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@#Abstract: Objective To investigate the diagnostic efficacy of rifampin-resistant real-time fluorescent quantitative nucleic acid amplification detection technology (GeneXpert MTB/RIF) in bronchoalveolar lavage fluid (BALF) combined with peripheral blood tuberculosis infection T cell spot test (T-SPOT) and tuberculosis antibody (TB-Ab) in smear-negative pulmonary tuberculosis. Methods The clinical data of 114 cases of clinically diagnosed smear-negative pulmonary tuberculosis, 80 cases of non-tuberculous pulmonary diseases and 22 cases of smear-positive pulmonary tuberculosis in our hospital from January 2019 to January 2021 were retrospectively analyzed. The detection results of peripheral blood T-SPOT, TB-Ab and BALF GeneXpert in the three groups were analyzed. The sensitivity, specificity, negative predictive value, positive predictive value, false negative rate, false positive rate and Youden index of the three detection methods were compared. The differences in the positive detection rate of smear-negative pulmonary tuberculosis between the separate detection and the combined detection of the three methods were compared. The receiver operating characteristic curve (ROC) was performed to calculate the area under the curve (AUC). Results The sensitivity of BALF GeneXpert and peripheral blood T-SPOT and TB-Ab was 66.91%, 80.88% and 90.44%, respectively. The specificity was 98.75%, 73.75% and 41.25%, respectively; the diagnostic coincidence rates were 78.70%, 78.24% and 72.22%, respectively, which were higher than 70.00%. In the smear-negative pulmonary tuberculosis group, the positive detection rates of these three methods in the smear-negative pulmonary tuberculosis group were 63.15%, 79.82% and 90.35%, respectively, and the differences were statistically significant compared with those in the non-tuberculosis pulmonary disease group (all P<0.01). The positive detection rate of the three combined methods in the smear-negative pulmonary tuberculosis group was 96.49 %, which was significantly higher than that of TB-GeneXpert method and T-SPOT, and the differences were statistically significant (χ2=37.283, P<0.01; χ2=13.612, P<0.01); the Youden index of combined detection was significantly higher than that of single detection, and the AUC of combined detection was 0.977, which was significantly higher than that of single detection. Conclusion BALF GeneXpert combined with peripheral blood T-SPOT and TB-Ab can significantly improve the diagnostic rate of bacterial-negative pulmonary tuberculosis, providing a strong basis for guiding clinical treatment.
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Objective:To explore the value of contrast-enhanced ultrasound(CEUS) in the diagnosis of peripheral pulmonary lesions, and the diagnostic efficiency of CEUS combined with multiple tumor markers in the diagnosis of peripheral lung malignancy.Methods:A total of 76 patients with peripheral lung lesions treated in Chongqing University Three Gorges Hospital from September 2019 to September 2021 were included. According to the pathological results, the 76 patients with 76 peripheral lung lesions were divided into malignant lesions (48 cases) and benign lesions (28 cases). After contrast agent injection, the arrive time (AT), difference of AT between the lesion and lung tissue(tAT) were analyzed quantitatively. The ROC curve was plotted to calculate the area under the curve and the optimum threshold. Serum cyrokeratin fragment antigen 21-1(CYFRA21-1), carcino-embryonic antigen(CEA) and neuron specific enolase(NSE) level were detected and analyzed between the two groups, and the diagnostic efficacies of tAT combined with 3 serum tumor markers and 4 combined markers for peripheral pulmonary malignant lesions were analyzed.Results:AT and tAT of malignant lesions were greater than those of benign lesions, and the differences were statistically significant (all P<0.05). The area under the ROC curve (0.759) of tAT in the diagnosis of peripheral pulmonary malignant lesions was greater than that of AT (0.675), and the best cut-off point was 2.5 seconds (later arrival signified malignancy), the sensitivity of tAT in the diagnosis of peripheral pulmonary malignant lesions was 91.7%, and it was higher than AT, which showed more reliable diagnostic value for peripheral pulmonary malignant lesions. When tAT was combined with 3 serum tumor markers in the diagnosis of peri-pulmonary malignant lesions, the area under the combined diagnosis curve was the largest (0.878) and the sensitivity was the highest (97.9%). Conclusions:tAT is of certain value in the differential diagnosis of benign and malignant peripheral pulmonary lesions. Combination of tAT with multiple serum tumor markers can improve the diagnostic efficiency of peripheral pulmonary malignant lesions.
