X线监视下低张力食管拉网在诊断食管癌中的应用研究

从１９９２年１０月至１９９５年４月，我们对５８例食管癌常规拉网检查失败者应用改进后的食管细胞采集器在Ｘ线监视下应用低张方法行食管拉网细胞学检查，一次拉网阳性者５６例，占９６．６％，２次阳性２例，占３．４％，总成攻率为１００％。     

食管拉网细胞学对食管癌病变和危险因素的探讨

１９９５年７月－１９９５年１０月在泰国南部食管癌区宋卡省进行的食管拉网细胞学检查是将我国的拉网细胞诊断方法第一次用于国外，泰南５５９例检者细胞学结果显示与中国食管癌高发区林县相同的三大特点：１．高的不正常细胞发生率；２．高的过度角细胞出现率；３．大量的霉菌和炎性细胞。再一次证明在癌的高发区存在高比率的癌前病变，并提示存在可能的危险因素，霉菌感染和维生素缺乏，同时，拉网细胞学结合对受检者审查发现吸烟     

食管拉网细胞端粒酶活性检测及临床应用研究

目的：检测食管拉网细胞中端粒酶活性，探讨其在食管癌诊断及预测预后的临床应用价值。方法：应用端粒重复序列扩增法，对３０例食管拉网细胞标本及相应的癌组织和癌旁正常食管组织进行检测。结果：３０例食管拉网标本中端粒酶活性阳性率为８３．３％（２５／３０），相应癌组织中阳性率为９６．７％（２９／３０），１４例正常食管组织中阳性率为１４．３％（２／１４）。拉网细胞和癌组织中端粒酶阳性率与正常组织相比较差异有显著     

食管拉网细胞学对食管癌前病变和危险因素的探讨

 1995年7月-1995年10月在泰国南部食管癌高发区宋卡省进行的食管拉网细胞学检查是将我国的拉网细胞学诊断方法第一次用于国外。泰南559例受检者细胞学结果显示与中国食管癌高发区林县相同的三大特点：1．高的不正常细胞发生率；2．高的过度角化细胞出现率；3．大量的霉菌和炎性细胞。再一次证明在癌的高发区存在高比率的癌前病变；并提示存在的可能的危险因素：霉菌感染和维生素缺乏。同时，拉网细胞学结合对受检者审查发现吸烟、饮酒、嚼烟草也是与食管上皮改变有关的因素。     

多发性原发性食管癌及食管贲门双原发癌的诊断和治疗

为提高多发性食管癌及食管贲门双原发癌的诊断率及生存率，本文对６５８例食管癌手术治疗患者的资料作回顾性分析。其中多发性原发性食管癌１９例，占２．９％。食管贲门双原发癌２例，占０．３％。作者认为，要提高本病的诊断率，应切实做好以下工作：①完善的食管吞钡造影；②纤维胃镜下可疑部位的多点活组织检查；③胃超声检查；④多次分段食管拉网检查；⑤术中细致的外科探查；⑥术后连续病理切片检查。提示：早期诊断和及时手术     

食管鳞状上皮涂片细胞AgNORs的计量研究

应用银梁技术对１０５例食管拉网涂片细胞进行了ＡｇＮＯＲｓ计量研究。检测结果：正常底层细胞ＡｇＮＯＲｓ均数（３．０８）多于正常中层细胞（２．３７）。随增生和病变级别增高，ＡｇＮＯＲｓ均数逐级增高：轻度增生、重度增生Ⅰ级、重度增生Ⅱ级、近癌和鳞癌细胞分析为３．６１、４．６９、５．６４、６．６４和８．０６（Ｐ＜０．０１）。证明ＡｇＮＯＲｓ是一种反映细胞增殖水平的较敏感的指标：食管上皮细胞学增生分级方法是     

MAP治疗非小细胞肺癌的疗效分析

选取本院１９９０年２月～１９９２年２月经细胞学、组织学证实的非小细胞肺癌６３例，用ＭＡＰ方案治疗取得满意效果。其中腺型占６５．１％，鳞型及低分化型分别占２５．４％和９．５％。化疗后总有效率为３９．７％（２５／６３）均为ＰＲ，１例ＰＤ。Ⅱ、Ⅲ、Ⅳ期有效率分别为６０．０％、４２．４％和３２．０％；鳞型和腺型有效率分别为３７．５％和３４．２％，低分化型非小细胞癌最佳达８３．３％，Ｐ值均＞０．０５。副反应     

