细胞角蛋白20诊断膀胱癌

膀胱镜加活组织病理检查是诊断膀胱癌的最基本方法 ,但由于其侵入性 ,给患者带来痛苦 ,使其应用受到限制。长期以来 ,尿液脱落细胞学检查以其非侵入性特点 ,在对膀胱肿瘤的诊断和随访方面发挥了重要的作用 ,成为膀胱镜加活检模式的补充手段 ,在临床上得到了广泛的应用。遗憾的是 ,尿液脱落细胞学检查只对分化不良的泌尿道上皮肿瘤具有较高的敏感性 ,而对分化良好的膀胱肿瘤的诊断敏感性较低。因此 ,临床上迫切需要一种敏感性高、无创性的诊断技术应用于膀胱癌的早期诊断和随访。细胞角蛋白 2 0就是一种极有可能成为诊断膀胱癌的特异性生物标…     

金丝桃素荧光细胞学检查在膀胱癌诊断中的应用研究

目的:研究金丝桃素荧光细胞学检查在膀胱癌诊断中的应用。方法:(1)利用DMSO将金丝桃素溶解,采用不同的孵育时间孵育正常膀胱尿路上皮和膀胱癌细胞株,探索最佳孵育时间,并置于共聚焦显微镜下观察细胞株荧光强度的分布。(2)取临床资料完整、病理结果明确的膀胱癌标本库标本低级别5例、高级别5例,正常膀胱尿路上皮组织5例;消化组织,并将细胞悬浮,金丝桃素孵育细胞,将其荧光强度与细胞株标准强度比对,验证标准强度分布。(3)对108例可疑膀胱癌患者同时行金丝桃素尿荧光细胞学、尿脱落细胞学和经腹部超声检查,并以病理检查确诊,比较分析以上检查方法诊断膀胱癌的敏感性和特异性。结果:金丝桃素最佳孵育时间为15 min,正常细胞株与RT4、J82,以及正常组织与低级别尿路上皮癌、高级别尿路上皮癌,荧光强度均有明显区别,且在患者得到验证。108例可疑膀胱癌患者中,经病理证实78例为膀胱癌。78例膀胱尿路上皮癌患者中72例金丝桃素结果阳性,23例尿脱落细胞学阳性,57例经腹部超声诊断为膀胱癌,灵敏度分别为9.23%(72/78)、29.49%(23/78)、73.08%(57/78)。30例同期治疗的其他泌尿系疾病患者中2例金丝桃素结果假阳性,尿脱落细胞学检查1例假阳性,经腹超声检查8例假阳性,特异度分别为93.33%(28/30)、96.67%(29/30)、73.3%(22/30)。正常对照组:30例正常人检查结果均无异常。金丝桃素诊断膀胱尿路上皮癌的灵敏度显著优于尿脱落细胞学(P0.05)和腹部超声检查(P0.05),但低于病理切片(P0.05)。特异性接近尿脱落细胞学(P0.05)和病理切片检查(P0.05),优于经腹部超声检查(P0.05)。金丝桃素诊断膀胱尿路上皮癌,低级别和高级别的灵敏度分别为:90.5%(38/42)、9.44%(34/36)。尿脱落细胞学诊断低级别和高级别的膀胱尿路上皮癌灵敏度分别为23.8%(10/42)、36.1%(12/36)。在低级别和高级别的膀胱尿路上皮癌中,金丝桃素的敏感性均高于尿脱落细胞学(P0.001和P0.001)。结论:采用金丝桃素作为光敏剂的膀胱癌尿荧光细胞学检查灵敏度比尿脱落细胞学高、特异性相似,是一种较为理想的无创性量化诊断膀胱癌检查方法。     

