细胞图像光度学计量对鉴别诊断小细胞型乳腺癌的价值研究

目的:探讨小细胞型乳腺癌针吸细胞图像的光度学特征及与乳腺良性病变之间的量化差异和鉴别价值。方法:用MPIAS—500多媒体病理细胞图像分析仪,对22例小细胞型乳腺癌的针吸细胞分胞体、胞核和胞浆三大结构进行了细胞图像光密度值9项指标的计量研究,并以20例乳腺良性病变做对照。结果:在9项指标中小细胞型乳腺癌有6项指标与乳腺良性病变差异非常显著(P<0.01), 其中胞体1项,胞核2项,胞浆3项;有3项指标差异显著(P<0.05)。结论:利用细胞图像分析仪对小细胞型乳腺癌进行光度学分析,其多参数的光密度指标对协助针吸细胞学鉴别诊断小细胞型乳腺癌有重要参考价值。     

细胞形态在乳腺良恶性病变中的体视学定量研究

本文采用ＭＰＩＡＳ－５００多媒体病理图文分析系统对５０例乳腺癌及３０例乳腺良性病变细胞形态进行了多参数的体视学定量研究。在２６项参数中有２３项参数乳腺癌与乳腺良性病变差异非常显著（Ｐ＜００１），２项差异显著（Ｐ＜００５），１项无显著性差异（Ｐ＞００５）。同时对定量参数进行灵敏度和特异度评估测算，有１５项参数特异度达９０％以上，其中７项参数达１００％；灵敏度９项参数达９０％以上。本文研究结果充分揭示了乳腺良恶病变细胞的立体形态学特征，其多参数的定量结果对鉴别诊断乳腺良恶性病变有重要价值     

BRCA1在散发性乳腺癌中的表达及意义

目的探讨BRCA1在散发性乳腺癌发生发展中的作用.方法应用免疫组化技术对5例正常乳腺组织、10例良性病变乳腺组织及55例乳腺癌组织进行BRCA1免疫染色,比较BRCA1在良恶性乳腺组织中表达差异以及与乳腺癌临床病理特征之间的关系.结果BRCA1在全部良性乳腺组织中均呈阳性显色,BRCA1染色深度分级中3+细胞占100%,阳性细胞数分级中4+细胞占100%,其全部定位于细胞核.然而只有80%(44/45)的乳腺癌组织BRCA1呈阳性反应,BRCA1染色深度分级中3+细胞只占22%,阳性细胞数分级中4+细胞只占22%,其亚细胞定位除细胞核外,也见于胞浆甚至胞核和胞浆同时存在.Ⅰ级、Ⅱ级、Ⅲ级乳腺癌其阳性细胞数分级中3+～4+细胞分别占70%、50%、10%;染色深度分组中2+～3+细胞分别占77%、66%、20%;细胞核定位率分别为77%、75%及40%.上述差异均有统计学意义(P＜0.05).BRCA1与乳腺癌组织学分型、肿块大小及发病年龄无相关关系.结论BRCA1在乳腺癌组织中表达下降,亚细胞定位异常,可能参与散发性乳腺癌的发生发展.     

细胞黏附分子CD15在乳腺癌的表达及与C—ebB—2、nm23、cath—D的关系

目的　研究细胞黏附分子CD1 5在乳腺癌表达的临床病理意义及其与C erbB 2、nm2 3、cath D相互关系。方法　应用了微波修复免疫组化技术S-P法检测了 84例乳腺癌及 2 0例乳腺良性病变中CD1 5的表达。结果　CD1 5主要在肿瘤细胞膜及细胞浆内表达 ;在乳腺良性病变阳性率低 (2 0 % ) ,在乳腺癌中阳性率为 57.1 4 % (48/84) ,其表达与乳腺癌组织学分级高、淋巴结有转移、C erbB 2表达、cath D间质表达呈正相关 ;而与nm2 3表达负相关。结论　细胞黏附分子CD1 5在乳腺癌细胞增殖、分化及转移过程中发挥重要作用 ,其表达可作为反映乳腺癌低分化及易转移的有用指标     

