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25 October 2018, Volume 17 Issue 05 Previous Issue    Next Issue

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The qualitative diagnostic value of vessel convergence sign inground glass nodules of lung CAO Qiqi, YANG Wenjie, YAN Fuhua, LIU Yan 2018, 17 (05):  521-525.  DOI: 10.16150/j.1671-2870.2018.05.008 Abstract ( 558 )   PDF (688KB) ( 193 )   Objective: To study the qualitative diagnostic value of vessel convergence sign in ground glass nodules (GGNs) of lung in chest enhanced CT images. Methods: A retrospective analysis of 136 GGNs with 5-20 mm in diameter showed in dynamic enhanced CT image and confirmed by surgical pathology including 20 benign nodules, 32 pre-invasive lesions(PL), 31 minimally invasive adenocarcinoma(MIA) and 53 invasive adenocarcinoma(IAC) was performed. All patients were examined with dual-source CT for chest enhanced CT scan to observe and analyze the occurrence of GGN vessel convergence sign. Vessel convergence sign was classified into pulmonary artery abnormality (type Ⅰ) and pulmonary vein abnormality (type Ⅱ). Compared the occurrence of different types of vessel convergence sign in benign and malignant nodules. Results: Vessel convergence sign was found in 73 of the 136 GGNs (53.68%), the occurrence rate in benign GGNs(6/20, 30.00%) was significantly less than that in malignant GGNs (67/116, 57.76%) (P=0.021). For type Ⅰ vessel convergence sign, there was no significant difference between benign and malignant GGNs[10.00% (2/20) vs 13.79% (16/116), P=0.644], and between different pathological types of malignant GGNs [PL 12.50% (4/32), MIA25.81% (8/31), IAC7.55% (4/53), all P>0.05]. The occurrence rate of type Ⅱ vessel convergence sign in malignant GGNs (51/116, 43.97%) was significantly higher than that in benign GGNs(4/20, 20.00%) (P=0.044). With the increase in infiltration degree, the occurrence rate of type Ⅱ vessel convergence sign increased [PL21.88% (7/32), MIA25.81% (8/31)], IAC67.92% (36/53), P<0.001]. Significant differences in occurrence rate of type Ⅱ vessel convergence sign were found between IAC and MIA(P<0.001), as well as between PL and MIA (P<0.001), but not between PL and MIA (P=0.714). Conclusions: Vessel convergence sign showed potential value in the differentiation between benign and malignant GGNs. The presence of pulmonary vein vessel convergence sign in GGNs indicates the high risk of IAC. References | Related Articles | Metrics

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Quantitative assessment of therapy response of non-small cell lung cancer with dual-energy CT GU Shengjia, CAO Qiqi, YAN Fuhua, YANG Wenjie 2018, 17 (05):  526-532.  DOI: 10.16150/j.1671-2870.2018.05.009 Abstract ( 330 )   PDF (1312KB) ( 123 )   Objective: To investigate the level of iodine-uptake estimated by dual-energy CT (DECT) for assessing the therapy response of non-small cell lung cancer (NSCLC) treated with chemotherapy or target therapy and to determine whether DECT criteria can evaluate the response of NSCLC treated with chemotherapy or target therapy. Methods: Thirty NSCLC patients receiving chemotherapy or target therapy and contrast-enhanced DECT scan at baseline and follow-up (at least 8 weeks and one time point) were analyzed retrospectively. Iodine-uptake level of the target lesion was measured and compared with the longest diameter and CT value of the target lesion. The 30 target lesions were evaluated by RECIST criteria, Choi criteria and dual energy CT criteria, respectively. Paired t test was used to compare the longest diameter, CT value and iodine-uptake level of the lesion at baseline and follow-up examination. Kappa statistics were used to evaluate the agreement between the results of the three response evaluation items. McNemar test was used to compare the partial response rate of DECT criteria, RECIST criteria and Choi criteria. Results: The lowering of iodine-uptake level assessed by DECT between baseline and follow-up was distinct (-10.47±23.34)%, P<0.05), while the longest diameter and CT density did not show significant change[ (-3.45±15.76)%, P>0.05; （-4.80±25.00）%, P>0.05]. DECT had better consistency with Choi criteria(kappa=0.718, P<0.05) than with RECIST （kappa=0.302, P<0.05). The partial response rate of DECT criteria had significant difference with RECIST criteria (P<0.05) and no significant difference with Choi criteria (P>0.05). Conclusions: The iodine-uptake level measured by DECT is more sensitive to evaluate the early response of NSCLC when treated with chemotherapy and target therapy than both the longest diameter and CT value. DECT criteria based on iodine uptake level and longest diameter has the potential to be a feasible method to evaluate the response of NSCLC treated with chemotherapy and target therapy. References | Related Articles | Metrics