膀胱癌与生存素

膀胱癌是在泌尿生殖道发生占第二位的癌。最普通型膀胱癌是尿乳突细胞癌（Urothelial cell carcinoma,UCC）,大约占所有膀胱肿瘤的95％。检查膀胱肿瘤的金标准是细胞学检查。大多数UCC为浅表肿瘤,侵袭深度限于膀胱壁黏膜下（Ta、T1期）,大约有70％的患者在初次切除后复发,其中有的最终将向侵袭性和更具浸润性病变进展（T2-T4期）。这就迫使所有浅表膀胱癌患者在追踪期间需频繁地做细胞学检查。该检查虽较准确,但为有创检查,且检查费用较高,患者经济负担较重,加之小的乳头损害,以及原位平面生长的癌常常易被漏诊。自20世纪末发现生存素（Survivin）,用于膀胱癌的诊断及预测复发以来,已成为热点研究领域。     

超声引导下细针吸取细胞学检查在体表肿物诊断中的应用

目的探讨超声引导下细针吸取细胞学检查在体表肿物诊断中的应用价值。方法2010年8月-2012年8月对149例患者167个浅表肿物进行超声引导下细针吸取细胞学检查,将穿刺细胞学诊断资料与手术病理及临床随访结果进行对照分析。细胞学诊断结果分为良性、恶性、可疑恶性及吸出物不足4类。结果超声引导下167个结节共计实施穿刺操作293次,一次性穿刺成功率96．2％,二次穿刺成功率100％。167个结节中,经病理及临床随访证实20个结节为恶性,147个结节为良性;经细胞学诊断132个（79．0％）结节为良性,14个（8.4％）结节为恶性,6个（3．6％）结节为可疑恶性,15个（9．0％）结节为吸出物不足,细胞学诊断敏感性为79．2％,特异性为87．5％,准确性为91．0％。结论超声引导下细针吸取细胞学检查对于浅表肿物诊断具有实时观察、准确安全、创伤小等优点,标本满意率及病理诊断准确性高,可作为体表肿物诊断的首选方法。     

影响胸部CT导向穿刺活检准确性因素的探讨：（附100例分析）

目的：评价胸部ＣＴ导向穿刺活检中ＣＴ定位、取材方法、病变等因素对本项检查准确性的影响。材料与方法：回顾分析１００例资料完整的病例。分别计算用不同取材方法，对不同部位病灶检查的准确性，分析各因素对准确性的影响。结果：对肺部恶性病变细胞学和组织学诊断的正确率分别是９０％和８７％，对肺部良性病变细胞学和组织学诊断的正确率分别是６０％和８４％。对纵隔和胸膜病变组织学诊断准确性高。结论：细胞学诊断对肺部恶性病变的诊断准确性高，组织学诊断对肺部良性病变的准确性高，对肺部病变应根据影像学诊断决定取材方式。对纵隔、胸膜等处病灶应取得充分的组织学标本方易作出确切诊断。     

3.0T MR扩散加权成像对膀胱癌T分期的诊断价值

目的探讨MR扩散加权成像(DWI)对膀胱癌T分期的诊断价值。资料与方法使用Philips Achieva3.0 T高场强超导型MR机,应用腹部多通道相控阵线圈,对44例膀胱癌患者,共71处病灶行MR检查,观察其DWI表现,并与手术病理分期结果进行对照分析。结果 71处病灶中,有蒂型病灶占60.56%(43/71),在DWI上均表现为C形或拱形样结构,其T分期的诊断符合率为95.35%(41/43)。DWI诊断膀胱癌T分期的准确度非常高,其准确度、敏感度和特异度分别为88.73%、84%、91.3%。DWI对膀胱癌T分期准确性优于T2WI(71.83%),但联合T2WI,可提高其对分期诊断的准确性(90.14%)。结论 3.0 T高场强MR DWI所表现C形或拱形样结构,可作为早期膀胱癌较特征性的诊断征象。联合其他序列,可提高DWI对分期的诊断准确性。     

甲状腺结节超声引导下细针抽吸诊断的影响因素

随着超声技术的进展及检查应用的普及,甲状腺结节的检出率也逐年上升。超声引导下细针抽吸细胞学检查因具有对结节良恶性诊断的高敏感性与特异性、安全简便且并发症少等优点而成为术前诊断的主要依据,减少了一些不必要的手术。尽管细针抽吸细胞学检查的诊断率高、应用广泛,但仍存在一定的局限性,其中重要的一点是无法得到满意的标本。标本取材对细胞学检查结果有较大影响。现就影响标本取材满意度的因素及解决方案予以综述。     

