超声弹性成像与增强磁共振成像联合应用对乳腺癌的诊断价值

目的评价超声弹性成像与增强磁共振成像(MRI)联合应用对乳腺癌早期诊断的应用价值。方法回顾性分析2011年2月至2013年10月在我院就诊并接受手术的54例同时进行过超声弹性成像和增强MRI检查的临床确诊乳腺癌的患者,以病理作为金标准,分析UE、增强MRI及UE和增强MRI联合应用对乳腺癌的诊断敏感度、假阳性率、准确度进行统计,根据结果判断各种检查方法对乳腺癌的诊断效率。结果 54例患者共73个乳腺病灶UE和增强MRI联合应用的诊断的最为准确。结论 UE和增强MRI联合应用对早期乳腺癌具有非常重要的临床诊断意义。     

彩色多普勒超声与磁共振成像在原发性肝外胆管癌患者诊断中的价值差异

目的：探讨彩色多普勒超声与磁共振成像（MRI）在原发性肝外胆管癌患者诊断中的应用价值。方法回顾性分析120例原发性肝外胆管癌患者彩色多普勒超声和MRI资料,比较两种检查方法诊断的阳性率、误诊率、漏诊率及梗阻部位准确率。结果两种检查方法对肝外胆管癌诊断的阳性率、误诊率及梗阻部位准确率差异无统计学意义（P＞0.05）;但彩色多普勒超声检查漏诊率明显高于MRI（P＜0.05）。结论彩色多普勒超声可作为肝外胆管癌首选影像学筛查方法,但对于临床高度怀疑肝外胆管癌、而彩色多普勒超声未检出者应加行 MRI,以提高诊断的准确性。     

彩色多普勒超声诊断乳腺肿瘤35例分析

目的分析乳腺肿瘤的彩色多普勒超声表现,评价彩色多普勒超声在乳腺肿瘤诊断中的价值。方法回顾性分析我院于2013年1月至11月收治35例乳腺肿瘤患者的临床资料,均行彩色多普勒超声检查,并与术后病理检查结果对比。结果 35例患者中,共见43个乳腺肿块,术后均提检病理,结果显示良性肿块27个,超声诊断的符合率为93.10%(27/29),恶性肿块13个,超声诊断的符合率为92.86%(13/14)。结论超声结合血流信号检查在乳腺肿瘤的诊断方面具有很好的应用价值。     

影像超声在乳腺癌诊断中的应用

目的探讨超声在乳腺癌诊断中的应用效果,为提高乳腺癌临床诊断正确率提供可靠依据,使患者得到及时治疗,保障患者生活质量与生命安全。方法选取同1名具有专业知识及丰富经验的临床医学影像检验医师对37例乳腺癌患者均进行超声检查,记录超声检查阳性情况与病理结果符合率,给予分析后得出结论。结果 37例患者经超声诊断为乳腺癌比例83.78%,诊断符合率虽然较高,但与病理诊断结果仍具有一定差异,对比结果具有统计学意义(P<0.05);乳腺癌患者大多表现为浸润性导管癌、浸润性髓样癌以及导管原位癌三种类型。结论临床医师应对疑似乳腺癌患者进行综合性医学影像及实验室检查,结合患者实际临床表现,从而对其病情进行确诊,提高临床诊断正确率,使患者得到及时治疗,提高疗效及降低死亡率,值得临床推广应用。     

彩色多普勒超声诊断甲状腺腺瘤的临床意义

目的探讨甲状腺腺瘤采用彩色多普勒超声诊断的临床意义。方法回顾性总结分析我院于2011年9月至2013年8月收治45例甲状腺腺瘤患者的临床资料,做颈部彩色多普勒超声检查,分析患者的超声图像特征,并与术后根据病理结果进行对比研究。结果 45例患者甲状腺腺瘤声像图表现为单发结节及多发结节,以低回声为主,常伴囊性变、出血及钙化,边界清晰、包膜完整、血流信号较丰富,超声诊断与手术病理诊断符合率为93.3%。结论彩色多普勒超声在甲状腺腺瘤的诊断中具有重要的临床意义。     

超声与钼靶在乳腺恶性肿瘤诊断中的价值比较

目的分析超声和钼靶在乳腺恶性肿瘤诊断中的价值比较。方法回顾性分析我院收治的42例乳腺恶性肿瘤患者,乳腺病灶切除术前均进行超声和钼靶检查,病灶切除术后均进行病理学的诊断。结果本组42例乳腺恶性肿瘤患者中,超声诊断符合率是83.33%(35/42);钼靶摄片诊断符合率是80.95%(34/42);将超声和钼靶联合进行诊断,符合率达90.48%(38/42)。结论在乳腺恶性肿瘤的诊断中,应联合超声和钼靶摄片,以提高诊断符合率。     