小细胞型乳腺癌细针吸取细胞学诊断探讨

目的:探讨小细胞型乳腺癌细针吸取细胞学诊断要点及鉴别诊断.方法:分析26例小细胞型乳腺癌临床、细针穿刺和细胞学特点,同时与64例乳腺增生症、82例乳腺纤维腺瘤对照.结果: 26例小细胞型乳腺癌:≥40岁、穿刺针感脆样或偏软均占88.5%(23/26),穿刺容易吸出物质占80.8%(21/26),以散在或小细胞群为主、圆形细胞核占绝大多数、核间疏松排列均占76.9%(20/26),排列杂乱、无极性占84.6%(22/26),腺腔样、腺管样、爆竹样、栅栏样排列分别为61.5%(16/26)、34.6%(9/26)、19.2%(5/26)、30.8%(8/26),散在细胞中等量以上、圆形核占绝大多数均占84.6%(22/26),胞浆完整88.5%(23/26),未见肌上皮细胞92.3%(24/26),均明显高于乳腺增生症、乳腺纤维腺瘤的相对病例数,差异有统计学意义,均P＜0.01;细胞数量多的占69.2%(18/26),明显高于乳腺增生症4.7%(3/64),P＜0.01;黏液变的纤维间质成分及其与乳腺上皮细胞混杂均0例,明显低于乳腺纤维腺瘤的98.6%(80/82)、75.6%(62/82),均P＜0.01.结论:细胞量较多,以小细胞群或散在细胞为主,细胞排列松散、紊乱无极性,易见腺腔、腺管、爆竹、栅栏等特殊排列,胞浆完整、核圆形,散在细胞较易见,肌上皮细胞不见,≥40岁,穿刺针感脆样或偏软、容易吸出物质等是小细胞型乳腺癌细针吸取细胞学诊断要点,与乳腺增生症、乳腺纤维腺瘤可以鉴别.     

乳腺癌针吸细胞形态定量的人工神经网络诊断模型的建立及应用研究

目的 建立乳腺癌针吸细胞形态定量参数的人工神经网络诊断模型，并验证其在辅助FNA诊断乳腺癌的价值。方法 利用MPIAS-2000系统对60例乳腺癌及30例乳腺良性病变的针吸细胞学涂片进行形态定量测定，对获得的29项形态参数进行人工神经网络建模分析，并用盲法对其鉴别诊断能力进行评价。结果 所建立的网络模型经过14次训练后即可达到误差要求，诊断模型对乳腺癌及乳腺良性病变的诊断正确率为100％，其特异性和敏感性均为100％。结论 乳腺良恶性病变的针吸细胞学涂片进行ANN分析所建立的诊断模型，对乳腺癌及良性病病变的鉴别诊断具有较高的应用价值，为辅助针吸细胞学诊断乳腺良恶性病变提供了新的思路。     

紫外线照射对乳腺癌细胞NFkB、p53和MDM2的影响

目的　了解NFkB家族蛋白在乳腺癌细胞系的表达及紫外线照射后所引起的变化。方法　用L_15培养液培养并传代 9个乳腺癌细胞系 ,收获细胞 ,对其进行胞浆、胞核蛋白质提取 ,Western印迹法观察NFkB家族蛋白及其抑制物的表达 ;采用 2 0J/m2 剂量紫外线照射细胞 ,继续培养细胞并提取蛋白质进行检测。结果　 9个乳腺癌细胞系p5 0、p65和IkB_α胞浆表达阳性率分别为 :88 9%、5 5 6%、77 8% ,胞核表达阳性率分别为 :66 7%、44 4%、2 2 2 %。紫外线照射后胞核p5 0、p65和IkB_α阳性率分别为 :10 0 %、10 0 %、3 3 3 %。p5 3在乳腺癌细胞表达阳性率为 44 4% ,MDM2表达阳性率为 3 3 3 % ,紫外线照射后p5 3和MDM2表达阳性率分别为 :66 7%、77 8%。结论　NFkB、p5 3和MDM2与乳腺癌细胞的发生、发展有关。紫外线照射可引起胞核NFkB及细胞MDM2阳性率明显提高 ,NFkB和MDM2可望成为判断乳腺癌预后新的标志物。     

尿激酶型纤溶酶原uPA和P27蛋白在乳腺癌中的表达及其意义

目的　探讨正常乳腺组织、良性病变乳腺组织、乳腺癌中uPA和P2 7蛋白的表达水平及其意义。方法　应用免疫组织化学方法对 8例正常乳腺组织、2 4例良性病变乳腺组织及 66例乳腺癌中uPA、P2 7蛋白的表达进行测定。结果　uPA和P2 7蛋白在 66例乳腺癌中的高表达率分别为 5 7.6%、5 3 .0 % ,uPA在乳腺癌中的表达水平明显高于正常和良性病变乳腺组织 (P <0 .0 5 ) ;而P2 7蛋白在乳腺癌的表达水平明显低于正常和良性病变乳腺组织 (P <0 .0 5 )。uPA和P2 7蛋白在乳腺癌中的表达有显著相关性 ,它们与乳腺癌的病理学特征显著相关。结论　P2 7蛋白和uPA的表达水平可能与乳腺癌的发生、发展和预后有关 ,而且对于指导乳腺癌的治疗有一定的临床意义。     