膀胱癌的MRI诊断价值

目的:总结膀胱癌的MRI征象,探讨MRI对膀胱癌分期的作用及鉴别诊断要点。方法:对探讨经手术与病理证实23例膀胱癌的MRI回顾性对比分析。其中男性,19例,女性,4例,年龄50~90岁,平均年龄70岁。18例行MRI增强检查。结果:膀胱三角区及膀胱后侧壁是最常见好发部位,表现为膀胱壁突向腔内肿块和(或)膀胱壁局限性不规则增厚;肿瘤平扫T1WI等或略高信号,T2WI呈高信号,Gd-DTPA动态增强早期肿块显著强化。根椐肿瘤生长方式可分为:①小结节型,②广基肿块型,③浸润型。MRI对膀胱癌定位、定性诊断正确率分别为95.7%(22/23)、91.3%(21/23);术前MRI诊断与TNM分期符合率为82.3%(19/23),MRI较病理分期偏高。结论:膀胱癌的MRI表现具有独特性。T1加权主要用于肿瘤的定性诊断,T2加权主要用于肿瘤的术前分期;MRI检查多方位、多序列成像,是显示膀胱癌最理想的检查方法。     

多层螺旋CT对膀胱癌的诊断价值

目的:探讨多层螺旋CT对膀胱癌的诊断价值.方法:回顾性分析经手术病理证实的82例膀胱癌,分析多层螺旋CT对肿瘤大小及数目的显示情况、病灶的强化程度以及判断侵犯范围的准确性.结果:多层螺旋CT能较准确地显示膀胱癌的大小和数目,较好地显示膀胱癌的大体形态、生长方式及强化程度,评价膀胱癌侵犯范围的敏感性、特异性和准确性均处于较高水平;CT定性诊断准确性达到93.90%.结论:多层螺旋CT是诊断膀胱癌最具价值的影像学检查手段,作为膀胱癌的常规检查项目,检查技术关键在于薄层和增强多期扫描,这对于发现病灶、大体分型、分期和定性诊断均十分重要.     

磁共振扩散加权成像在膀胱癌术后随访中的应用价值

目的探讨扩散加权成像(DWI)及表观扩散系数(ADC)值在膀胱癌术后随访中的应用价值。资料与方法膀胱癌术后可疑复发患者44例,于3.0 TMRI上行常规平扫增强及DWI检查。比较增强序列与DWI鉴别膀胱癌复发及炎症的能力。采用配对t检验比较膀胱癌复发与炎症的ADC值区别,并绘制ADC值诊断膀胱癌复发的受试者工作特征(ROC)曲线。结果增强序列诊断膀胱癌复发的准确性、敏感性及特异性分别为79.5%、96%、57.9%;DWI为95.5%、96%、94.7%。DWI诊断结果与病理一致性相当好(Kappa=0.907),增强序列一致性中等(Kappa=0.564)。DWI与病理诊断结果的McNemar检验无显著差异(P>0.05),增强序列与病理诊断结果有显著差异(P<0.05)。膀胱癌复发的平均ADC值为(0.90±0.23)×10-3mm2/s,显著低于炎症(1.32±0.14)×10-3mm2/s。ADC值鉴别膀胱癌复发与炎症的准确率高(ROC曲线下面积=0.93),ADC值取1.075×10-3mm2/s时是最佳诊断界值(敏感性+特异性=1.833)。结论 DWI序列对膀胱癌术后鉴别肿瘤复发及炎症瘢痕有重要...     