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Analysis of CT imaging characteristics of primary pulmonary lymphoma and review of literature MA Yuanyuan, WANG Yan, SONG Qi, CHENG Kemin, ZHAO Xia, WANG Li, JIANG Xufeng, ZHAO Weili, YAN Fuhua 2018, 17 (05):  533-537.  DOI: 10.16150/j.1671-2870.2018.05.010 Abstract ( 497 )   PDF (731KB) ( 293 )   Objectives: To analyze the imaging features of primary pulmonary lymphoma and to differentiate it from other pulmonary tumors. Methods: CT imaging of patients proved by pathology as primary pulmonary lymphoma were analyzed retrospectively, and relevant literatures were reviewed. Results: Ten patients were enrolled in this study,7 patients were confirmed as mucosa-associated lymphoid tissue lymphoma (MALT),1 patient was diffuse large B cell lymphoma (DLBCL), and 2 patients were peripheral T-cell lymphoma. Air bronchogram could be seen in 8 patients. Vessel floating sign and mild enhancement could be seen in 9 patients.Halo sign could be seen in the edge of lesion in 8 patients. There were no special features in clinical manifestation. Conclusions: The imaging of primary lymphoma of lung is complicated and varied. There is no specific feature in both CT and clinical features. Air bronchogram, mild enhancement, vessel floating sign and halo sign could be the relatively specific sign of primary lymphoma in lung. The diagnosis of primary lymphoma in lung depends on pathological examination. For differential diagnosis, immunohistochemical staining and molecular pathological examination may be helpful. References | Related Articles | Metrics

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Study on mechanism of synergistic effect of ASP2215 combined with SAHA on FLT3-ITD mutant cell line ZHU Qingfeng, HU Xiaoli, ZHU Jianyi, LANG Wenjing, ZHONG Jihua, CHEN Fangyuan 2018, 17 (05):  538-546.  DOI: 10.16150/j.1671-2870.2018.05.011 Abstract ( 255 )   PDF (2157KB) ( 103 )   Objective: To study the synergistic effect and mechanism of FLT3 inhibitor ASP2215 combined with HDAC inhibitor SAHA on FLT3-ITD mutated cell line MV4-11. Methods: MV4-11cells were treated with ASP2215, SAHA or ASP2215 combined with SAHA at different concentrations, and then cell morphological changes were observed, cell viability was detected by CCK-8 method and apoptosis rate measured by flow cytometry. Phosphorylation of FLT3 and downstream signaling molecule STAT5, as well as the levels of apoptosis regulated proteins Mcl-1, Bcl-xL, Bcl-2, Baxand Caspase-9/3 were detected by Western blot. Results: ① Compared with wild-type FLT3 cell line THP-1, ASP2215 could specifically inhibit the proliferation of FLT3-ITD mutated AML cell line MV4-11. ② ASP2215 or SAHA alone could inhibit the viability of MV4-11 cells in a dose and time dependent manner. Moreover, the combination of the two drugs could synergistically inhibit the viability of MV4-11cells, and the CI values of combination of the two drugs at different concentrationswere all less than 1. ③ASP2215 or SAHA alone could induce apoptosis of MV4-11 cells in a dose and time dependent manner, and there was a synergistic effect for the two drugs combined to induce apoptosis of MV4-11 cells. Apoptosis was accompanied by cleaved activation of caspase-3 and caspase-9. Combination of the two drugs caused more cleaved activation of caspase-3 and caspase-9 than the effect of single-drug. Morphologically, the changes of apoptosis and necrosis increased with the increase of drug concentration, and combination of the two drugs could lead to more obvious cell apoptosis and necrosis changes. ④The FLT3 inhibitor ASP2215 could reduce the phosphorylation level of FLT3 receptor and the downstream molecule STAT5, and SAHA also had a slight inhibitory effect on the phosphorylation of FLT3 and the downstream molecule STAT5. Both ASP2215 and SAHA induced a decrease in McL-1 and Bcl-xL anti-apoptotic proteins, with a slight down-regulation of Bcl-2 protein and a slight up-regulation of Bax protein expression. Combination of the two drugs further reduced the Mcl-1, Bcl-xL expression level and Bcl-2/Bax protein ratio when compared with the effect of single-drug. Conclusions: ASP2215 combined with SAHA can synergistically inhibit the proliferation and enhance the apoptosis of MV4-11 cell line with FLT3-ITD mutation. The mechanism involves the inhibition of FLT3-STAT5 pathway and the regulation of apoptosis-related proteins Mcl-1, Bcl-xL and Bcl-2/Bax protein ratio. References | Related Articles | Metrics