论四维超声在子宫内膜癌中的应用

目的通过四维超声与二维超声在子宫内膜癌的诊断与对其术前临床分期的对比分析,探索四维超声在子宫内膜癌超声诊断实践中的应用及其重要作用。方法针对26例子宫内膜癌患者进行二维超声与四维超声检查,记录两次超声检查的术前分期准确率、病理诊断与疾病类型诊断的符合率以及肿瘤检出率,并对检查结果进行比较分析。结果本组26例子宫内膜癌患者在二维超声检查中检出14例（53.8%）,而四维超声检查中检出21例（80.8%）,两者比较,差异显著有统计学意义（P〈0.05）。在诊断阳性病例中,二维超声病理诊断符合8例（57.1%,8/14）,而四维超声病理诊断符合15例（71.4%,15/21）。两者比较,差异显著有统计学意义（P〈0.05）。二维超声在术前正确分期10例,正确率为71.4%,四维超声在术前正确分期16例,正确率为76.2%,两者比较,差异不显著无统计学意义（P〉0.05）。结论四维超声在子宫内膜癌的超声诊断实践中应用广泛,意义重大,值得在临床推广使用,希望引起广大超声工作者的重视并运用。     

常规超声与超声弹性成像诊断甲状腺良恶性结节患者的临床效果

目的研究常规超声与超声弹性成像诊断甲状腺良恶性结节患者的效果。方法选取我院在2012年3月至2015年1月间收治的110例甲状腺结节患者的临床资料,所有患者均经病理证实为甲状腺结节,患者均给予常规超声检查与超声弹性成像检查,分析两种检查方式的检出情况。结果 1常规超声检查恶性率为44.55%,良性率为55.45%,病理检查结果恶性率为29.09%,良性率为70.91%,对比有统计学意义(P<0.05)。2超声弹性成像检查与常规超声检查结果对比无统计学意义(P>0.05)。3常规超声检查的特异度、敏感度、诊断符合率分别为64.10%、65.63%、64.55%,超声弹性成像的特异度、敏感度、诊断符合率分别为92.31%、93.75%、92.73%,对比有统计学意义(P<0.05)。结论超声弹性成像在甲状腺良恶性结节的诊断中应用效果较好,可对良性、恶性结节进行鉴别,值得临床推广应用。     

宫腔镜及B超在异常子宫出血中的诊断价值

目的分析异常子宫出血中运用宫腔镜以及B超进行诊断的价值。方法选取1642例异常子宫出血患者先进行B超筛选,以此得到B超诊断。然后,进行宫腔镜检查时结合B超的诊断,最后得到宫腔镜以及B超两者结合的诊断结果。另外,进行内膜活检,有需要时则可以进行诊刮、组织病理检查,再比较诊断的结果符合率。结果跟病理诊断结果对比,单纯B超诊断符合率是56.0%,宫腔镜联合B超诊断的符合率是80.8%。可见,两者检查方法的联合,比单独B超诊断的符合率高很多。结论联合宫腔镜与B超进行异常子宫出血的诊断值得推广。     

经腹部联合阴道超声在妇科急腹症诊断中的应用价值

目的探讨经腹部联合阴道超声在妇科急腹症诊断中的临床应用价值。方法选取2011年1月至2012年12月的100例急腹症患者,将其随机分为两组,观察组患者采用经腹部联合阴道超声诊断,对照组患者单纯采用经腹部超声诊断,对两组患者的诊断结果进行对比。结果观察组患者诊断符合47例,漏诊3例,无1例误诊,符合率为94.0%;对照组患者诊断符合42例,漏诊6例,误诊2例,符合率为84.0%。观察组患者的诊断效果明显优于对照组,差异有统计学意义（P〈0.05）。结论采用经腹部联合阴道超声治疗妇科急腹症可取得明显的治疗效果。     

保乳手术治疗早期老年乳腺癌的临床价值

目的探讨保乳手术治疗早期老年乳腺癌的临床价值。方法将我院近期收治的早期老年乳腺癌患者150例,随机分为治疗组和对照组,各75例,治疗组患者进行保乳手术,对照组患者进行传统手术,对比分析两组患者经过手术后临床疗效,以及生活质量等。结果治疗组患者的手术中出血量、拔引流管时间、总的引流量及术后并发症显著优于对照组患者(P<0.05),同时治疗组患者经手术治疗后其生活质量高于对照组患者(P<0.05)。结论相比于传统的手术保乳手术具有手术后恢复时间短、并发症少及患者生活质量高等方面的优势,在临床治疗上可以进行大力推广。     

