术中放疗保留乳腺手术12例

近20年来,我国乳腺癌的发病率上升至女性恶性肿瘤的首位,且发病逐步趋向年轻化.我们从1997年6月～2003年10月开展早期乳腺癌术中放疗保留乳腺手术的研究,现报告如下.     

原发性宫颈混合性生殖细胞瘤1例

1 临床资料 患者女性, 53岁,于1998年9月因阴道不规则流血半年,检查发现"宫颈腺癌",10月13日在我院行广泛全子宫切除加盆腔淋巴结清扫术.术后病理示:宫颈内膜腺癌.此后定期复查.     

子宫体癌Ⅰ期术后放疗临床分析

子宫体癌是女性生殖系统常见恶性肿瘤,近年来发病率有上升趋势.1993年10月～1998年12月,我科收治Ⅰ期子宫体癌患者12例,全部给予术后放疗,现报告如下.     

女性甲下血管球瘤12例误诊临床报告

血管球瘤是一种少见的良性肿瘤,可发生于身体各部位,但多发于手指甲下,以中青年女性多见.由于对此病认识不足,临床误诊较多.我院自1997年9月至2007年10月共收治女性手部甲下血管球瘤误诊病例12例,其中1例多发病例曾因疼痛剧烈而截去一指.现报告如下.     

35岁以下女性乳腺癌临床分析

目的探讨青年女性乳腺癌的诊断和最佳治疗方法.方法回顾性分析了1985年1月至1999年10月收治的67例青年女性乳腺癌的临床资料.结果在67例患者中,62例行乳腺癌根治术、改良根治术及乳房单纯切除术,4例行肿瘤局部切除术,1例行保留乳房的乳癌根治术.术后完成正规CMF或CAF方案化疗者31例,非正规CMF或CAF方案化疗者29例.14例患者行内分泌治疗.3例患者于术后3月至2年时出现局部复发,38例患者在随访1月至8年时出现肺、骨、肝及脑转移.全组患者3年、5年生存率分别为67%、50%.结论青年女性乳腺癌的诊断主要依赖于医患双方的警惕,乳房钼靶X线摄影帮助有限,应重视并规范辅助化疗,术后放疗可明显降低局部复发.     

第二代ABL激酶抑制剂治疗对格列卫耐药的慢性粒细胞白血病急变期3例报告

自2006年10月～2007年3月本院应用第二代ABL激酶抑制剂达沙替尼(da satinib,百时美施贵宝公司Sprycel)治疗对格列卫耐药的慢性粒细胞白血病急变期(CML -BP)3例,现将结果报道如下. 例1,女性,45岁.因反复脾脏肿大1年余入院.     

宫颈癌内瘤1例

1 病案摘要 患者女性,25岁,未婚,有性生活史.因"白带增多10月,发现宫颈病变3月"于2006年11月1日入我院.患者月经规律,10月前无诱因出现白带量多,色黄,接触性阴道少量出血2次,未引起注意.3月前外院体检发现宫颈口1枚大小约2cm×2cm息肉样、表面光滑的赘生物.     

食管癌高发区1.5万队列人群内镜筛查与食管癌胃癌死亡研究

目的:磁县是我国北方食管癌高发区.河北医科大学第四医院肿瘤研究所自2001年开展40～69岁为目标人群的内镜碘染色队列筛查,以期降低食管癌高发区的发病率和死亡率.方法:2001年10月～2002年10月选择磁县4个乡,干预人群22016例,对照人群33410例,总覆盖人群5.5万,其中干预人群40～69岁中男性3 257例,女性3 339例,对照人群中男性4 299例,女性4 430例.干预人群采用内镜碘染色筛查,筛查率53.2%.内镜碘染色筛查食管鳞状上皮和贲门腺上皮原位癌及黏膜内癌97例,食管和贲门重度不典型增生102例;对照人群观察肿瘤自然发病率和死亡率.肿瘤发病死亡登记编码应用ICD-0-2.2008年6月～9月根据全县肿瘤发病死亡登记数据库,对该队列人群进行随访核实.结果:干预人群食管癌死亡133例,胃癌48例,对照组人群分别为259例和37例.男性食管癌死亡相对危险度RR=0.76,95%CI(0.59～0.98),P=0.038;女性RR=0.51,95%CI(0.35～0.75),P=0.000.男性胃癌死亡相对危险度RR=2.45,95%CI(1.4～4.29).P=0.010;女性RR=0.99,95%CI(0.47～1.99),P=0.906.结论:食管癌高发区内镜碘染色大人群队列筛查历经6年时间演变,男性和女性食管癌死亡危险度下降,有显著性差异,但内镜筛查对胃癌死亡危险未见到保护作用.     