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Exploration of an automated prenatal Down syndrome screening adjustment protocol based on patient samples ZHANG Haiou, CHENG Weiwei, HU Wenjing, LIU Mengdi, FAN Jianxia, QIAN Yiyuan 2018, 17 (05):  547-551.  DOI: 10.16150/j.1671-2870.2018.05.012 Abstract ( 383 )   PDF (618KB) ( 119 )   Objective: To explore an automated prenatal Down syndrome screening adjustment protocol for the second trimester triple marker screening to create a better method for prenatal screening with quality assurance. Methods: The multiple of median (MoM) of 13 024 second trimester maternal serum screening samples were adjusted using cumulative sum (CUSUM) adjustment protocol with adjustment targeting median of MoM (mMoM) outside 0.90-1.10 per batch or outside 0.95-1.05 per batch. The Down syndrome risk is recalculated according to the adjusted MoM. Result: Two adjustment protocols improved the percentage of median MoM within 0.90-1.10 and 0.95-1.05 from(64%, 90% to 67%, 99% and 85%, 99%). The differences of detection rate and false positive rate for Down syndrome between the original results and two adjustment protocols were mild. Conclusions: Clinical laboratory should consider the improving of current prenatal screening protocol with our automated CUSUM adjustment protocol. References | Related Articles | Metrics

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Expression of BRAF V600E (VE1) in thyroid papillary carcinoma and its clinical significance CAI Rong, MIN Xuewen, CHEN Meirong, SHEN Yating, SHI Qunli, ZHOU Xiaodie 2018, 17 (05):  552-556.  DOI: 10.16150/j.1671-2870.2018.05.013 Abstract ( 1153 )   PDF (761KB) ( 150 )   Objective: To investigate the expressions of BRAF V600E, CK19 and galectin-3 antibodies in papillary thyroid carcinoma, and study the diagnostic value of BRAF V600E antibody when in corporating with the clinicopathological characteristics of PTC. Methods: The clinicopathological data of 80 patients with PTC were analyzed; 31 cases of nodular goiter and 13 cases with Hashimoto thyroiditis were served as controls. BRAF V600E, CK19 and galectin-3 antibodies in PTC and control group were detecteds and the correlation between BRAF V600E antibody and clinicopathological characteristics of PTC was analyzed. Results: Correlation between thyroid membrane invasion and lymph node metastasis was observed in PTC patients(P<0.05). The positive rates of BRAF V600E, CK19 and galectin-3 antibodies in patients with PTC were 62.50%, 98.75%, 95.00%, respectively. The sensitivity of CK19 combined with galectin-3antibodies was 95.00%, and the specificity of BRAF V600 antibody was 100%. The specificity of CK19 and galection-3 antibodies could be improved by combining with BRAF V600 antibody. There was no statistical correlation between expression of BRAF V600E antibody and age, gender, lesion size, thyroid membrane invasion, lymph node metastasis, histological subtype of PTC (P>0.05). Conclusions: The combined detection of BRAF V600E, CK19 and Galectin-3 antibodies is helpful for the pathological diagnosis of PTC.Meanwhile, BRAF V600E antibody plays a preliminary screening role for the mutation of BRAF V600E gene. References | Related Articles | Metrics