肝细胞癌DNA干系倍体分析及其临床意义

目的:测量与分析肝细胞癌DNA干系倍体及其临床意义。方法:使用TIGER细胞图像分析仪测量 4 5例肝细胞癌组织 4 μm、10 μm切片上DNA干系倍体值。4 μm组织切片测量肝细胞癌细胞核DNA的光密度,10 μm组织切片测量单个完整肝细胞癌细胞核的体积,经TIGER细胞图像分析仪计算获得以单个完整肝细胞癌细胞核体积为单位的DNA总量(以体积积分光密度表述),以同一切片内正常淋巴细胞作为内对照,计算其DNA干系倍体值。结果:⑴无 1例DNA干系倍体为二倍体;DNA干系倍体值在 2～ 5范围者 11例;在 5～ 8范围者 2 8例;大于 8者 6例。⑵DNA干系倍体与瘤体大小、有无淋巴结转移、组织学分级、术后生存率等有相关性。结论:DNA干系倍体能较准确反映肝细胞癌的生物学特性,为认识肝细胞癌的病理学特征以及判断预后提供了有价值的客观依据。     

乳腺肿瘤中DNA含量、Ki-67指数、肿瘤微血管密度（MVD）的定量研究

 目的 探讨DNA含量、Ki-67指数、肿瘤微血管密度（MVD）在乳腺肿瘤中意义、相关关系及计算机图象分析技术在肿瘤研究中的应用。方法 运用计算机图像分析系统对60例乳腺癌、28例乳腺癌前病变、25例乳腺良性病变中Ki-67、MVD及DNA含量进行定量检测。结果 Ki-67标记指数、微血管密度、细胞DNA相对倍体均值（U值）按乳腺良性病变、乳腺癌前病变及乳腺癌的顺序呈递增趋势，且随乳腺癌分级的增高而显著增高。结论 DNA相对倍体均值（U值）和Ki-67标记指数均能较好地反映肿瘤细胞增生活性。肿瘤MVD反映血管生成，是恶性实体性肿瘤生长和增殖的基础，是淋巴结转移的重要因素。计算机图像分析仪能够对肿瘤的组织切片进行多种参数的自动测量分析，为乳腺癌的自动化诊断及淋巴结转移判断提供方便。它将逐步应用到临床病理诊断工作中。     

基于人工神经网络的诊断模型对针吸细胞学诊断小细胞型乳腺癌的应用研究

目的探讨人工神经网络（ANN）诊断模型对小细胞型乳腺癌的针吸细胞学诊断价值。方法利用MPIAS-2000系统对60例乳腺癌及30例乳腺良性病变针吸细胞的29项形态定量参数进行定量分析，建立人工神经网络诊断模型，对19例小细胞型乳腺癌进行人工神经网络诊断模型的判别分析。结果人工神经网络诊断模型对小细胞乳腺癌及良性病变的诊断特异性为100％，敏感性为84．2％。结论利用乳腺癌针吸细胞形态定量的人工神经网络诊断模型，对辅助针吸细胞学诊断小细胞型乳腺癌具有重要的参考价值。     

Detection of residual subclinical ovarian carcinoma after completion of adjuvant chemotherapy.

PURPOSE: We sought to test the hypothesis that the presence of telomerase activity in peritoneal washings of patients treated for ovarian carcinoma is a sensitive and specific indicator of the presence of residual disease. We hypothesized that this test, if added to second-look procedure protocols, could help determine whether residual disease is present or not in patients who have completed their adjuvant chemotherapy for ovarian carcinoma. EXPERIMENTAL DESIGN: Peritoneal washings were obtained from 100 consecutive patients undergoing a second-look procedure after treatment for ovarian carcinoma (cases) and from 100 patients undergoing surgery for benign gynecological conditions (controls). The washings were assayed for telomerase activity using the telomerase repeat amplification protocol. The results were compared to the histological and cytological findings. RESULTS: Among our 100 cases, 82 (82%) had either positive second-look procedures or expressed telomerase in their peritoneal washings. Fifty-three (53%) had positive second-look procedures, whereas 66 (66%) tested positive for telomerase. Twenty-nine of the 47 patients (62%) with negative second-look procedures tested positive for telomerase. Of the 53 patients with positive second-look procedures, 37 (70%) tested positive for telomerase. None of the 100 controls (0%) expressed telomerase in their peritoneal washings. CONCLUSIONS: Telomerase activity in peritoneal washings of patients treated for ovarian carcinoma and undergoing a second-look procedure may provide a means of increasing the sensitivity of such procedures for the detection of residual disease while maintaining a high level of specificity.     

