乳腺癌手术创面脱落癌细胞的临床研究

目的探讨乳腺癌手术创面脱落癌细胞与临床病理分期的关系,为术中采用杀灭脱落癌细胞的措施提供理论依据。方法对１０９例乳腺癌患者手术创面冲洗液进行细胞学检查,并将其中１０４例的结果与临床病理结果做对比分析。结果本组１０４例患者,脱落癌细胞阳性者３６例,占３４．６％。Ⅰ期、Ⅱ期及Ⅲ期乳腺癌患者手术创面脱落癌细胞检出率分别为３．８％、２９．８％和８５．７％。Ｔ１、Ｔ２和Ｔ３以上癌细胞检出率依次为１０．８％、３３．３％和７７．３％。腋淋巴结转移数目４枚以上者手术创面脱落癌细胞阳性率为７６．０％,而无腋淋巴结转移者仅１３．５％。结论乳腺癌手术结束时,采用杀灭或去除手术创面脱落癌细胞的措施,是必要的。     

乳腺癌患者手术创面冲洗液细胞学检查的价值

目的　观察乳腺癌患者手术创面脱落癌细胞与临床病理分期的关系 ,为术中采用杀灭脱落癌细胞的措施提供依据。　方法　对 2 6 2例乳腺癌患者手术创面冲洗液进行细胞学检查 ,并将结果与临床病理分期做对比分析。　结果　本组患者脱落癌细胞阳性者 6 3例 ,占 2 4%。Ⅰ、Ⅱ、Ⅲ、Ⅳ期乳腺癌患者脱落癌细胞检出率分别为 5 3%、2 7 1%、79 3%、10 0 %。T1、T2 和T3 以上者 ,脱落癌细胞检出率分别为 6 1%、18 9%、5 1 3%。腋淋巴结转移数目超过 3枚者 ,脱落癌细胞阳性率为5 8 6 % ;而转移数目≤ 3个和无腋淋巴结转移者 ,阳性率分别为 14 3%、14 1%。　结论　乳腺癌患者手术创面脱落癌细胞检出率随着肿瘤增大、病期进展、淋巴结转移数目的增多而增加 ,术中创面采用杀灭脱落癌细胞的措施是必要的。     

直肠癌全直肠系膜切除术

目的 比较全直肠系膜切除（ＴＭＥ）和传统手术方法对直肠癌术后局部复发及长期生存率的影响。方法 将１９９３年９月起采用ＴＭＥ术的直肠癌患１６８例与１９８１～１９９２年行传统切除方法的１２６例患进行比较,分析两组的临床病理参数。结果 手术后并发症发生率无差异,ＴＭＥ组２年复发率为４．６％,明显低于对照组的２０．６％（Ｐ＝０．００１）,２年及３年生存率ＴＭＥ组分别为８７．１％和８０．３％,对照组分别为７６．１％和６８．７％,ＴＭＥ组生存率高于对照组（Ｐ＝０．０１３）。ＴＭＥ技术、肿瘤的Ｄｕｋｅｓ分期,患的年龄、肿瘤距肛门的距离等因素中,只有ＴＭＥ是独立影响生存率的指标,ＴＭＥ、肿瘤的Ｄｕｋｅｓ分期是独立的影局部复发的指标,结论 对于距离肛门１２ｃｍ范围内的直肠癌,采用ＴＭＥ技术能有效地降低局部复发率及提高患生     

经腹壁超声在膀胱肿瘤诊断与分期中的意义

行经腹Ｂ超检查临床疑诊为膀胱肿瘤患者２９９例，经与膀胱镜检和术后病理结果对照，２７１例证实为膀胱肿瘤，１０例为非膀胱肿瘤，１８例经腹Ｂ超漏诊。本组经腹Ｂ超诊断准确率为９０．６％（２７１／２９９），误诊率为３．３％（１０／２９９），漏诊率为６．０％（１８／２９９）。经腹壁超声判断膀胱肿瘤分期总的正确率为８８．６％（Ｔ_１期肿瘤８９．１％，Ｔ_２期为８６．８％，Ｔ３期为８７．５％，Ｔ_４期为１００．０％）。经腹壁超声方法简单，患者无痛苦，对膀胱肿瘤诊断与分期的准确性较高，应作为膀胱肿瘤的常规检查方法。     

