diagnostic efficacy.Conclusions Combined scoring of CEUS and UE can improve the accuracy in the differential diagnosis of TI-RADS 4 type nodules.
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Objective To determine whether low frequency ultrasound mediated microbubbles destruction (UMMD) could inhibit VX2 orthotopic hepatic tumor growth in rabbit models.Methods Twenty-four New Zealand white rabbits were implanted with VX2 tumor in left hepatic lobe to establish a homograft rabbit model of liver neoplasms in situ,which were randomly divided into four groups(6 rabbits in each group):group A (intravenous saline only),group B (intravenous microbubbles only),group C (intravenous saline+ low frequency focused ultrasound exposure),and group D (intravenous microbubbles+low frequency focused ultrasound exposure).After 3 days consecutive treatment,tumor volume(TV),and peak intensity (PI) were monitored by conventional ultrasound and contrast enhanced ultrasound(CEUS) on 0,1,7,14 and 21 days after treatment.The rabbits were euthanized at the end of the experiment.Tumor tissues were evaluated by HE stain.Results The parameters of TV and PI of each tumor had no significant difference among four groups before treatment(all P>0.05).TV had no significant difference among four groups on 1 day after treatment(all P>0.05);PI in group C and group D were significantly lower than those in group A and group B (all P0.05).The pathological changes of necrosis tissue,hemorrhagic damage of microvessel and thrombosis were observed in the tumors of group D only,whereas these changes occurred rarely in other groups.Conclusions UMMD can inhibit the growth of VX2 hepatic tumors in rabbits,and be used as a promising novel therapeutic strategy to liver neoplasms.
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OBJECTIVE:To evaluate the rationality of cefoxitin use in our hospital. METHODS:Evaluation index and evalua-tion criteria were established on the basis of DUE. The relative weight of evaluation index were calculated by using attribute-based AHM weight method,and the gas between medical orders and complete rational ones were evaluated by using TOPSIS processing method. The proportion of rational medical orders were calculated to evaluate the rationality of drug use. RESULTS:Among 116 medical records,there were 19%reasonable medical orders(including 4.3%complete reasonable medical orders,5 cases),50%ba-sically reasonable medical orders(58 cases)and 31% unreasonable medical orders(36 cases). CONCLUSIONS:It is reasonable and feasible to use AHM weighted TOPSIS method to evaluate the rationality of cefoxitin. The utilization of cefoxitin in our hospital is basically reasonable,but there are still many problems.
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Objective:To share a drug treatment experience for multiple drug resistant Pseudomonas aeruginosa.Methods:A retrospective analysis of the pharmaceutical care participated by clinical pharmacist for one case of intervertebral space infection with multiple drug resistant Pseudomonas aeruginosa was carried out.Results:Pharmacists participated in the whole treatment process,made the combined antimicrobial regimen (fosfomycin + ceftazidime + ciprofloxacin),and adjusted the time sequence.As a result,satisfactory curative effect was obtained.Conclusion:The infection with multiple drug resistant Pseudomonas aeruginosa may be treated with the three-drug therapy.Clinical pharmacists can play a positive role in the treatment of complicated infections.
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Objective To evaluate the association of the size of thyroid nodules and the diagnostic value of repeat fine needle aspiration cytology(FNAC) in diagnose of thyroid nodules.Methods One hundred and forty-three thyroid nodules in one hundred and thirty-five patients with repeat FNAC and thyroidectomy were retrospectively analyzed.The nodules were divided into three groups according to the largest diameter(L):GroupA,L＜0.5 cm;GroupB,0.5 cm≤L≤1.0cmandGroupC,L＞1.0cm.Yield of FNACs were divided into six levels according to the classification criteria of the Bethesda system,and Level Ⅰ,Ⅲ,Ⅳ,Ⅴ were defined as the indefinite cytological diagnosis.Results The diagnostic rate of repeat FNAC was obviously higher in group B compared with group A and group C,with significantly statistical difference (P ＜0.05).The risk of malignancy for persistently indefinite diagnostic aspirates after repeat FNAC was significantly reduced with statistical difference from the initial indefinite diagnostic aspirates in group B (P ＜0.05),while there was no statistical difference between group A and group C (P＞0.05).The diagnostic accuracy of repeat FNAC in group B was significantly higher than that in group A(P ＜0.05),but not in group C (P ＜0.05).Conclusions The repeat FNAC has a higher efficiency in those nodules with a largest diameter between 0.5 cm and 1.0 cm,and a repeat FNAC can be suggested.
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OBJECTIVE:To explore the establishment of DUE criteria for the evaluation of glucocorticoids(GCs)use in oncol-ogy department of our hospital,and to evaluate the rationality of glucocorticoid use. METHODS:DUE criteria for GCs in our hos-pital was established preliminary,and used to evaluate medication indication,medication course,medication results,etc. Medical records of 300 patients receiving GCs were collected from oncology department of our hospital during Apr. to Dec. in 2013(before intervention)and Jun. 2014 to Mar. 2015(after intervention)via hospital information system. The application of GCs was evaluat-ed. RESULTS:Pexamethasone sodium phosphate injection was used most frequently in our hospital(82.34%),followed by Dexa-methasone acetate tablet(15.33%)and prednisone asetate tablets(2.33%). The mest common purpose of GCs use in oncology de-partment of our hospital is radiotherapy and chemotherapy induced vomiting prevention and treatment(55.55% of total case),fol-lowed by anti-inflammatory therapy(14.19%)and chemotheraphy drug pretreatment(12.76%). After intervention,rational use of GCs for tumor had been improved greatly,and the rate of unqualified drug dosage and medication course decreased from 6.87% to 3.95%,and that of decreased from 3.58% to 2.74%. CONCLUSIONS:The establishment of DUE criteria and continuous criteria improvement during clinical rational drug use guidance can promote rational use of GCs in oncology department.
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Objective To evaluate the diagnostic value of puncture feeling combined with fine-needle aspiration cytology (FNAC) for thyroid nodules.Methods One thousand and fourteen thyroid nodules were retrospectively analyzed.Eighty-six thyroid nodules were performed repeat FNAC.All nodules were confirmed by pathology,the agreement of puncture feeling at different time was evaluated by Kappa test.Results There were 751 malignant nodules and 263 benign nodules.Sensitivity and accuracy of FNAC combined with puncture feeling were higher than those of single FNAC or single puncture feeling (x2 =11.609,4.433 and P =0.00,0.04;x2 =19.369,6.697 and P =0.00,0.01,respectively).There were no statistically differences in the sensitively and accuracy between single FNAC and puncture feeling (x2 =1.230,0.242 and P =0.27,0.62,respetively).The Kappa values of inter-observer and intra-observer were 0.829(P =0.00) and 0.885(P =0.00) respectively with statistically significance.Conclusions Puncture feeling combined with FNAC can improve the sensitivity and accuracy in the diagnosis of thyroid nodules,the reproducibility of puncture feeling is excellent.