乳腺肿块~(99)Tc~m-MIBI显像、X线钼靶及细针细胞学检查的对比研究

目的　评价联合运用核素显像 (SMM)、X线钼靶照相 (MG)及细针细胞学穿刺 (FNAC)种方法在乳腺癌早期诊断中的价值。方法　对 5 7例女性乳腺肿块患者术前行SMM检查 ,对其中 5 4例分别行MG及FNAC检查 ,以术后病理结果为金标准 ,判断以上 3种方法在乳腺癌早期诊断中的灵敏度及特异性。结果　除 3例局部切除术者外 ,其余 5 4例SMM发现乳腺恶性肿瘤 31例 ,MG为 2 8例 ,FNAC为 37例 ,SMM、MG及FNAC的灵敏度分别为 79 5 %、71 8%、94 9% ,准确性分别为 78 9%、72 2 %、96 3% ;联合运用 3种方法 5 4例患者至少有 1种方法可以诊断。肿瘤99Tcm 甲氧基异丁基异腈 (MIBI)聚集与肿瘤的大小、孕激素受体及c erbB 2蛋白表达相关 (P <0 0 5 )。结论　联合运用SMM、MG及FNAC可以提高乳腺癌的早期诊断率 ,乳腺99Tcm MIBI阳性显像可能对预后估计及化疗方案的选择有一定的价值。     

Tissue polypeptide antigen in the follow-up of patients with urinary bladder cancer compared with conventional urine cytology

The incidence of bladder cancer has demonstrated a rapid increase during the last decades. The aim of this study is to determine the clinical value of serum tissue polypeptide antigen (TPA) as a tumour marker for urinary bladder cancer in comparison with conventional urine cytology. Urine and blood samples were obtained from a total of 108 patients (group A) with a known history of bladder cancer, who presented for their routine 3 month follow-up. These 108 patients included 45 patients with high grade and 63 patients with low grade bladder cancer, and 30 patients with lower urinary tract symptoms (LUTS) and no history of bladder cancer (group B). Urine and blood samples from fifty healthy adults (group C) were also tested; this group served as the control group for estimating the normal range of serum TPA values. In all group A patients cystoscopy and/or bladder biopsies were performed. All blood and urine samples were tested for TPA and conventional urine cytology respectively. Results showed that the upper normal range for TPA was 1.0 ng/mL(0.9 ± 0.04) in the control group. For the subgroups of patients with high and low grade bladder cancer elevated serum TPA levels were found in 52% and 40% of the patients respectively. The overall serum TPA sensitivity and specificity were 50% and 85% respectively for patients with known bladder cancer (group A). We found the sensitivity of cytology for high grade bladder (GIII) carcinomas to be 72%; however when urine cytology was combined with serum TPA the overall sensitivity reached 80%. We conclude that serum TPA combined with urine cytology may be used as a prognostic marker for bladder cancer.     

MR imaging-guided sonography followed by fine-needle aspiration cytology in occult carcinoma of the breast

OBJECTIVE: In patients with axillary metastases as clinical evidence of possible occult breast cancer, a combined approach of MR imaging, sonography, and aspiration biopsy cytology was evaluated. SUBJECTS AND METHODS: Thirty-one women with metastatic adenocarcinoma in their axillary lymph nodes originating from an unknown primary site underwent MR imaging of the breast because physical examination and mammography findings were normal. Twenty of the 31 women had no history of malignancy, 10 had been previously treated for contralateral breast cancer, and one patient had nodal metastases in the contralateral axilla at the time breast cancer was detected. When a contrast-enhancing lesion was revealed on MR imaging of the breast, sonography and fine-needle aspiration cytology were also performed. RESULTS: MR imaging revealed the primary breast cancer in eight (40%) of the 20 patients without a history of malignancy. MR imaging of the breast revealed a second primary cancer in three (27%) of the 11 patients with previous or simultaneous breast cancer. All lesions were identified with sonography and verified by cytology and histology. CONCLUSION: In women with axillary lymph node metastases from adenocarcinoma, MR imaging of the breast should be added to clinical examination and mammography before defining the breast cancer as occult. The combined approach of MR imaging, sonography, and aspiration fine-needle cytology is a good alternative to the MR imaging-guided biopsy.     