乳腺癌术后患侧上肢PICC置管化疗的临床应用

目的探讨PICC在乳腺癌患者患侧上肢临床使用效果。方法确定健侧上肢无法置管,患侧上肢无肿胀,术中只结扎腋静脉的分支,对腋静脉没有影响的25例患者,实施患侧上肢PICC置管,置管后做好肢体及导管护理。结果 25例患侧置管患者,14例在贵要静脉置管,11例肘正中静脉置管,胸片显示：管尖端均进入上腔静脉中下端,留置时间为126～168d,6～8疗程。贵要静脉发生穿刺口感染1例,肘正中静脉发生静脉炎4例,经处理后症状改善,全部顺利完成化疗,无严重并发症发生,顺利拔管。结论正确评价患侧上肢血管,严格规范置管和导管维护,重视对患者宣教,乳腺癌患者患侧上肢可行PICC置管。     

Mesenteric cyst with milk of calcium

A mesenteric cyst with milk of calcium in an adult patient is presented. Preoperative evaluation included plain film, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). To our knowledge, the presence of milk of calcium in a mesenteric cyst has not been previously described.     

早期大剂量rhu-EPO对早产心神经发育的保护作用

目的探讨早期大剂量重组人促红细胞生成素(rhu-EPO)对早产儿神经发育的保护作用。方法选取符合条件的早产儿共42例,随机分为2组,治疗组和对照组各21例。两组患儿生后院内均予常规治疗及出院后早期干预治疗。治疗组于生后1、2、3天分别经静脉给予EPO1000U/kg。比较两组早产儿①生后3天内头颅B超及以后每周至少一次至出院时头颅B超异常发生率;纠正胎龄40周时、3个月、6个月头颅CT或MRI异常率;②在纠正胎龄40周时的新生儿神经行为测定(NBNA);纠正胎龄6个月、12个月Gesell发育量表评分;③纠正胎龄40周、6个月、12个月脑干听觉诱发电位(ABR)异常率。结果①EPO治疗组头颅B超、头颅CT或MR异常率低于对照组,两组间有显著性差异;②NBNA及Gesell发育量表评分治疗组优于对照组,差异有显著性;③ABR于纠正胎龄40周时两组间无显著差异,纠正胎龄6、12个月时治疗组异常率均较对照组低,且有显著性差异。结论早期大剂量使用EPO可显著改善早产极低出生体重儿儿预后,促进其神经系统发育。     

Management and cost analysis of cancer patients treated with G-CSF: a cohort study based on the French national healthcare insurance database

Objectives: To describe the management and costs associated with G-CSF therapy in cancer patients in France.

Methods: This study analyzed a representative random population sample from the French national healthcare insurance database, focusing on 1,612 patients with hematological or solid malignancies who were reimbursed in 2013 or 2014 for at least one G-CSF treatment dispensed in a retail pharmacy. Patient characteristics and treatment costs were analyzed according to the type of cancer. Then the costs and characteristics of patients associated with the use of different G-CSF products were analyzed in the sub-set of breast cancer patients.

Results: The most frequent malignancies in the database population were breast cancer (23.3%), hematological malignancies (22.2%), and lung cancer (12.4%). The reimbursed G-CSF was pegfilgrastim in 34.1% of cases, lenograstim in 26.7%, and filgrastim in 17.9%. More than one G-CSF product was reimbursed to 21.3% of patients. The total annual reimbursed health expenses per patient, according to the type of G-CSF, were €27,001, €24,511, and €20,802 for patients treated with filgrastim, lenograstim, and pegfilgrastim, respectively. Ambulatory care accounted for, respectively, 35%, 38%, and 41% of those costs. In patients with breast cancer, ambulatory care cost was €7,915 with filgrastim, €7,750 with lenograstim, and €6,989 with pegfilgrastim, and the respective cost of G-CSF was €1,733, €1,559, and €3,668.

Conclusion: All available G-CSF products have been shown to be effective in cancer patients, and both daily G-CSFs and pegylated G-CSF are recommended in international guidelines. Nevertheless, this analysis of G-CSF reimbursement indicates that the choice of product can markedly affect the total cost of ambulatory care.     

Real-world utilization of molecular diagnostic testing and matched drug therapies in the treatment of metastatic cancers

Aims: To assess the frequency of biopsies and molecular diagnostic testing (human DNA/RNA analysis), anti-cancer drug use (genomically-matched targeted therapy [GMTT], unmatched targeted therapy [UTT], endocrine therapy [ET], and chemotherapy [CT]), and medical service costs among adults with metastatic cancer.

Methods: Adults diagnosed with metastatic breast, non-small cell lung (NSCLC), colorectal, head and neck, ovarian, and uterine cancer (2010Q1–2015Q1) were identified in the OptumHealth Care Solutions claims database and followed from first metastatic diagnosis for ≥1 month and until the end of data availability. Utilization was assessed for each cancer cohort (all and patients aged ≥65 years); per-patient-per-month (PPPM) medical service costs were assessed for all patients. Testing frequency estimates were applied to Surveillance, Epidemiology, and End Results Program data to estimate the number of untested patients (2010–2014).