适形放射治疗Ⅱ～Ⅲ期非小细胞肺癌近期疗效观察

近年来 ,肺癌的发病率逐年上升 ,在许多大中城市肺癌已成为恶性肿瘤发病率的首位。但肺癌的治疗效果并无明显提高 ,5年生存率极低 ,仅为 10 %左右。随着计算机技术的发展 ,国外率先开展了非小细胞肺癌 (NSCLC)的适形放射治疗 ,取得令人鼓舞的结果。为研究适形放射治疗非小细胞肺癌的疗效和其急性并发症的发生率 ,笔者于 2 0 0 0年 10月起进行本研究 ,现将结果报道如下。一、材料与方法1.临床资料 :2 0 0 0年 10月至 2 0 0 2年 2月 ,38例Ⅱ～Ⅲ期未行手术的非小细胞肺癌进入研究。男性 2 5例 ,女性 13例 ;中位年龄 6 1岁 (49～ 77岁 ) ;中…     

胰腺癌B超与CT诊断对照分析

我们对1989年10月至1993年10月之间的50例B超手术、病理诊断.其中40例又做了CT检查的胰腺癌患者进行了对照分析。 资料和方法 本组50例,其中男性35例.女性15例,年龄范围41～66岁,本院住院32例。其中18例均经本院B超、CT检查确诊后而到外地住院手术切除,经追踪调查证实为胰腺癌。     

Combined use of cytology,p16 immunostaining and genotyping for triage of women positive for high-risk human papillomavirus at primary screening

Human papillomavirus (HPV) testing is very sensitive for primary cervical screening but has low specificity. Triage tests that improve specificity but maintain high sensitivity are needed. Women enrolled in the experimental arm of Phase 2 of the New Technologies for Cervical Cancer randomized controlled cervical screening trial were tested for high-risk HPV (hrHPV) and referred to colposcopy if positive. hrHPV-positive women also had HPV genotyping (by polymerase chain reaction with GP5+/GP6+ primers and reverse line blotting), immunostaining for p16 overexpression and cytology. We computed sensitivity, specificity and positive predictive value (PPV) for different combinations of tests and determined potential hierarchical ordering of triage tests. A number of 1,091 HPV-positive women had valid tests for cytology, p16 and genotyping. Ninety-two of them had cervical intraepithelial neoplasia grade 2+ (CIN2+) histology and 40 of them had CIN grade 3+ (CIN3+) histology. The PPV for CIN2+ was >10% in hrHPV-positive women with positive high-grade squamous intraepithelial lesion (61.3%), positive low-grade squamous intraepithelial lesion (LSIL+) (18.3%) and positive atypical squamous cells of undetermined significance (14.8%) cytology, p16 positive (16.7%) and, hierarchically, for infections by HPV33, 16, 35, 59, 31 and 52 (in decreasing order). Referral of women positive for either p16 or LSIL+ cytology had 97.8% sensitivity for CIN2+ and women negative for both of these had a 3-year CIN3+ risk of 0.2%. Similar results were seen for women being either p16 or HPV16/33 positive. hrHPV-positive women who were negative for p16 and cytology (LSIL threshold) had a very low CIN3+ rate in the following 3 years. Recalling them after that interval and referring those positive for either test to immediate colposcopy seem to be an efficient triage strategy. The same applies to p16 and HPV16.     

The Impact of Triage for Atypical Squamous Cells of Undetermined Significance with Human Papillomavirus Testing in Cervical Cancer Screening in Japan