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Clinical characteristics of type 2 diabetes complicated with hepatitis E ZHANG Yiyun, XU Lei, TANG Zhaosheng, CHEN Yinghua, DOU Qin, FENG Bo 2018, 17 (05):  557-561.  DOI: 10.16150/j.1671-2870.2018.05.014 Abstract ( 449 )   PDF (620KB) ( 89 )   Objective: To study the clinical characteristics of type 2 diabetes mellitus complicated with hepatitis E.Methods: The clinical characteristics of 119 type 2 diabetes patients complicated with hepatitis E were retrospectively analyzed. The results were compared with type 2 diabetes patients without hepatitis E (simpletype 2 diabetes mellitus) and with simple hepatitis E patients. Results: The number of patients between 50-69 years of age was higher in type 2 diabetes complicated with hepatitis E group (65%). HbA1C was lower than that in simple type 2 diabetes group（P<0.01）. There were no statistical significant differences between the two groups in fasting and postprandial blood glucose（P>0.05）. Compared with simple hepatitis E group, total bilirubin and AST were lower in type 2 diabetes patients complicated with hepatitis E（P<0.05）. There were no significant differences in renal function and blood lipid indexes between these three groups. Conclusions: HbA1C in type 2 diabetes patients complicated with hepatitis E was lower than that in patients with type 2 diabetes alone.Thereare no significant differences in other blood glucose indice. Compared with simple hepatitis E patients, there was no further decline in liver function in type 2 diabetes patients complicated with hepatitis E. The three groups had no significant differences in renal function and blood lipid indice. References | Related Articles | Metrics

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Analysis and study on value of MRI in diagnosis of trigeminal neuralgia LI Yunfeng, JIANG Hong, LI Ning, SUN Qingfang 2018, 17 (05):  562-565.  DOI: 10.16150/j.1671-2870.2018.05.015 Abstract ( 537 )   PDF (409KB) ( 136 )   Objective: To study the diagnostic value of MRI in trigeminal neuralgia. Methods: From January 2016 to May 2018, 100 patients with primary trigeminal neuralgia were treated in our hospital. Before operation, the patients were examined by MRI. The images of three dimensional fast imaging employing steady state acquisition 3D-FIESTA and three dimensionaltime of flight 3D-TOF were collected. The neurovascular contact compression was evaluated by two radiologists who are experienced in MRI diagnosis. The sensitivity, specificity and accuracy of 3D-FIESTA and 3D-TOF in the diagnosis of neurovascular contact compression in trigeminal neuralgia were calculated and compared. The display rate of 3D-FIESTA and 3D-TOF for different responsible blood vessels was calculated and compared. Results: Of the 100 cases of trigeminal neuralgia, 75 cases were confirmed by surgery having nerovascular contact compression in cisternal segment of the trigeminal nerve and adjacent brain stem tissue. The diagnostic sensitivity, specificity and accuracy of 3D-FIESTA and 3D-TOF in patients with trigeminal neuralgia were not different significantly(97.33% vs 94.67%, 92.00% vs 96.00%, 96.00% vs 95.00%, respectively) (P>0.05). The results of 3D-FIESTA and 3D-TOF in diagnosis of neurovascular contact compression in patients with trigeminal neuralgia were consistent with that found surgically. The Kappa values were higher than 0.7. The display rates of 3D-FIESTAST and 3D-TOF in superior cerebellar artery, anterior inferior cerebellar artery and vertebral artery were 100.00%.The display rates of two or more arteries and artery + vein were not 100.00%. However, the difference was not statistically significant (P>0.05). Conclusions: Preoperative MRI can clearly display the neurovascular contact compression in patients with primary trigeminal neuralgia, especially 3D-FIESTA and 3D-TOF imaging, which can be used not only as the main diagnostic method of trigeminal neuralgia, but also as an auxiliary means of localization for surgery in patients with trigeminal neuralgia. References | Related Articles | Metrics