Results: Patients with metastatic cancer (n?=?8,193; breast [n?=?3,414], NSCLC [n?=?2,231], colorectal [n?=?1,611], head and neck [n?=?511], ovarian [n?=?275], and uterine [n?=?151]) were 63 years old (mean), with 11.1–22.2 months of observation. Biopsy and molecular diagnostic testing frequencies ranged from 7% (uterine) to 73% (ovarian), and from 34% (head and neck) to 52% (breast), respectively. Few were treated with GMTT (breast, 11%; NSCLC, 9%; colorectal, 6%). Treatment with UTT ranged from 0.7% (uterine) to 21% (colorectal). Biopsy, diagnostic testing, and anti-cancer drug therapy were less frequent for those ≥65 years. Medical service costs (PPPM, mean) ranged from $6,618 (head and neck) to $9,940 (ovarian). The estimated number of untested new patients with metastatic cancer was 636,369 (all) and 341,397 (≥65).

Limitations: In addition to the limitations of claims analyses, diagnostic testing frequency may be under-estimated if patients underwent testing prior to study inclusion.

Conclusions: The low frequency of molecular diagnostic testing suggests there are opportunities to better inform management of patients with advanced cancer, particularly decisions to treat with GMTT.     

Cost drivers for breast,lung, and colorectal cancer care in a commercially insured population over a 6-month episode: an economic analysis from a health plan perspective

Aims: In the absence of clinical data, accurate identification of cost drivers is needed for economic comparison in an alternate payment model. From a health plan perspective using claims data in a commercial population, the objective was to identify and quantify the effects of cost drivers in economic models of breast, lung, and colorectal cancer costs over a 6-month episode following initial chemotherapy.

Research design and methods: This study analyzed claims data from 9,748 Cigna beneficiaries with diagnosis of breast, lung, and colorectal cancer following initial chemotherapy from January 1, 2014 to December 31, 2015. We used multivariable regression models to quantify the impact of key factors on cost during the initial 6-month cancer care episode.

Results: Metastasis, facility provider affiliation, episode risk group (ERG) risk score, and radiation were cost drivers for all three types of cancer (breast, lung, and colorectal). In addition, younger age (p?p?p?p?p?Conclusions: Value-based reimbursement models in oncology should appropriately account for key cost drivers. Although claims-based methodologies may be further augmented with clinical data, this study recommends adjusting for the factors identified in these models to predict costs in breast, lung, and colorectal cancers.     

Healthcare costs associated with skeletal-related events in breast cancer patients with bone metastases

Background:

Patients with bone metastases secondary to breast cancer are pre-disposed to skeletal-related events (SREs), including spinal cord compression (SCC), pathologic fracture (PF), surgery to bone (SB), and radiotherapy to bone (RT).

Objective:

To document current patterns of healthcare utilization and costs of SREs in patients with breast cancer and bone metastases.

Methods:

This was a retrospective, observational study using the Thomson MedStat MarketScan Commercial Claims and Encounters database from 9/2002 to 6/2011. Study subjects included all persons with claims for breast cancer and for bone metastases, and ≥1 claims for an SRE. Unique SRE episodes were identified based on a gap of at least 90 days without an SRE claim, and classified by treatment setting (inpatient or outpatient) and SRE type (SCC, PF, SB, or RT).

Results:

Of 17,266 patients with breast cancer and bone metastases, 9142 (53%) had one or more SRE episodes. Among 5809 patients who met all other criteria, there were 7617 SRE episodes over mean (SD) follow-up of 17.2 (15.2) months. The percentage of episodes that required inpatient treatment ranged from 11% (RT) to 76% (SB). On average, inpatient SCC episodes (n?=?83 episodes) were most costly; while outpatient PF episodes (n?=?552 episodes) were least costly. Of the total SRE costs (mean [SE] $21,072 [$36,462]/episode), 36% were attributable to outpatient RT (n?=?5265 episodes) and 31% to inpatient PF (n?=?838 episodes).

Limitations:

The administrative claims data used in this study may lack sensitivity and specificity for identification of clinical events and may not be generalizable to other populations. Also, for some SRE episode categories, the number of events was small and cost estimates may lack precision.

Conclusion:

In patients with breast cancer and bone metastases, SREs are associated with high costs and hospitalizations.     

补脾益气汤联合表柔比星和环磷酰胺治疗乳腺癌患者的疗效

目的 探讨补脾益气汤联合表柔比星和环磷酰胺治疗乳腺癌患者的疗效.方法 选取2019年3月至2020年3月于葫芦岛市中心医院肿瘤科住院治疗的乳腺癌全切术后患者74例作为研究对象,随机分为西药组与联合组,各37例.对西药组患者进行60 mg/m2表柔比星注射液+600 mg/m2环磷酰胺注射液+5％葡萄糖注射液500 ml...