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Objective:To analyze the consistency of clinical imaging and clinicopathological finds of retinoblastoma (RB) optic nerve invasion.Methods:A retrospective case study. Fifteen children with 15 eyes who were diagnosed with RB and underwent enucleation at the Eye Center of Beijing Tongren Hospital from November 2017 to January 2022 were included in the study. Among them, there were 9 males with 9 eyes and 6 females with 6 eyes. The mean age was 1.75±1.61 years. All affected eyes were designated International Classification of Retinoblastoma group E. There were 7 cases with secondary neovascularization glaucoma, 2 cases with closed funnel-shaped detachment of the retina and tumor touching the posterior capsule of the crystal, and 6 cases with tumor touching the back surface of the crystal and posterior chamber of the 15 children. All children underwent CT or magnetic resonance imaging (MRI). Among them, CT examination was performed in 4 cases, MRI examination in 4 cases, and MRI and CT examination in 7 cases. All the children underwent eyeball enucleation, paraffin sections were taken from the eyeball, and sagittal section of the eyeball with optic nerve tissue was taken for pathological examination. Imaging diagnosis was based on optic nerve thickening and/or enhancement. The pathological diagnosis was based on the growth of RB tumor cells across the post-laminar of optic nerve. The pathological diagnosis was based on the growth of RB tumor cells across the sieve plate. The area under the curve (AUC) of receiver operating characteristic curve was used to evaluate the diagnostic ability of imaging examination. The sensitivity, PPV and 95% confidence interval ( CI) of imaging examination were obtained based on the confusion matrix. With pathology as the gold standard, intragroup correlation coefficient (ICC) was used to test the consistency of imaging and pathology. Results:All the 15 cases were diagnosed with RB by pathological examination. Of the 15 cases, 7 cases were diagnosed with RB optic nerve invasion by imaging and 8 cases without nerve invasion; 12 cases of RB optic nerve invasion were diagnosed by pathology after operation. Three cases without nerve invasion. Among them, 4 cases had identical imaging and pathological findings. The sensitivity and PPV of MRI and CT were 0.33 (95% CI 0.11-0.64) and 0.57 (95% CI 0.20-0.88), respectively. The value of AUC (the area under the curve) in the ROC curve of MRI and CT were 0.51 (95% CI 0.24-0.77) and 0.52 (95% CI 0.25-0.78), respectively. The AUC values of both were 0.5-0.7, indicating low diagnostic accuracy. ICC test evaluated the consistency of MRI and CT with pathological examination, 0.61 (95% CI 0.97-0.87) and 0.63 (95% CI 0.12-0.88) for MRI and CT, respectively. Therefore, the consistency of MRI, CT and pathology was moderate. Conclusion:Compared with the pathological findings, the sensitivity and accuracy of MRI and CT in the diagnosis of RB optic nerve post-laminar invasion are lower, and the consistency between MRI and CT with pathology is only moderate.
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Objective To investigate the relationship between histological chorioamnionitis(HCA) and the outcome of preterm labor. Methods A total of 218 cases of premature delivery in the Department of Obstetrics and Gynecology of our hospital from January, 2015 to December, 2017 were divided into two groups according to the result of placenta pathological diagnosis. The observation group was diagnosed with histological chorioamnionitis by placenta pathology examination. The control group was not diagnosed with histological chorioamnionitis. The delivery gestational week, the rate of premature rupture of membranes, the rate of puerperal infection, the rate of postpartum hemorrhage, the rate of wound healing failure, the average body mass of newborn infants, the rate of early-onset sepsis, asphyxia, respiratory distress syndrome rate, pathological jaundice rate, neonatal mortality between the two groups were compared. And the impact of histological chorioamnionitis on the outcome of preterm labor was explored. Results The delivery gestational week of the observation group was (32. 0±1. 0) weeks, and the rate of postpartum hemorrhage, the rate of premature rupture of membranes, the rate of puerperal infection and the rate of wound healing were 21. 24％, 80. 50％, 16. 81％, 11. 50％, respectively. The delivery gestational week of the control group was(34. 0±1. 0) weeks, and the rate of postpartum hemorrhage, the rate of premature rupture of membranes, the rate of puerperal infection and the rate of wound healing were 10. 48％, 65. 70％, 7. 62％, 3. 81％, respectively. The delivery gestational week of the observation group was small. And the rate of premature rupture of membranes, wound healing failure rate, puerperal infection rate, postpartum hemorrhage rate in the observation group was significantly higher than that of the control group, and the difference was statistically significant(P＜0. 05). The mean neonatal weight in the observation group was(1710±355)g,and the asphyxia rate, early-onset sepsis rate, respiratory distress syndrome rate, pathological jaundice rate and neonatal mortality were 21. 24％, 33. 63％, 38. 05％, 19. 47％ and 9. 73％. The mean neonatal weight in the control group was(2270±450)g,and the asphyxia rate, early-onset sepsis rate, respiratory distress syndrome rate, pathological jaundice rate, neonatal mortality were 9. 52％, 18. 10％, 12. 38％, 8. 57％, 2. 86％. The average body weight of infants in the observation group was low. And the rates of early onset sepsis, asphyxia, respiratory distress syndrome, pathological jaundice and neonatal mortality were significantly increased. The difference was significant (P＜0. 05). Conclusion The placental pathology examination in all preterm patients should be done to avoid missed diagnosis of HCA, and to help early diagnosis and treatment of pregnant women with intrauterine infection and high-risk newborns and improve prognosis.
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Objective To explore the diagnosis rate.pathology types and positive rate of cancer cell in spu-tum of early central pulmonary carcinoma in three obstructive signs on chest X ray screened by fiberbromchoscope.Methods 326 cases of three obstructive signs with high risk of lung cancer were screened for central pulmonarycarcinoma by spiral CT.biopsy by fiberbronchoscope and cytological examination of sputum.Results 32 patients were diagnosed with central pulmonary carcinoma,with morbidity of 9.8%.In these patients,21 were confirmed with obstructive pneumonia(65.6%),7 with obstructive atelectasis(21.9%),4 with obstructive emphysema(12.5%);In terms of pathology type,16 cases were defined as squamous cell carcinoma(50.0%),9 as small cell carcinoma(28.1%).3 were as large cell carcinoma(9.4%).2 were as adenocarcinoma(6.3%),1 as admosquamous carci-noma(3.1%),1 as bronchial gland carcinoma(3.1%);cancer cell could be found in sputum of 5 patients of 32 cases,among them,it was found in 3 of 21 patients with obstructive pneumonia(14.3%),1 in 7 patients with ob-structive atelectasis(14.3%),1 in 4 patients with obstructive emphysema(25.0%).Conclusion The prevelance of early central pulmonary carcinoma in three obstructive signs on chest X-ray is 9.815%,in which squamous carci-noma and small-cell carcinoma are common in pathology type.Screening can increase the detection rate of early pul-monary carcinoma.