肾盂癌P16蛋白的表达及意义

目的 探讨Ｐ１６蛋白与肾盂癌病分级、临床分期、预后及肿瘤增生活性的关系。方法：采用免疫组织化学技术对３１例肾盂癌标本中Ｐ１６蛋白表达进行检测。结果 ３１能盂癌Ｐ１６蛋白表达阳性率为５８．１％，其中Ⅰ级、Ⅱ级和Ⅲ级肿瘤阳性率分别为７５．０％、６６．７％和２５．０％（Ｐ〈０．０５），Ｔ１～Ｔ２和Ｔ３～Ｔ４期肿瘤阳性率分别为６６．７％和４６．２％（Ｐ〈０．０５）。显示Ｐ１６蛋白表达阳性率随肾盂癌病理分级     

近红外线扫描及彩色多普勒超声对乳腺癌的诊断价值比较

为了提高乳腺癌诊断的准确性，我们拟用病理结果为金标准以探讨近红外线扫描和彩色多普勒超声联合应用对乳腺癌的诊断价值。１资料和方法１．１临床资料本组病例均系我院门诊或住院的女性患者，年龄２０～６７岁。乳腺癌５１例，其中Ｔ０期３例，Ｔ１期２７例，Ｔ２期１８...     

食管癌术前分期评价：食管腔内超声,计算机断层扫描？…

比较食管腔内超声计算机断层扫描和临床分期对食管癌术前分期的价值。方法３６例食管癌患者，术前均进行ＥＵ检查，其中８例因管腔严重狭窄末获得全面评估。２１例进行了ＣＴ分期。ＥＵ、ＣＴ和传统临床分期结果分别与手术病理分期比较。结果传统临床分期确率仅为３６％，ＣＴ对肿瘤浸润程度，局部淋巴结受累及ＰＩＮＭ分期的准确率分别为３８．１％、５７．１％和４７．６％，ＥＵ为７７．８％、７２．２％和７０．２％，去除严重狭     

不同术式对T_1乳腺癌病人的疗效评估

目的：探讨不同术式对Ｔ１乳腺癌的疗效。方法：观察Ｈａｌｓｔｅｄ术、改良根治术和乳房象限切除加腋淋巴结清扫术对２７４例Ｔ１乳腺癌病人预后的影响;并分析全部病人的腋淋巴结转移情况。结果：Ｔ１乳腺癌病人１０年生存率为８４．７％;标准根治术与改良根治术后病人的１０年生存率分别为８０．５石％和８４．１％（Ｐ＞０．０５）;乳房象限切除加腋淋巴结清除术与根治术相比,Ｔ１Ｎ０Ｍ０病人的１０年生存率分别为１００％和９０．４％（Ｐ＞０．０５）;全组腋淋巴结转移率为２７．７％;９７．４％的转移淋巴结位于低位组。结论：３种术式治疗Ｔ１乳腺癌病人的效果相同,从美观及心理因素上考虑,提倡行保守性手术;２／３以上Ｔ１病人无腋淋巴结转移,一律行腋淋巴结清除对预后意义不大,前哨淋巴结活检可以解决这一问题;腋淋巴结转移绝大多数在低位组,在不能进行前哨淋巴结活检的情况下,可仅清除低、中位淋巴结。     

82例晚期食管癌的外科治疗

我们自１９８６～１９９７年为８２例晚期食管癌患者施行了食管次全切除、颈部食管胃吻合术,效果良好。１　临床资料与方法１．１　一般资料　本组８２例中,男５６例,女２６例。年龄４８～７２岁,平均６１岁。食管上段癌３例,中段癌５３例,下段癌２６例。病变长度５～１２ｃｍ,平均７．５ｃｍ。ＴＮＭ分期：Ｔ３Ｎ１Ｍ０２３例,Ｔ４Ｎ１Ｍ０５１例,Ｔ４Ｎ２Ｍ０８例。肿瘤侵及主动脉５４例（６５．８５％）,侵及左肺下叶２例（２．４４％）,侵及奇静脉３例（３．６６％）。病理检查：鳞状细胞癌７９例,腺癌３例。颈胸腹共切除淋…     