早期乳腺癌的CR、B超联合针吸细胞学诊断与病理对照分析

目的:探讨钼靶CR摄影、高频超声及针吸细胞学在乳腺肿块术前检查的联合应用,提高早期乳腺癌的诊断符合率。方法:对经手术病理确诊的126例早期乳腺癌(病灶直径≤2.0cm)与术前钼靶CR摄影、高频超声及针吸细胞学联合检查进行对比,分别得出诊断符合率。结果:钼靶CR摄影、高频超声、针吸细胞学及三种检查方法联合应用的诊断符合率分别为85%、83%、91%、98%。结论:对乳腺肿块患者进行术前联合检查是诊断早期乳腺癌的有效方法。     

端粒酶活性和p16基因甲基化检测对肺癌早期诊断的价值

目的　从分子生物学的角度探索端粒酶活性和p16基因甲基化检测对肺癌早期诊断意义。方法　用PCR -TRAP -ELISA半定量及PCR -TRAP银染定性法、甲基化相关的PCR法 ,检测 49例肺癌、2 8例肺部良性疾病的纤维支气管镜后痰液脱落细胞端粒酶活性及p16基因甲基化状态 ,检测结果与组织病理、细胞学进行对照研究。结果　肺癌痰液标本的细胞学敏感性为 5 5 .1% ,特异性为 10 0 % ;端粒酶活性的敏感性为 71.4% ,特异性为 89.3% ;p16甲基化的敏感性为 2 8.6 % ,特异性为 10 0 % ;三者联合检测的敏感性为 90 .9% ,特异性为 89.3%。结论　痰液的细胞学、端粒酶活性表达及p16基因甲基化联合检测可提高肺癌痰检的敏感性 ,有助于肺癌早期诊断。     

Lung cancer screening.

Prior attempts to screen for lung cancer using chest radiography and sputum cytology have proved unsuccessful. Recent reports have investigated the role of spiral CT in early lung cancer detection and have suggested that screening would be of value. Prior to the introduction of a national lung cancer screening programme, it would be essential to demonstrate that this would reduce mortality and would be cost effective.     

Role of multimedial diagnosis of breast cancer in women below 36 year of age

PURPOSE: To evaluate the sensitivity for breast cancer of different diagnostic tests performed in a consecutive series of women aged under 36 years. MATERIALS AND METHODS: The study analyses 155 women with breast cancer incident in the Tuscany Cancer Registry from 1985 to 2000. The sensitivity of each method was evaluated in relation to the most recent test performed during the year before diagnosis and to different variables, such as tumour size and calendar period. RESULTS: Sensitivity was 70.3 % for physical examination, 76.0% for mammography, 69.1% for ultrasonography and 80.6% for cytology (86.2% if inadequate samples are excluded). Sensitivity was associated to pT category for physical examination (pT1=60.6%; pT2-4=86.4%; chi squared=10.2, p= 0.001) and for ultrasonography (pT1=61.9%; pT2-4=92.0%; chi squared=5.7, p=0.01) and to breast radiological density for mammography (50-100% density=75.5%; 0-50% density=91.3%; chi squared=1.85, p<0.17). Among 112 cases examined with palpation, mammography and cytology, these methods had a sensitivity of 78.5%, 75.8% and 91.9%, respectively, and an overall sensitivity of 98.2%. Among 65 cases examined with palpation, ultrasonography and cytology, these methods had a sensitivity of 67.6%, 70.7% and 92.3%, respectively, and an overall sensitivity of 95.3%. Among 123 cases examined with palpation, imaging (mammography and/or ultrasonography) and cytology, these methods had a sensitivity of 76.4%, 78.0% and 90.2%, respectively, and an overall sensitivity of 96.7%. Cancer was suspected by one method only in 2.4% of cases with palpation, 1.6% with imaging and 7.3% with cytology. Comparison between mammography and ultrasonography was possible in 58 cases undergoing both tests: sensitivity was 79.3% for ultrasonography and 74.1% for mammography, respectively chi squared=0.1, p=0.66). If sensitivity had been determined according to the test performed immediately before diagnosis it would have been higher, that is 74.4% for palpation, 76.8% for mammography, 73.5% for ultrasonography and 90.9% for cytology (97.7% if inadequate samples were excluded), and overall sensitivity would be 96.1%. CONCLUSIONS: Differential diagnosis of breast cancer in women aged under 36 years is difficult, sensitivity being lower as compared to older women, with the only exception of cytology. The association of multiple tests (diagnostic imaging and cytology) is crucial to achieve an acceptable false negative rate. In particular, the extensive use of cytology in the presence of an even minimal doubt at palpation and/or imaging is strongly recommendable. Sensitivity must be calculated on the basis of an independent pathology registry, and false negatives must be defined within a given period after the test. Analysis limited to tests performed immediately before diagnosis leads to a biased overestimation of sensitivity.     