同时性食管贲门重复癌34例报告

１９７６年１月至１９９４年１２月，我们收治同时性食管贲门重复癌３４例，占同期食管、贲门癌病人的０．７％（３４／５０４０）。全组食管病变全部为鳞癌，贲门病变中腺癌３２例、恶性纤维组织细胞瘤和平滑肌肉瘤各１例。术前诊断率７０．６％（２４／３４），手术切除率７９．４％（２７／３４），术后１、３、５年生存率分别为８７．５％（２１／２４）、４５．０％（９／２０）和１８．８％（３／１６）。作者认为：注意各项检查的相互配合及仔细的上消化道全面检查能提高诊断率，早期手术并扩大手术范围可提高手术疗效。     

肺癌患者多原发恶性肿瘤的诊断和治疗（附14例报告）

本文报告了作者自１９７９年４月至１９９３年１２月期间收治的１４例肺癌患者的多原发恶性肿瘤，发生率２．４％（１４／５８０），肺的多原发癌６例，占１．０％，３例同时性，３例异时性。第二个原发肿瘤发生在其他脏器者８例，占１．４％。男性１２例，女性２例，年龄３４～６８岁，本文讨论了多原发恶性肿瘤的诊断和治疗，作者认为对肺癌术后患者仔细的Ｘ线检查是重要的，继续随访很必要。肺叶切除是首次和二次手术最常用的方法。     

220例肿瘤细胞学及病理学诊断对比

２２０例肿瘤细胞学及病理学诊断对比广东省顺德县医院唐振民，陈友权，章锦芳１９８７年！月至１９９４年２月，我们采用细针穿刺细胞学检查方法对２２０例可疑恶性肿瘤进行诊断并与术后病理诊断结果对比，诊断符合率为９３．４％。说明细针穿刺细胞学检查有较好的诊断实...     

B超引导细针穿刺细胞块对肝癌的诊断价值

目的:探讨经皮细针穿刺(fine needle aspiration,FNA)细胞块与涂片细胞学检查对肝细胞癌的诊断价值。方法:在B超引导下进行定位穿刺,应用细胞块切片检查和涂片细胞学检查方法观察168例临床疑为肝占位性病变的细针穿刺标本,其中肝恶性肿瘤101例。结果: FNA细胞块切片诊断正确率98．0％(99／101), FNA细胞学定性诊断率为90．1％(91／101)而分型诊断正确率仅为75．2％(76／101);两者之间差异有统计学意义,x2=20．09,P<0．01。结论:经B超引导下FNA细胞块切片检查,能够清晰显示细胞排列及组织结构,并且可多张切片做特殊染色及免疫组化染色,对组织定性和分型诊断接近术后病理诊断,与涂片细胞学结合诊断可优势互补,有很高应用价值。     

食管贲门癌128例内镜观察分析

本文报告纤维胃镜检查8207例经病理证实的食管贲门癌128例,检出率1.55％,表明活检结合印检,刷检细胞学检查,阳性率达61.36％,联合诊断不仅阳性率高,而且可提高对早期食管贲门癌的阳性率。它是以胃镜观察及活检为基础。以印、刷检细胞学检查为核心的一种比较敏感的联合检查方法。     

Ultrasonographically guided biopsy of thoracic tumors. A comparison of large-bore cutting biopsy with fine-needle aspiration.

A prospective study to compare the safety and diagnostic accuracy of ultrasonographically guided transthoracic large-bore cutting biopsy histologic examination with fine-needle aspiration cytologic examination was conducted in 149 patients with thoracic tumors (29 mediastinal tumors and 120 pulmonary masses). The authors found that large-bore cutting biopsy under ultrasonographic guidance could be as safe as fine-needle aspiration, whereas diagnostic accuracy was significantly higher (97% versus 59% in malignant tumors, respectively, P less than 0.05; 85% versus 33% in benign lesions, respectively, P less than 0.05). The size, depth, and location of lesions did not influence the results of transthoracic needle aspiration or cutting biopsy. In 77 patients with primary lung cancer, fine-needle aspiration cytologic examination, although achieving 88% positive cytologic results, identified the histologic cell type accurately in only 70%, whereas Tru-Cut (Top Surgical, Tokyo, Japan) biopsy was 97% accurate in confirmative histologic diagnosis. Fourteen patients had discordant cytologic and histologic diagnoses, and the cases of 3 (3.9%) were between small cell lung cancer and non-small cell lung cancer. The diagnostic accuracy of Tru-Cut biopsy also was significantly higher than that of fine-needle aspiration in metastatic cancers (90% versus 33%, respectively) and mediastinal tumors (100% versus 46%, respectively). The authors conclude that transthoracic cutting biopsy under ultrasonographic guidance is safe and has a higher diagnostic accuracy as compared with fine-needle aspiration. This technique is particularly useful for benign lesions or tumors with pleomorphic morphologic characteristics, such as lymphomas and thymomas.     