利用基质辅助激光解析电离飞行时间质谱联合磁珠技术寻找乳腺癌血清蛋白标志物

目的探索乳腺癌与乳腺良性疾病和健康人血清蛋白质谱表达差异,寻找具有鉴别诊断意义的血清蛋白标志物。方法实验分为两大组：（1）决策树模型组共293例标本,包括3个亚组,分别为乳腺癌组110例标本、乳腺良性疾病组113例和健康组70例,建立决策树（乳腺癌诊断）模型;（2）盲法验证组共34例标本,包括3个亚组分别为乳腺癌组7例标本、乳腺良性疾病组13例及健康组14例,进行盲筛验证决策树模型。采用弱阳离子磁珠捕获乳腺癌患者血清中的蛋白,使用基质辅助激光解析电离飞行时间质谱（MALDI—TOF—MS）仪检测绘制蛋白峰。应用Biomarker Wizard TM3．1软件和Biomarker Patterns TM5．0软件分析数据。统计分析采用方差分析法和秩和检验法。计算决策树模型诊断的准确率以及盲法验证模型诊断乳腺癌的敏感性和特异性。结果在决策树模型组中检测到了47个差异有统计学意义的蛋白峰（P〈0．050）。应用BPS5．0软件,以相对损失最小的原则从这47个蛋白峰中选取了4个蛋白峰,分别为相对分子质量（Mr,本文中相当于质荷比m／z）9292．5、Mr11707．2、Mr15504．5和Mr16107．9,用其建立决策树模型（乳腺癌诊断模型）。该模型判断乳腺癌、乳腺良性疾病及健康人的准确率分别为99．09％、95．58％、92．86％。盲法验证该模型诊断乳腺癌的敏感性为71．43％,特异性为88．89％。结论应用MALDI—TOF—MS联合磁珠技术可以检测乳腺癌血清中差异蛋白峰并可以建立决策树（乳腺癌诊断）模型。选择的4个差异蛋白蜂建立的决策树模型诊断乳腺癌具有好的准确性和较好的敏感性及特异性。决策树模型能将乳腺癌与乳腺良性疾病及健康人相鉴别。寻找到的Mr9292．54、Mr11707．2、Mr15504．5以及Mr16107．9的蛋白峰有望成为鉴别乳腺癌与乳腺良性疾病和健康人的有效的肿瘤血清蛋白标记物。     

High-grade atypical epithelial cells in pancreatic mucinous cysts are a more accurate predictor of malignancy than "positive" cytology

BACKGROUND:

The Sendai guidelines for risk assessment of malignancy in patients with mucinous cysts lists “positive” cytology as a high‐risk feature. In the current study, the authors hypothesized that a cytological threshold of high‐grade atypical epithelial cells (AEC) is a more accurate predictor of malignancy.

METHODS:

The clinical, radiological, and cytological data of 112 patients with histologically confirmed mucinous cysts of the pancreas were reviewed. Cytology slides were blindly reviewed and cells were classified as benign, AEC, or malignant. On histology, neoplasms were grouped as benign (low‐grade and moderate dysplasia) and malignant (high‐grade dysplasia/carcinoma in situ and invasive carcinoma).

RESULTS:

There were 92 patients with an intraductal papillary mucinous neoplasm (IPMN) and 20 with a mucinous cystic neoplasm; 39 were malignant and 73 were benign (42 with low‐grade dysplasia and 31 with moderate dysplasia). Only 28% (11 of 39) of the malignant cysts were cytologically malignant with a sensitivity of 29%, a specificity of 100%, and an accuracy of 75%. AEC detected 17 additional cancers (44% of all malignant cysts; 16% more than detected on the basis of “positive” cytology). By using AEC as a surgical triage threshold, the sensitivity was 72%, the specificity was 85%, and the accuracy was 80%, with similar values for small (≤3 cm) branch duct IPMN. Nine of 73 (12%) benign cysts were identified with AEC, 4 of which had moderate dysplasia. AEC had a positive predictive value of 87% for the detection of a mucinous cyst with moderate dysplasia or worse.