Stereotaxic cytologic examination of non-palpable lesions of the breast. Experience with 791 consecutive cases

The authors report on 791 consecutive cases undergoing stereotaxic cytology for nonpalpable lesions detected at mammography. Histologic diagnosis (malignant = 179, benign = 107) or mammographic follow-up after at least one year (benign = 275) was available in 561 cases. The overall inadequacy rate of stereotaxic cytology was 0.21, and dependent on lesion type (benign = 0.25, malignant = 0.13 p less than 0.001) and on sampling operator experience (range 0.17-0.31, p less than 0.001). Sensitivity (dubious + positive, after exclusion of inadequates) was 0.83 and dependent on histologic type (infiltrating = 0.87, intraductal = 0.68). Specificity (negative/benign, after exclusion of inadequates) was 0.96. Stereotaxic cytology helped in reducing the number of unnecessary benign biopsies and the biopsy ratio was 0.6 benign to 1 malignant biopsy. In cases with moderate suspicion at mammography the radiologist felt reassured by negative cytology and advised mammographic control rather than surgical biopsy. Cytology was determinant in advising surgical biopsy in 9 cancer cases whereas the absence of cytologic positivity contributed to diagnostic delay in 2 cancer cases. Overall, stereotaxic cytology allowed a relevant reduction of unnecessary benign biopsies and should be routinely employed in the diagnostic work-up of nonpalpable lesions detected at mammography.     

Differential diagnosis of intracystic breast lesions in hemorrhagic cysts

The authors report on 117 consecutive hemorrhagic breast cysts cases. All patients underwent cytologic examination of cystic fluid content and US or pneumocystography. Ten cancers (9 infiltrating, and 1 lobular in situ) and 22 papillomas had histologic confirmation--out of 45 cases undergoing surgical biopsy. Seventy-two cases exhibiting no intracystic growth have been followed for 5.4 years on the average and no cancer has developed so far. Pneumocystography or US had 100% predictive value for intracystic lesions; we observed that surgical biopsy could be safely avoided when both examinations were negative, that is in about 3/4 cases. No differential diagnosis of cancer and papilloma was possible on pneumocystography or US. Even though positive cytology was highly predictive for cancer, cytology exhibited poor sensitivity and surgical biopsy was necessary in all cases presenting with intracystic growth.     

Supplementary tissue-core histology from fine-needle transthoracic aspiration biopsy

Biopsies of 150 consecutive suspected lung cancers were performed with fine needles having circumferentially beveled tips that produced cytology and tiny tissue cores suitable for histology. Visible tissue cores were aspirated in 92% (n = 138) and histologic diagnoses were obtained in 72% (n = 108). There were 118 (79%) proven malignant and 27 (18%) proven benign lesions. Sensitivity and specificity of cancer diagnoses were 97% and 100%, respectively. Biopsy histology was the only positive cancer specimen in two biopsies (1.7%). Biopsy cytology was the only positive cancer specimen in 20 cases (17.2%). Biopsy cytology and histology agreed with the proven cell type in 71.8% and 78.6% of cancers, respectively. As expected, when large-cell undifferentiated carcinoma was regarded as a nonspecific cell type consistent with either poorly differentiated adenocarcinoma or poorly differentiated epidermoid carcinoma, biopsy-cell-type accuracy increased greatly. Specific benign diagnoses were obtained in 44% of the 27 biopsies of proven benign lesions: cytology (four), core histology (five), and bacteriology (nine). Simple and complicated pneumothorax occurred in 10% and 4% of biopsies, respectively. It was concluded that biopsy with fine, circumferentially beveled needles can produce useful histology to supplement biopsy cytology.