Usefulness of liquid-based cytology specimens for the immunocytochemical study of p16 expression and human papillomavirus testing: a comparative study using simultaneously sampled histology materials

BACKGROUND: In cervical lesions, the overexpression of p16 is reported to be closely associated with high-risk human papillomavirus (HPV) infection. The objective of the current study was to confirm the usefulness of liquid-based cervical specimens for p16 staining as well as tissue sections. METHODS: A total of 98 patients with cervical lesions were entered into the current study. After the cytologic examination using liquid-based cervical smears, the same slides were immunostained for p16 and were compared with slides of simultaneously obtained, immunohistologically stained tissue sections. Moreover, the status of the HPV infection was examined by polymerase chain reaction using residual cytologic samples. RESULTS: Using liquid-based Pap smears, 98 cases were diagnosed as atypical squamous cells of undetermined significance (38 cases), low-grade squamous intraepithelial lesion (12 cases), high-grade squamous intraepithelial lesion (HSIL) (33 cases), and invasive carcinoma (15 cases). The concordance rate between the cytologic and histologic diagnoses was found to be higher in high-grade lesions compared with low-grade lesions. Immunohistochemistry revealed that all HSIL and invasive carcinoma cases contained p16-positive cells in the liquid-based Pap smears and diffuse p16 staining was observed in all high-grade lesions with greater than CIN Grade 3 cervical intraepithelial neoplasia except for two adenocarcinoma cases. Of the 98 cases, 60 were found to be positive for high-risk HPV and 55 of these 60 HPV-positive cases were found to be p16 positive on cytologic examination. There were 16 cases that demonstrated marked discrepancies between the cytologic and histologic diagnoses. CONCLUSIONS: The results of the current study confirmed that the immunohistochemical detection of p16 was more sensitive and specific than HPV status in cervical lesions using a liquid-based method as well as tissue samples, suggesting that p16 should be used as a satisfactory biomarker for the primary screening of cervical cytology.     

应用内镜下碘染色在食管癌高发区进行普查的意义

背景与目的：食管癌的死亡率一直居高不下,主要是由于其早诊率较低。为提高食管癌的早诊率,本研究探讨在我国食管癌高发区应用直接内镜下碘染色进行普查提高食管癌早诊率的可行性。方法：应用直接内镜下碘染色在我国食管癌高发区对3164名高危人群进行3次普查,每个普查对象均在着色区取一块活检组织,且每例可疑病例也均在食管的不着色区取活检组织作病理检查,然后将食管鳞状上皮的着色情况与其对应的病理检查结果进行对照。结果：（1）早期食管癌100％碘染色阳性,染色级别多为I级。早期食管癌检出率为1．6％－4．59％,中晚期食管癌的检出率为0．29％－1．09％,食管癌的早诊率均在75％以上。（2）食管鳞状上皮重度不典型增生95．6碘染色阳性,其中91．3％病例碘染色级别为I和Ⅱ级。食管鳞状上皮重度不典型增生检出率为4．49％－7．68％。（3）中度不典型增生96．6％碘染色阳性,73．3％病变染色级别为Ⅱ和Ⅲ级。（4）92．3％轻度不典型增生碘染色阳性,86．5％病变染色级别为Ⅱ和Ⅲ级。（5）而只有0．9％的炎症和0．4％的正常组织碘染色级别为I和Ⅱ级,正常组织大多数为阴性或Ⅲ级。结论：在食管癌高发区应用直接内镜下碘染色进行普查,对早期食管癌及其癌前病变有较高的检出率。     

食管癌,胃癌常用筛查诊断方法比较

在食管癌、胃癌高发区农村,对35岁以上男女476人,采用同步盲法依次应用肿瘤耳部信息诊断仪、隐血珠、拉网细胞学、胃镜、刷片、组织学活检6种方法进行了筛查诊断,并应用判定矩阵统计学方法对其敏感性、特异性、符合率、正确指数、阳性预报值、阴性预报值等14项指标进行了综合评价.结果表明食管拉网细胞学检查是普查发现食管癌、贲门癌的较好方法.应用纤维胃镜直视、刷片或活检对于明确诊断有重要作用,但也有一定局限性.对每项检查的费用和效益进行了综合分析,并对普查和临床应用提出了建议.     