CONCLUSIONS:

AEC are a more accurate predictor of malignancy than “positive” cytology in aspirates of pancreatic mucinous cysts, including small branch duct IPMN. AEC warrant a “suspicious” interpretation for appropriate surgical triage. Cancer (Cancer Cytopathol) 2010;. © 2010 American Cancer Society.     

CT结肠造影对结直肠癌的诊断价值

目的:探讨CT结肠造影(CTC)技术在结直肠癌术前诊断与分期中的应用价值。方法:对临床怀疑结直肠癌的33例患者进行CTC检查,将影像学结果与病理结果进行比较,分析CTC的敏感性与特异性。结果:22例患者CTC诊断为结直肠癌,其中20例被病理证实,CTC对结直肠癌诊断的敏感性为100%(20/20),特异性为84.6%(11/13)。CTC对结直肠癌分型诊断符合率为90%(18/20),其中对肿块型诊断的敏感性为100%,特异性为100%;对浸润型诊断的敏感性为77.8%,特异性为100%;对溃疡型诊断的敏感性为100%,特异性为85.7%。CTC对结直肠癌分期诊断符合率为75%,对Duke'sA期病变诊断的敏感性为100%,特异性为94.1%;对B期病变诊断的敏感性为80%,特异性为73.3%;对C期病变诊断的敏感性为60%,特异性为100%;对D期病变诊断的敏感性为71.4%,特异性为100%。结论:CTC检查能够提供多方面的诊断信息,对结直肠癌的诊断及术前分期都很有价值。     

Mammography and ultrasound imaging of preinvasive and invasive canine spontaneous mammary cancer and their similarities to human breast cancer

Understanding the evolution of proliferative breast disease such as atypical hyperplasia and carcinoma in situ is essential for clinical management of women diagnosed with these lesions. Therefore, an animal model that faithfully represents human breast disease in every aspect from spontaneity of dysplasia onset, histopathologic features, and genetics to clinical outcome is needed. Previously, we studied canine spontaneous atypical hyperplasia and ductal carcinoma in situ (low, intermediate, and high grade) and reported their similarities to human lesions in histopathologic and molecular features as well as prevalence. To further validate the resemblance of these lesions to humans, we examined their mammographic and sonographic characteristics in comparison with those of human's as well as the potential of the human Breast Imaging Reporting and Data System (BI-RADS) to predict canine disease. Nonlesional, benign, and malignant mammary glands of dogs presented to Sassari Veterinary Hospital were imaged using mammography and ultrasonography. The images where then analyzed and statistically correlated with histopathologic findings and to their similarities to humans. Our results showed that canine mammary preinvasive lesions, benign, and malignant tumors have mammographic abnormalities, including the presence, pattern, and distribution of macrocalcification and microcalcification, similar to their human counterparts. BI-RADS categorization is an accurate predictor of mammary malignancy in canine, with 90% sensitivity and 82.8% specificity. The similarities of mammographic images and the ability of BI-RADS to predict canine mammary malignances with high specificity and sensitivity further confirm and strengthen the value of dog as a model to study human breast premalignancies for the development of prognostic biomarkers.     

Moc-31, fibronectin and CEA in the differential diagnosis of malignant effusions: An immunocytochemical study

In discriminating benign and malignant origins of cytologically suspicious effusion smears a panel of antibodies against carcinoembryonic antigen (CEA), Fibronectin (F) and MOC-31 was used with immuno-cytochemical techniques. One hundred and thirty seven effusions were studied of which 107 had a malignant and 30 a benign aetiology as determined by clinical and histological examination. Cytologically 24 were diagnosed as benign, 97 as malignant and 14 as suspicious. Staining for F was positive in all effusions of benign and 3 of malignant origin. MOC-31 was positive in 95 (88.8%) of effusions of malignant origin but none of benign origin. Positive CEA was observed in 43% of effusions of malignant origin and in 10 of benign origin. The combination of MOC-31 positivity measured the sensitivity and specificity of the cytological examination in cases where the cytological examination result was suspicious as did F positivity improve the sensitivity for a benign origin of the effusion. Positivity or negativity for CEA is less valuable than the other parameters.