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Clinicopathologic analysis of skin melanocyte lesions YANG Ruxue, LI Nan, ZHOU Ting, ZHAO Yan, CHEN Shaohua, ZHU Qing, FENG Zhenzhong 2018, 17 (05):  566-571.  DOI: 10.16150/j.1671-2870.2018.05.016 Abstract ( 418 )   PDF (1057KB) ( 125 )   Objective: To explore the clinicopathologic features and differential diagnosis of cutaneous melanocyte lesions. Methods: The clinical manifestation, morphology and immunophenotypic characteristics of 1 case of blue nevus, 1 case of borderline nevus and 1 case of malignant lentigo maliana melanoma were analyzed. Results: The 3 cases had lesions located in skin with different sizes, showing melanin cell hyperplasia, with various growth pattern and degree of differentiation and overlapping in existing. Immunohistochemical tests showed that the proliferated cells in all 3 cases had positive expressions of S-100 protein and HMB45. Conclusions: Various pathological types of melanocyte lesions are seen. Histopathology and immunohistochemistry showed different degrees of similarity, and the differentiation of benign and malignant lesions was very difficult. Clinicians should consider comprehensively the clinical characteristics, gross features, microscopic findings, immune phenotype and supplemented by molecular detection if necessary to make an accurate diagnosis. References | Related Articles | Metrics

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Analysis of two different methods for detecting Mycoplasma pneumoniae IgM in children with lower respiratory tract infection YAN Huajie, FAN Deping, SHAO Jie 2018, 17 (05):  572-574.  DOI: 10.16150/j.1671-2870.2018.05.017 Abstract ( 514 )   PDF (323KB) ( 142 )   Objective: To investigate the value of indirect immunofluorescence (IFA) and passive agglutination (PPA) for the diagnosis of Mycoplasma pneumonia (MP) infection in children with lower respiratory tract infection. Methods: The detection of serum MP-IgM via PPA and IFA in 388 children with lower respiratory tract infection was analyzed, including the difference in positive rates of the two methods in different time points during the course of disease. Results: The overall positive rate of MP-IgM was 32.5% (126/388). The detecting results were influenced by days of fever, and there was no significant difference between the two methods when the fever was 0-3 days (P>0.05). There was a difference in positive detection rates between the two methods with the increase in days of fever. For fever more than 4 days, the positive detection rate of PPA (25.14%, 119/388) was higher than that of IFA (18.0%; 70/388) (P<0.05). A lack of consistency was existed between the two methods (Kappa=0.126). The specificity of IFA method (97%) was higher than that of PPA (82%), and the sensitivity of PPA method (90%) was higher than that of IFA (53%). Conclusions: In children with mycoplasma pneumonia infection of lower respiratory tract, there is no significant difference in positive detection rate between the two methods for cases with no fever or with fever 1-3 d. However, for cases with fever over 4 days, detection of MP-IgM using combined PPA and IFA is conducive to the positive detection of MP-IgM. References | Related Articles | Metrics

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Pulmonary ciliated muconodular papillary tumor: clinical pathologic analysis of two cases and review of literature CHEN Xiaoyan, YANG Xiaoqun, YUAN Fei, ZHANG Jing, WANG Chaofu 2018, 17 (05):  575-580.  DOI: 10.16150/j.1671-2870.2018.05.018 Abstract ( 769 )   PDF (1370KB) ( 103 )   Objective: To investigate the clinical manifestation, pathological feature, immunophenotype, differential diagnosis of ciliated muconodular papillary tumor. Methods: Clinical data from two cases of CMPT were collected, analyzed retrospectively, including clinical, pathologic features, imaging findings, immunophenotype. Results: In frozen section examination during operation, one case was diagnosed as minimally invasive mucinous adenocarcinoma, the other was considered as CMPT or minimally invasive mucinous adenocarcinoma. Histologic findings of paraffin embedded tissue sections revealed that the tumor consisted of papillary, glandular architecture, a minimal extent of micropapillary structure, discontinuous lepidic growth. There was abundant extracellular mucin surrounding the tumor, which formed pools of mucin, with chronic inflammatory cell infiltration in the stroma. The epithelial components of the lesion consisted of ciliated columnar cells, mucous cells, basal cells. The basal cells provided a scaffold in the ou-ter layer, the ciliated columnar cells, mucous cells intermingled at the surface of the glandular/papillary structures. All three types of cells showed no nuclear atypia, no mitotic figures. Tissue necrosis was not observed. The basal cells expressed P63, P40, while a subset of basal cells expressed TTF-1. Both ciliated columnar cells, mucous cells expressed CK7, MUC-1, whereas TTF-1, Napsin A, SP-A, P63showed a patchy moderate intensity staining, P40showed no staining. The ciliated columnar cells were focally positive for MUC5AC. All three types of cells showed a low Ki-67index. Conclusions: CMPT of lung is a newly defined, extremely rare tumor with characteristic histological findings, immunophenotype. There is a potential diagnostic pitfalls for CMPT because it is easily misdiagnosed as mucinous adenocarcinoma by imaging findings, in the frozen section examination. The accurate pathologic diagnosis depends on the morphologic characteristics of paraffin-embedded tissue section, immunohistochemical staining References | Related Articles | Metrics