No association between HPV infection and the neoplastic progression of esophageal squamous cell carcinoma: result from a cross-sectional study in a high-risk region of China

Esophageal cancer is a leading cause of cancer death, especially in developing countries. In high-risk regions, squamous cell carcinoma is the most common type of esophageal cancer, and its etiology remains poorly understood. The purpose of this study was to evaluate the association between human papillomavirus (HPV) infection and esophageal squamous cell carcinoma (ESCC) and related precursor lesions in a high-risk area of China. We conducted a cross-sectional study among adult inhabitants of Linxian, China. All subjects were interviewed about potential risk factors, had the length of their esophagus sampled by a balloon cytology examination and underwent endoscopy with mucosal iodine staining and biopsy of all unstained lesions. A multivalent HPV hybridization probe, Digene Hybrid Capture II (Gaithersburg, MD), which recognizes high-risk types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68, was used to determine the HPV infection status of the cytologic specimens, and the endoscopic biopsies were used to classify each subject's esophageal disease. 740 subjects completed the cytologic and endoscopic exams, and 702 had adequate cytologic and biopsy specimens. Using a cutpoint of > or =3.0 pg/ml of HPV DNA to define a positive test, HPV positivity was identified in 13% (61/475) of subjects without squamous dysplasia, 8% (8/102) with mild dysplasia, 7% (6/83) with moderate dysplasia, 16% (6/38) with severe dysplasia and zero (0/4) with invasive ESCC. Changing the cutpoint defining a positive test did not change the association of HPV infection and dysplasia grade. In this high-risk population, infection of esophageal cells with high-risk HPV types occurs in 13% of asymptomatic adults with no evidence of squamous dysplasia and a similar proportion of individuals with mild, moderate or severe dysplasia. This suggests that HPV infection is not a major risk factor for ESCC in this high-risk Chinese population. Further studies are warranted to determine if infection with this agent is associated with neoplastic progression in a subset of cases.     

Ultrasonically guided fine-needle biopsy of space-occupying lesions in liver

105 patients with liver space-occupying lesions were biopsied with fine-needle guided by ultrasound. Smear cytologic examination was performed in all and histologic examination was done simultaneously in some. The diagnosis accuracy rate was 95.2%, sensitivity was 94.9%, specificity was 96.2% which were higher than those diagnosed by ultrasound only (accuracy rate 86.7%) and no complications occurred. The results of cytology, histology and both methods combined are analysed and compared. It shows that the combined examination may increase the diagnosis accuracy rate.     

河南林县食管癌防治研究现场普查工作中X线诊断早期食管癌的经验

 1984年，中国医学科学院肿瘤研究所医务人员在河南林县食管癌高发区进行了食管癌普查，X线检查177例，均为细胞学发现有鳞癌细胞者。X线诊断早期癌122例，高度可疑早期癌21例，X线阴性34例。食管镜及病理证实早期癌160例，食管上皮不典型增生17例。所有病例作了X线与食管镜的对照观察。X线诊断的准确性为81.4%，敏感性为84.3%，假阳性为4.4%，假阴性14.1%。以上结果表明X线检查在早期食管癌的诊断中有较重要的作用，但是最后的诊断需内镜与病理证实。     

经支气管针吸活组织检查术对肺癌的诊断价值及其安全性

目的探讨支气管针吸活组织检查术（TBNA）在肺癌诊断中的价值及其安全性。方法回顾性分析82例胸部CT提示纵隔、肺门淋巴结肿大或支气管周围肿物患者TBNA的细胞学结果。标本采用新柏氏细胞学检测。结果82例患者中TBNA阳性者43例,阳性率为52．4％。其中,小细胞癌18例,鳞癌11例,腺癌9例,未定型癌5例。39例表现为管壁外压伴黏膜改变的患者,TBNA、冲洗、刷检、钳检阳性率分别为64．1％、7．7％、25．6％、48．7％,总阳性率为76．9％。43例黏膜正常者单纯行TBNA检查,18例阳性,阳性率为41．9％。82例TBNA均未出现明显并发症。结论TBNA扩大了支气管镜的检查范畴,提高了内镜诊断阳性率,是常规支气管镜检查的重要补充手段,安全性好,值得临床进一步推广应用。