食管腔内超声在食管癌患者中的应用

目的研究经食管探头超声仪（ＴＥＥＰ）在食管癌诊断和治疗中的应用价值。方法１９９６年９月至１９９７年８月,３２例食管癌患者术前进行上消化道钡餐、纤维胃镜和ＴＥＥＰ等检查。其中７例患者术前予以ＣＴ扫描检查。所有患者切除的标本,包括淋巴结,均送病理检查,并将术前ＴＥＥＰ和ＣＴ检查情况与术中、术后病理结果进行对比分析。结果纤维胃镜、ＴＥＥＰ和病理所测的肿瘤长度分别为４５２４±１８０６ｃｍ（ｘ±ｓ）、５２６９±１９１６ｃｍ（ｘ±ｓ）和５３４５±１９０１ｃｍ（ｘ±ｓ）。纤维胃镜测的肿瘤长度与病理结果比较,差异有显著性意义（Ｐ＜００５）,而ＴＥＥＰ测的肿瘤长度与病理结果比较,差异无显著性意义（Ｐ＞００５）。ＴＥＥＰ术前Ｔ、Ｎ分期的准确率分别为８０６％（２５／３１）和７７３％（３３／４４）,而ＣＴ术前Ｔ分期的准确率仅为４２９％（３／７）。结论对于食管癌的术前ＴＮ分期,ＴＥＥＰ是一项可靠的检查手段。ＴＥＥＰ比ＣＴ准确。在测量食管癌肿瘤长度时,ＴＥＥＰ比胃镜精确。该检查手段安全,在我们的临床应用中,未出现任何并发症。     

腹腔镜下进展期胃癌根治术中腹腔游离癌细胞检测的意义

目的探讨腹腔镜下进展期胃癌根治术对腹腔脱落肿瘤细胞检测的影响,并探讨提高腹腔游离癌细胞检出率的方法。方法选取华中科技大学同济医学院附属协和医院胃肠外科35例初治的进展期胃癌病人,行腹腔镜下胃癌根治术。所有病人分别在术中探查前及关腹前各行一次腹腔冲洗,并收集灌洗液。比较两组灌洗液中肿瘤脱落细胞阳性检出率及肿瘤标志物上皮膜抗原(epithelial membrane antigen,EMA)、癌抗原(carbohydrate antigen,CA)125、CA19-9和癌胚抗原(carcinoembryonic antigen,CEA)的表达情况。结果35例进展期胃癌病人探查前腹水或腹腔灌洗液中涂片细胞学检查中检出阳性率为5.7%(2/35),关腹前为5.7%(2/35),两者统计比较差异无统计学意义(P>0.05)。免疫组织化学法检测探查前与关腹前腹水或腹腔灌洗液中EMA的表达(4/35,3/35)比较,差异无统计学意义(P>0.05);两个时间点CA125的表达(1/35,3/35)比较,差异无统计学意义(P>0.05)。探查前腹水或腹腔灌洗液中,腹腔灌洗液脱落细胞学法游离癌细胞检出阳性率为5.7%(2/35),而免疫组织化学法检测EMA的阳性率为11.4%(4/35),两者比较差异有统计学意义(P=0.010);免疫组织化学法检测CA125的阳性率为8.6%(3/35),与腹腔灌洗液脱落细胞学法(2/35)比较,差异有统计学意义(P=0.005);免疫组织化学法联合检测EMA及CA125的阳性率为11.4%(4/35),与腹腔灌洗液脱落细胞学法(2/35)比较,差异有统计学意义(P=0.010)。结论腹腔镜下进展期胃癌根治术并不会增加癌细胞脱落风险,且肿瘤脱落细胞发生率低。但腹腔镜下胃癌根治术后腹腔游离癌细胞的诊断,需要更为有效的检测方法。     