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Comparison of diagnostic value of new infection biomarker presepsin with procalcitonin, C-reactive protein and interleukin-6 in diagnosis of bacterial infection DU Kun, YANG Xi, BIAN Binxian, REN Yiqian, ZHANG Guanghui 2018, 17 (05):  581-585.  DOI: 10.16150/j.1671-2870.2018.05.019 Abstract ( 464 )   PDF (549KB) ( 147 )   Objective: To explore the diagnostic value of a new infection biomarker presepsin (soluble CD14 molecular subtype) in bacterial infection, and compared with procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) for the diagnosis of bacterial infection. Methods: Patients with positive blood culture admitted between December 2016 and May 2017 were enrolled, and 57 cases of normal healthy subjects at the same period were served as controls.The levels of serum presepin, procalcitonin, CRP and IL-6 were determined. Using ROC curve and survival analysis to evaluate the value of different biomarkers for the diagnosis of bacterial infection, and to explore whether there were differences between different age groups. Results: The level of serum presepsin was significantly high in bacterial infection group than in non-infectioncontrol group （P<0.05）. In the infection group, there was no significant difference in serum presepsin le-vel between patients of different age groups (P>0.05). Compared with other diagnostic biomarkers through ROC curve analysis, the area under curve（AUC） of presepsin was 0.854, higher than 0.802 of PCT and 0.772 of CRP and 0.693 of IL-6, respectively. AUC of serum PCT level for differentiating gram-negative from gram-positive bacterial infection was 0.944, higher than those of presepsin and IL-6. Conclusion: The infection biomarkers presepsin has high sensitivity and specificity for the diagnosis of bacterial infection, and it can be applied in patients of different age group and in differentiating gram-negative from gram-positive bacterial infection. References | Related Articles | Metrics

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Comparison and application of whole blood interferon-gamma release assays and ELISA for detection of antibodies against Mycobacterium tuberculosis in auxiliary diagnosis of bacterium-negative pulmonary tuberculosis HE Meifang, LIU Jianhong, CHEN Chunhua, SHEN Hongyu 2018, 17 (05):  586-589.  DOI: 10.16150/j.1671-2870.2018.05.020 Abstract ( 454 )   PDF (510KB) ( 265 )   Objective: To investigate the value of interferon gamma release (IGRA) in the diagnosis of bacterial-negative pulmonary tuberculosis. Methods: A total of 93 patients with bacterial-negative tuberculosis and 40 healthy volunteers were enrolled in this study. Heparin sodium anticoagulant whole blood was collected. IGRA kit was used to detect the plasma IFN-γ level. Serum samples were collected for detection of Mycobacterium tuberculosis antibody(TBAb) by ELISA kit. Patients were divided into the elderly group and the young group for comparative analysis. Routine test indice ADA, erythrocyte sedimentation rate and lymphocyte count were performed. Results: The positive rate of IGRA was 84.94%, the sensitivity was 84.94%, the specificity was 90.00%, the positive predictive value was 95.18% and the negative predictive value was 72.00%. The positive rate of TBAb diagnosis was 52.69%, the sensitivity was 52.69%, the specificity was 85.00%, the positive predictive value was 67.20% and the negative predictive value was 40.96%. Rate of diagnosing tuberculosis using two methods, was statistically significant. There was no difference in age when using IGRA assays. There was significant differences in erythrocyte sedimentation rate between the two groups. Conclusion: Compared with ELISA, IGRA has higher sensitivity, specificity and positive predictive for diagnosing bacterium negative tuberculosis. References | Related Articles | Metrics