Background: One of the features of cervical cancer screening using the combination of cytology and humanpapillomavirus (HPV) testing is the triage for atypical squamous cells of undetermined significance (ASC-US). Theeffectiveness of the triage has been recognized widely. However, there are few reports evaluating this triage process inJapan. Material and Methods: We retrospectively examined the results of cytology and HPV co-testing for cervicalcancer screening in the Oyama area of Tochigi Prefecture between 2012 and 2014. Women who were ASC-US/HPVpositive and had cytologic abnormalities [low-grade squamous intraepithelial lesions (LSIL) or worse] were examinedby colposcopy. The results of the colposcopy testing were evaluated. In addition, we also examined the results of thosewho underwent co-testing a year after a ASC-US/HPV-negative result. Results: A total of 21,342 women receivedtheir first screening test during the study period, with 542 (2.5%) found to have ASC-US. Of the ASC-US-positivewomen, 289 (53.3%) were also HPV positive. The prevalence of CIN+ (cervical intraepithelial neoplasia or higher)in the ASC-US/HPV-positive group was 63.2%, with 81.8%, 16.4% and 4.8%. showing CIN 1, CIN 2 and CIN 3+,respectively. The prevalence of CIN+ in the LSIL group was 66.8%, with the majority having a low risk CIN 1 (76.6%)compared to CIN 2 (18.6%), and CIN 3+ (4.8%). No significant difference was observed between the LSIL and ASC-US/HPV-positive groups. The prevalence of women diagnosed with CIN in the ASC-US/HPV-negative group, followingco-testing a year after colposcopy was low (3%). Conclusions: The ASC-US/HPV-positive group was comparable tothe LSIL group in terms of prevalence of CIN+ lesions. Furthermore, low CIN prevalence after one year in the ASCUS/HPV-negative group provides confirmation that the screening interval could be extended. The application of HPVtriage (which is routine in other countries) to identify these groups would be of benefit in Japan.     

Detection of cervical precancer and cancer in a hospital population; benefits of testing for human papillomavirus

The aim was to determine the relevance of human papillomavirus (HPV) testing in identifying high-grade cervical intraepithelial neoplasia or worse (CIN2/3+) in a hospital population (n=3574) characterised by a high rate of cytological abnormalities and high-risk HPV infections. According to the results of the initial Papanicolaou and HPV test, women were directly referred for colposcopy/biopsy or recalled for a control visit. Sensitivity and specificity were corrected for verification bias. HPV-testing sensitivity was 94.3%, higher than that of cytological testing at any cut-off point (65.1%-86.8%), while specificity was greater for cytology than for HPV testing (99.3% or 91.8% versus 83.4%). The combination of both tests allowed 100% sensitivity and negative predictive value. We conclude that HPV testing is a relevant tool for the detection of cervical disease. The best way of combining cytology and HPV detection in screening programmes should be evaluated in large-scale studies.     

Accuracy of Visual Inspection with Acetic acid in Detecting High-Grade Cervical Intraepithelial Neoplasia in Pre- and Post-Menopausal Thai Women with Minor Cervical CytologicalAbnormalities

Purpose: To determine the accuracy of visual inspection with acetic acid (VIA) in detecting high-gradecervical intraepithelial neoplasia (CIN) in pre- and post-menopausal women with atypical squamous cells ofundetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) Papanicolaou (Pap)smears. Materials and Methods: Two hundred women (150 pre-menopausal and 50 post-menopausal) with ASCUSand LSIL cytology who attended the colposcopy clinic, Thammasat University Hospital, between March 2013and August 2014 were included. All women underwent VIA testing and colposcopy by gynecologic oncologists.Diagnostic values of VIA testing including sensitivity, specificity, positive predictive value (PPV) and negativepredictive value (NPV) for detecting high-grade CIN were determined using the histopathology obtained fromcolposcopic-directed biopsy as a gold standard. Results: VIA testing was positive in 54/150 (36%) pre-menopausalwomen and 5/50 (10%) post-menopausal women. Out of 54 pre-menopausal women with positive VIA testing,15 (27.8%) had high-grade CIN and 39 (72.2%) had either CIN 1 or insignificant pathology. Ten (10.4%), 43(44.8%) and 43 (44.8%) out of the remaining 96 pre-menopausal women with negative VIA testing had highgradeCIN, CIN 1 and insignificant pathology, respectively. Out of 5 post-menopausal women with positive VIAtesting, there were 4 (80%) women with high-grade CIN, and 1 (20%) women with insignificant pathology. Outof 45 VIA-negative post-menopausal women, 42 (93.3%) women had CIN 1 and insignificant pathology, and 3(6.7%) had high-grade CIN. Sensitivity, specificity, PPV and NPV of the VIA testing were 59.4%, 76.2%, 32.2%and 90.8%, respectively (60%, 68.8%, 27.8% and 89.6% in pre-menopausal women and 57.1%, 97.7%, 80%and 93.3% in post-menopausal women). Conclusions: VIA testing may be used as a screening tool for detectinghigh-grade CIN in women with minor cervical cytological abnormalities in a low-resource setting in order tolower the rate of colposcopy referral.     