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Objective@#To compare the clinical value of Siemens 64 row CT and 1.5 T MRI in the diagnosis of sinonasal inverted papilloma (SNIP).@*Methods@#From June 2008 to June 2017, 200 patients with inverted papilloma of the nasal cavity and paranasal sinuses admitted to Lyuliang People's Hospital were selected.All patients were confirmed by surgery and pathology, and preoperative MRI and CT examination were adopted.Pathological diagnosis was taken as the gold standard for clinical diagnosis, and the coincidence rate of MRI and CT examination with pathological diagnosis was analyzed.@*Results@#The detection rate of disease stage and origin site of pathological examination was significantly higher than those of CT examination (13.00%, 35.00%, 45.00%, 7.00%, 100.00% vs.10.00%, 21.00%, 53.00%, 16.00%, 85.00%, χ2=8.273, 15.273, all P<0.05). There was no statistically significant difference in the malignant detection rate between disease detection and CT (100.00% vs.75.00%; χ2=1.923, P>0.05). There was no statistically significant difference in the detection rate of stage and origin site between the two examination methods (13.00%, 35.00%, 45.00%, 7.00%, 100.00% vs.11.00%, 37.00%, 44.00%, 8.00%, 97.00%; χ2=0.384, 2.073, all P>0.05). The malignant detection rate of pathological examination was 100%, which was significantly higher than that of MRI (100.00% vs.25.00%; χ2=9.923, P<0.05). The malignant rate of MRI examination was 25.00%, which was significantly lower than that of CT examination(χ2=4.233, P<0.05). The detection rates of stage and origin site in MRI examination were significantly higher than those in CT examination (11.00%, 37.00%, 44.00%, 8.00%, 97.00% vs.10.00%, 21.00%, 53.00%, 16.00%, 85.00%; χ2=7.384, 8.073, all P<0.05).@*Conclusion@#There are advantages and disadvantages in the early diagnosis and treatment of inverted papilloma of nasal cavity and paranasal sinuses by CT and MRI, respectively.Therefore, it is suggested that CT and 1.5T MRI should be used together.The extent of the disease and the boundary between the disease and the surrounding soft tissue are more comprehensive, which is helpful to accurately evaluate the clinical stage and origin of the tumor before operation.
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Objective To compare the clinical value of Siemens 64 row CT and 1.5 T MRI in the diagnosis of sinonasal inverted papilloma (SNIP).Methods From June 2008 to June 2017,200 patients with inverted papilloma of the nasal cavity and paranasal sinuses admitted to Lyuliang People ˊs Hospital were selected.All patients were confirmed by surgery and pathology ,and preoperative MRI and CT examination were adopted.Pathological diagnosis was taken as the gold standard for clinical diagnosis ,and the coincidence rate of MRI and CT examination with patho－logical diagnosis was analyzed.Results The detection rate of disease stage and origin site of pathological examination was significantly higher than those of CT examination (13.00%,35.00%,45.00%,7.00%,100.00%vs.10.00%, 21.00%,53.00%,16.00%,85.00%,χ2 ＝8.273,15.273,all P ＜0.05).There was no statistically significant difference in the malignant detection rate between disease detection and CT (100.00%vs.75.00%;χ2 ＝1.923,P＞0.05).There was no statistically significant difference in the detection rate of stage and origin site between the two examination methods (13.00%,35.00%,45.00%,7.00%,100.00% vs.11.00%,37.00%,44.00%,8.00%, 97.00%;χ2 ＝0.384,2.073,all P＞0.05).The malignant detection rate of pathological examination was 100%, which was significantly higher than that of MRI (100.00%vs.25.00%;χ2 ＝9.923,P＜0.05).The malignant rate of MRI examination was 25.00%,which was significantly lower than that of CT examination (χ2 ＝4.233,P＜0.05). The detection rates of stage and origin site in MRI examination were significantly higher than those in CT examination (11.00%,37.00%,44.00%,8.00%,97.00% vs.10.00%,21.00%,53.00%,16.00%,85.00%;χ2 ＝7.384, 8.073,all P＜0.05).Conclusion There are advantages and disadvantages in the early diagnosis and treatment of inverted papilloma of nasal cavity and paranasal sinuses by CT and MRI ,respectively.Therefore,it is suggested that CT and 1.5T MRI should be used together.The extent of the disease and the boundary between the disease and the surrounding soft tissue are more comprehensive ,which is helpful to accurately evaluate the clinical stage and origin of the tumor before operation.