膀胱移行细胞癌患者尿脱落细胞中生存素的检测及其意义

目的:探讨膀胱移行细胞癌(TCCB)患者尿脱落细胞生存素(Survivin)蛋白和mRNA表达及其临床意义。方法:采用免疫组化SP法和巢式逆转录聚合酶链反应方法,对TCCB患者32例(TCCB组)、非TCCB16例(对照组)尿脱落细胞Survivin的蛋白和mRNA进行检测,同时行尿脱落细胞学检查。结果:TCCB组尿脱落细胞Survivin的蛋白、mRNA阳性表达率分别为28例(87.5%),32例(100%);对照组仅1例mRNA阳性表达(6.2%)。两组Survivin阳性率比较差异有统计学意义(P<0.01);尿液中Survivin的敏感性和特异性,分别为87.5%,80%和96.9%,93.8%。而尿脱落细胞阳性率为18例(56.2%),其敏感性和特异性分别为56.2%和100%。结论:尿脱落细胞Survivin检测诊断TCCB的敏感性和特异性均较高,且对患者无创、无痛苦,可作为早期诊断TCCB的敏感指标,其中RT-PCR检测敏感性更高。     

Squamous cell carcinoma of the penis: accuracy of tumor, nodes and metastasis classification system, and role of lymphangiography, computerized tomography scan and fine needle aspiration cytology

Among 118 patients with squamous cell carcinoma of the penis treated at our cancer institute between 1956 and 1989, we analyzed the accuracy of classification, using the tumor, nodes and metastasis system. We analyzed the role of lymphography, computerized tomography and fine needle aspiration cytology as additional staging procedures. The primary tumor (T category) was classified incorrectly in 26% of the cases. Overstaging was noted in 10% of the cases because of unsuspected infiltration and overstaging was noted in 16%. Overstaging occurred because of edema and infection masking the actual size and giving a misconception of infiltration, and also because of primary presentation as large exophytic tumors with no or minimal histopathological infiltration. When the regional lymph nodes were categorized simply as positive or negative 80% of the tumors were classified correctly and 20% incorrectly (13% were false positive and 7% were false negative). Regional lymph node invasion that escaped clinical examination was not detected by any imaging examination or fine needle aspiration cytology study. Positive findings were found only in patients with clinically suspected nodes. The classification of regional nodes by clinical examination only is hardly improved by additional imaging studies. Clinical decisions with respect to the management of regional lymph nodes should not be based on negative findings of lymphangiography, computerized tomography or fine needle aspiration cytology. In patients with proved metastasis additional imaging may be of some help in the detection of pelvic node invasion and the determination of the extent of involvement. We recommend lymphangiography as the examination of choice.     

Prognostic value of peritoneal lavage cytology in gastric cancer

The microscopic detection of free peritoneal tumour cells in peritoneal lavage fluid in gastric cancer patients is a useful predictor of peritoneal recurrence and poor prognosis. The aim of this study was to verify the prognostic significance of intraoperative peritoneal lavage cytology and its value as a predictor of peritoneal recurrence. We evaluated the presence of free peritoneal tumour cells with extemporary cytological examination in a series of 170 peritoneal washing samples from patients undergoing gastrectomy for gastric cancer over the period from January 1992 to June 2001. Twenty-eight patients (16%) had positive extemporary lavage cytology and there were no false-negatives as compared with the final examination. All patients with positive cytology presented serosal infiltration (T3/T4). Positive peritoneal lavage cytology was a predictor of poor prognosis and peritoneal recurrence: the 24 month survival rate was 17% for positive and 60% for negative cases (P = 0.003); in positive cases 71% of recurrences were located in the peritoneum. Intraoperative cytological examination of peritoneal washings can detect the presence of free malignant cells in the peritoneal cavity and can be used to select patients who may benefit from intraperitoneal chemotherapy.     

Clinical evaluation of basic fetoprotein in bladder cancer

PURPOSE: The early diagnosis of bladder cancer allows for effective local treatment and optimizes the success of surgical therapy. Basic fetoprotein (BFP), measured using a rapid latex immuno-agglutination method, was introduced for the detection of transitional cell carcinoma. The objective of this study was to determine whether there was a correlation between urine BFP level and the grade or stage of bladder cancer, and whether the level could serve as a biochemical marker of bladder cancer. MATERIALS AND METHODS: Single voided specimens were obtained from 66 patients with confirmed or suspicious bladder cancer on cystoscopy, urine cytology or BFP. Each sample was divided into 3 aliquots of which 1 was for urine analysis, 1 was tested for BFP according to latex immunoagglutination method and 1 was sent for cytological examination. All patients subsequently underwent bladder biopsy. RESULTS: There were 54 (82%) patients with biopsy confirmed bladder cancer and 12 (18%) with benign conditions of the bladder. Overall sensitivity with BFP and urine cytology was 38.9% and 48.1% respectively. Specificity was 58.3% and 75.0%, and positive predictive value was 80.8% and 89.7%, respectively. The positive rate of BFP and cytology was higher in invasive cancer (75% and 100%, respectively) than in superficial cancer (36% and 28%). There was no correlation between BFP level and tumor grade, while cytology had a strong association. Linear regression analysis showed the significant correlation between BFP level and tumor size (r = 0.695, p < 0.0001). The detection rate of bladder cancer was higher by the combination of BFP and cytology than by using alone. CONCLUSIONS: BFP in conjunction with urine cytology can increase the detection rate of bladder cancer. But BFP alone cannot be used as a screening test for bladder cancer.     