Incidence of High Grade Squamous Intraepithelial Lesions in Patients with Atypical Squamous Cells of Undetermined Significance Papanicolaou Smears at Naresuan University Hospital

Purpose: To determine the incidence of high-grade cervical intraepithelial neoplasia (CIN2-3) among patients with atypical squamous cells of undetermined significance (ASC-US) Papanicolaou (Pap) smears. Materials and Methods: One-hundred and eighty-seven patients with ASC-US Pap smears who underwent colposcopy with histological study were enrolled between September 2007 and August 2015. Patient factors (including age, parity, current pills used, HIV status, age at first sexual intercourse and number of sexual partners) were obtained. Logistic regression analysis was used to evaluate clinical factors associated with CIN2-3. Results: CIN was diagnosed in 92 of 187 women (49.2%). Sixty-one of these (32.6%) had CIN1 and 31 (16.6%) had CIN2-3. There was no woman who had invasive cancer. There was no correlation of high-grade CIN with factors in this study including age, parity, current pills used, HIV status, age at first sexual intercourse and number of sexual partners. Conclusions: Data from this study showed no invasive cervical cancer was found in patients with ASC-US. There was no patient factor associated with high grade intraepithelial neoplasia in patients with ASC-US Pap smears.     

P16/Ki-67双染联合DNA倍体分析在ASCUS分流诊断中的应用价值

目的： 探讨P16/Ki-67双染联合DNA倍体分析在宫颈意义不明的不典型鳞状细胞（ASCUS）分流诊断中的应用价值。方法： 选取2016年12月-2018年8月上海市长宁区妇幼保健院收治的经液基细胞学（LCT）诊断为ASCUS的患者115例，同时行P16/Ki-67双染检测，DNA倍体分析，且以阴道镜病理活检结果为金标准。结果： 115例患者阴道镜病理活检结果提示，宫颈上皮瘤变2级及以上（CIN2+）45例，其中CIN2级20例，CIN3级23例，鳞癌2例；P16/Ki-67双染检测CIN2+的灵敏性、特异性、诊断符合率分别为77.8%、77.1%、77.4%；DNA倍体分析检测CIN2+的灵敏性、特异性、诊断符合率分别为71.1%、34.3%、48.7%，且DNA倍体阴性的细胞标本中P16/Ki-67双染检测结果均为阴性；DNA倍体分析联合P16/Ki-67双染检测CIN2+的灵敏性、特异性、诊断符合率分别为92.9%、71.4%、86.3%，其中诊断符合率明显高于单纯采用DNA倍体分析（P < 0.05）。结论： P16/Ki-67双染相较于DNA倍体分析检测CIN2+具有更高灵敏度和特异度，两者联合检测能有效提高准确率，可辅助用于ASCUS的分流诊断。     

P16/Ki-67双染联合DNA倍体分析在ASCUS分流诊断中的应用价值

目的： 探讨P16/Ki-67双染联合DNA倍体分析在宫颈意义不明的不典型鳞状细胞（ASCUS）分流诊断中的应用价值。方法： 选取2016年12月-2018年8月上海市长宁区妇幼保健院收治的经液基细胞学（LCT）诊断为ASCUS的患者115例，同时行P16/Ki-67双染检测，DNA倍体分析，且以阴道镜病理活检结果为金标准。结果： 115例患者阴道镜病理活检结果提示，宫颈上皮瘤变2级及以上（CIN2+）45例，其中CIN2级20例，CIN3级23例，鳞癌2例；P16/Ki-67双染检测CIN2+的灵敏性、特异性、诊断符合率分别为77.8%、77.1%、77.4%；DNA倍体分析检测CIN2+的灵敏性、特异性、诊断符合率分别为71.1%、34.3%、48.7%，且DNA倍体阴性的细胞标本中P16/Ki-67双染检测结果均为阴性；DNA倍体分析联合P16/Ki-67双染检测CIN2+的灵敏性、特异性、诊断符合率分别为92.9%、71.4%、86.3%，其中诊断符合率明显高于单纯采用DNA倍体分析（P < 0.05）。结论： P16/Ki-67双染相较于DNA倍体分析检测CIN2+具有更高灵敏度和特异度，两者联合检测能有效提高准确率，可辅助用于ASCUS的分流诊断。     

Accuracy of visual inspection with acetic acid to detect cervical cancer precursors among HIV‐infected women in Kenya