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Objective: To investigate the clinical value of magnetic resonance imaging (MRI) combined with the diagnosis of bone scanning in bone tumors of knee. Methods: 70 patients with bone tumor of knee were enrolled in the research. And all of them were divided into MRI group (37 cases), bone scanning group (14 cases) and combined detection group (19 cases) according to different imageological examination mode when they were hospitalized. These images of imageological examination and pathological results were collected, and lesion property, lesion boundary, lesion range, invasiveness of lesion and homogeneousness of lesion interior in the images were analyzed and researched. The diagnostic values of various examination technique for bone tumor of knee were compared. Results:The diagnostic accordance rates of benign and malignant bone tumor of knee in the combined group were 100% and 92.86%, and they were 76.4% and 70% in MRI group, and they were 57.14% and 85.71% in bone scanning group. And the difference of diagnostic accordance rate between MRI group and bone scanning group was not significant (x2=2.336, P>0.05). The differences of diagnostic accordance rates of benign and malignant bone tumor of knee between MRI group and combined detection group were significant (x2=2.936, x2=3.524, P<0.05), respectively. And the diagnostic accordance rates of benign and malignant bone tumor of knee between bone scanning group and combined detection group also were significant (x2=3.718, x2=2.947, P<0.05), respectively. Besides, the differences of lesion boundary, lesion range and homogeneousness of lesion interior among the three group were significant (x2=4.001, x2=3.695, x2=2.852, P<0.05), respectively. Conclusion: The combination of MRI and bone scanning examination can partially increase the diagnostic efficiency at early stage for bone tumor of knee, and provide more comprehensive and more reliable image data for clinical practice. Therefore, it is beneficial to improve the prognosis of patients and it has higher application value in clinical practice.
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Objective To evaluate the value of endoscopic ultrasonography ( EUS) combined with conventional endoscopy for prediction of invasion depth of early gastric cancer and its therapeutic decision-making. Methods Patients with biopsy-proven gastric cancer underwent EUS and conventional endoscopy from July 2011 to January 2018 in Ningbo No. 2 Hospital. A total of 129 patients with early gastric cancer confirmed by postoperative pathology were enrolled in the study. The sensitivity, specificity, positive predictive value, negative predictive value, consistency ( the value of Kappa ) and area under receiver operating characteristic curve ( AUC) of EUS, conventional endoscopy and combination of two methods to assess the accuracy of tumor infiltration depth were analyzed. The accuracy of therapeutic decision-making based on the EUS, conventional endoscopy and combination of two methods were assessed. Results In intramucosal cancer, the sensitivity, specificity, positive predictive value, negative predictive value, the value of Kappa and AUC of EUS were 75. 00％, 82. 22％, 88. 73％, 63. 79％, 0. 536 and 0. 797, respectively, and for conventional endoscopy, these statistical values were 61. 9％, 93. 33％, 94. 55％, 56. 76％, 0. 481, and 0. 801, respectively. For the combination of two methods, these statistical values were 85. 71％, 82. 22％, 90. 00％, 75. 51％, 0. 666 and 0. 850, respectively. In submucosal cancer, the sensitivity, specificity, positive predictive value, negative predictive value, the value of Kappa and AUC of EUS were 51. 11％, 86. 91％, 67. 65％, 76. 84％, 0. 403 and 0. 697, respectively, and for conventional endoscopy, these statistical values were 57. 78％, 73. 81％, 54. 17％, 76. 54％, 0. 311 and 0. 678, respectively. For the combination of two methods, these statistical values were 71. 11％, 90. 48％, 80. 00％, 85. 39％, 0. 632 and 0. 817, respectively. The accuracies of therapeutic decision-making of EUS, conventional endoscopy and the combination of two methods were 83. 72％, 68. 22％ and 92. 25％, respectively. Conclusion Patients who are diagnosed as intramucosal caner by conventional endoscopy should not be recommended to undergo EUS. For those whose invasion depth is unclear, or diagnosed as submucosal cancer or deeper by conventional endoscopy, EUS should be performed for reassessment. The combination of two methods can improve the accuracy of distinguishing intramucosal and submucosal caners and therapeutic decision-making. Trial registration Chinese Clinical Trial Registry, ChiCTR-DDT-13003299.