Visual inspection with acetic acid (VIA) is becoming a more widely recommended and implemented screening tool for cervical cancer prevention programs in low‐resource settings. Many of these settings have a high prevalence of HIV‐infected women. We carried out a cross‐sectional validation study to define the sensitivity, specificity and predictive values of VIA among HIV‐infected women. Women enrolled in HIV care at the Family AIDS Care and Education Services clinic in Kisumu, Kenya, were recruited for participation. All participants underwent VIA followed by colposcopy performed by a second blinded clinician. At colposcopy, lesions suspicious for cervical intraepithelial neoplasia 2 or greater (CIN2+) were biopsied. Disease status was determined by final histopathologic diagnosis in women who underwent biopsies. A satisfactory colposcopy with no lesions was considered a negative result. From October 2010 to June 2012, 1,432 women underwent VIA and colposcopy. A total of 514 (35.7%) women had a positive VIA, and 179 (12.2%) had CIN2+ confirmed by colposcopically directed biopsy. Sensitivity, specificity, positive and negative predictive values of VIA for CIN2+ were 86.6, 71.6, 30.3 and 97.4%, respectively. Specificity, but not sensitivity, increased with older age. Among older women, sensitivity was affected by CD4+ count and use of antiretroviral therapy. Although they are impacted by age and immune status, test characteristics for VIA among HIV‐infected women are similar to what has been reported for general populations. Recommendations to use VIA as a screening tool should not vary by HIV status.     

The clinical performance of APTIMA human papillomavirus and Hybrid Capture 2 assays in the triage of lesser abnormal cervical cytologies

Objective

This study was performed to evaluate the clinical performance of APTIMA human papillomavirus (AHPV) assay and Hybrid Capture 2 (HC2) assay in screening for cervical disease, especially in women with atypical squamous cell of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL).

Methods

A total of 411 women diagnosed with ASC-US or LSIL were referred and further triaged by HC2 test. Prior to colposcopy, liquid-based cytology specimens were collected for the AHPV assay. Sensitivity and specificity were established based on the histological findings of cervical intraepithelial neoplasia (CIN).

Results

In all 411 subjects, the positive detection rate of AHPV assay was 70.8% (95% confidence interval [CI], 66.4 to 75.2), which was significantly lower than the positive detection rate of 94.9% obtained using HC2 test (95% CI, 92.3 to 96.8). Only one CIN 3-positive case was detected among the 120 AHPV-negative women, which was then confirmed by Pap smear test to be LSIL. The sensitivities of AHPV and HC2 for CIN 3 were similar (94.1% and 100%, respectively). However, AHPV showed a significantly higher specificity than HC2 test (30.2% and 5.3%, respectively; p<0.001).

Conclusion

AHPV assay is effective in identifying CIN 3-positive cases because of its high specificity and lower false-negative rate. The use of AHPV for the triage of ASC-US and LSIL might help to reduce the referral rate of colposcopy during cervical cancer screening.     

Risk of High-Grade Cervical Lesions in Atypical Squamous Cells of Undetermined Significance (ASC-US) Cytology: Comparison between HIV-Infected and HIV-Negative Women

Background and objective: Women with human immunodeficiency virus (HIV) infection have an increased risk of HPV infection, cervical neoplasia. This study was undertaken to compare the risk of having high-grade cervical lesions defined as cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in HIV-infected versus HIV-uninfected women who had atypical squamous cells of undetermined significance (ASC-US) on cervical cytology. Methods: Fifty-seven HIV-positive women aged 25-65 years with ASC-US cytology undergoing colposcopic examination between January 2008 and December 2020 at Chiang Mai University Hospital were reviewed. By matching 1:5 ratio, 285 HIV-negative women with ASC-US cytology in the same period were recruited as controlled subjects for comparison. The patient characteristics, HIV status, CD4 cell count within 6 months of colposcopy, antiretroviral therapy, parity, contraception, smoking history, number of sexual partners, and histopathology on cervical biopsy were analyzed. Results: Mean age ± SD of the HIV-positive and HIV-negative groups was 44.28 ± 8.53 years and 44.28 ± 9.68 years, respectively. HIV-positive women were significantly less likely to use contraceptive methods (36.8 % versus 48.8 % in HIV-negative women; P = 0.002). HIV-infected women significantly had more sexual partners than HIV-uninfected women. Both groups had similar risk for CIN 2+ (5.3 % in HIV-positive women compared with 4.9 % in HIV-negative women; odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.30 –3.87). After adjustment for no contraception use and number of sexual partners, the risk of CIN2+ in HIV-infected women remained unchanged; adjusted OR= 1.15, 95% CI = 0.27-4.92, P= 0.846). Conclusion: The risk of underlying high-grade cervical lesions in women with ASC-US on cervical cytology was approximately 5 %, regardless of HIV status.