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Objective • To investigate the diagnostic value of combined detection of cervical cytology and high-risk human papillomavirus (HPV) in cervical adenocarcinoma. Methods • The clinical data of patients diagnosed as cervical adenocarcinoma in the International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine from January 2006 to December 2017 were retrospectively collected and analyzed. A comparison among cytology detection, high-risk HPV test, and combined detection of both methods was performed. Results • A total of 2 291 cases of cervical cancer were collected, of which 480 cases were cervical adenocarcinoma patients. Finally, 409 cases of cervical adenocarcinoma were analyzed. The average age of all included patients was (46.8±11.4) years old. The proportion of the patients aged 35-55 was 59.2%. All the patients were divided into three groups, i.e., group A (cytology detection, n=208), group B (high-risk HPV test, n=103), and group C (cytology and high-risk HPV combined test, n=98). There were 142 (68.3%), 85 (82.5%), and 93 (94.9%) positive cases in group A, B, and C, respectively. There was a statistically significant difference among the three groups (P=0.000). In the patients with cervical in situ adenocarcinoma, the positive detection rates in group A, B and C were 70.6%, 100.0% and 100.0%, respectively (P=0.000). And in the patients with cervical invasive adenocarcinoma, the positive detection rates in group A, B, and C were 67.9%, 75.8% and 91.8%, respectively (P=0.000). Conclusion • Cervical cytology combined with high-risk HPV detection can significantly increase the positive detection rate of cervical adenocarcinoma.
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Objective To investigate the significance of combined detection of homocysteine(Hcy) and ischemia modified albu‐min(IMA) in serum to the diagnosis of acute myocardial infarction(AMI) .Methods The serum levels of Hcy and IMA were detec‐ted in 80 patients with acute myocardial infarction ,60 patients with angina pectoris and 40 healthy subjects(control group) ,and the results were statistically analyzed .Results The concentration of Hcy and IMA in AMI patients was significantly higher than which in the control group ,the difference is statistically significant(P<0 .05);the sensitivity of the Hcy+ IMA combined diagnosis was higher than that of the single project .Hcy and IMA was positively related(P<0 .05) .Conclusion The combined detection of Hcy and IMA levels in patients with acute myocardial infarction has a good effect on early diagnosis and monitoring ,and it is worth popularizing .
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Objective To investigate the diagnostic value of anti-cyclic citrullinated peptides ( CCP ) antibodies combined rheumatoid factors (RF) on elderly patients with rheumatoid arthritis.Methods From January 2012 to December 2014, 29 cases of elder patients in our hospital with rheumatoid arthritis (elder RA group, age >60 year), 47 cases of elderly health control group (elder RA group, age≥60), and 48 cases of elder patients without rheumatoid arthritis (non-elder RA group, age<60 year) were selected.The anti-CCP antibodies and rheumatoid factor (RF) levels of three groups were detected, and the significance of anti-CCP antibody combined RF on the diagnosis of elderly rheumatoid arthritis was analyzed.Results Diagnostic positive rate of anti-CCP antibodies +RF was significantly higher than that of anti-CCP antibodies, and the difference was significant (χ2 =7.632, P =0.006).Diagnostic positive rate of anti-CCP antibodies +RF was higher than that of RF, but the difference was not statistically significant (χ2 =3.107, P=0.078).The diagnostic positive rate of anti-CCP antibodies, RF, and anti-CCP antibodies +RF for diagnosis of elderly rheumatoid arthritis had no statistically difference with that of non-elderly RA group.The sensitivity and negative predictive value of anti-CCP antibodies +RF was higher than that of only anti-CCP antibodies and RF.The area under the ROC curve of detecting anti-CCP +RF was 0.786, which was higher than that of anti-CCP antibodies (0.699) and RF (0.663), indicated that the reliability of anti-CCP antibodies +RF was higher than that of anti-CCP antibodies and RF.Conclusion The anti-CCP antibodies and RF can diagnose elderly rheumatoid arthritis, and anti-CCP antibodies combined RF has more clinical significance.