Enhanced bladder cancer detection with the Lewis X antigen as a marker of neoplastic transformation

Recent evidence indicates that the Lewis X determinant is a tumor-associated antigen in the urothelium. Immunohistochemical analyses on frozen and deparaffinized, formalin-fixed tissue sections have demonstrated that the Lewis X antigen is not detected in normal adult urothelium except for occasional umbrella cells. However, papillomas and transitional cell carcinomas express this blood group-related antigen in more than 90% of the cases regardless of the grade or stage of the tumor, or the blood type or secretor status of the individual. To determine the presence of Lewis X antigen on exfoliated bladder epithelial cells we used an anti-Lewis X monoclonal antibody (P-12) and the avidin-biotin-peroxidase technique on 129 bladder barbotage specimens. Of 40 controls 34 were negative for Lewis X antigen, for a specificity of 85%. The 89 bladder tumor patients consisted of 14 with papilloma, 13 with flat carcinoma in situ, 49 with transitional cell carcinoma, and 13 with a positive cytology and negative biopsy results. Of these 89 patients 76 were considered positive for Lewis X antigen, for an over-all sensitivity 85.4%. The sensitivity for cytology alone was 61.2%. However, the combination of a positive cytology and/or positive Lewis X antigen result yielded a sensitivity of 93.2%. The data suggest that immunocytological detection of the Lewis X antigen on exfoliated bladder cells enhances the detection of urothelial tumor cells, particularly from low grade and low stage neoplasms.     

腹腔冲洗液CEA mRNA检测对胃癌微转移的临床评估及意义

目的：评估腹腔冲洗细胞学检查和CEAmRNA检测对胃癌预后的临床意义。方法：收集胃癌及对照（胃良性疾病）组患者的腹腔冲洗液标本,进行腹水细胞病理学和CEA巢式RT-PCR检测,并评价其与临床病理参数的关系。结果：腹水肿瘤细胞检测阳性率为30.3%,CEA巢式RT-PCR检测阳性率为48.5%,其结果与肿瘤分化程度、浸润深度、淋巴结转移和TNM分期有关（P〈0.05）,而与肿瘤的大小无关（P〉0.05）。对照组腹水肿瘤细胞和CEA检测阳性率均为0。结论：胃癌患者腹腔冲洗液CEAmRNA检测可作为判断胃癌侵袭转移、术后复发情况及患者预后的参考指标之一。     

Correlation of upper-tract cytology, retrograde pyelography, ureteroscopic appearance, and ureteroscopic biopsy with histologic examination of upper-tract transitional cell carcinoma

PURPOSE: To determine the accuracy of radiographic studies, ureteroscopy, biopsy, and cytology in predicting the histopathology of upper-tract transitional cell carcinoma (TCC). MATERIALS AND METHODS: From 1998 to 2006, 46 upper-tract lesions were diagnosed ureteroscopically and underwent nephroureterectomy, and 30 of them were subjected to direct ureteroscopic inspection and biopsy. Fresh samples were delivered to the cytopathology laboratory and histology samples were prepared whenever visible tissue was present. Radiological, ureteroscopic, cytology, and biopsy data were compared to the actual grades and stages of these 30 surgical specimens. RESULTS: Retrograde ureteropyelography was suggestive of malignancy in 29 of 30 cases, but did not predict the grade or stage accurately. Cytology was positive for malignancy in 21 of 30 cases (70%). Grading of ureteroscopic specimens was possible in all cases. At nephroureterectomy two cases were found to have no tumor (T(0)). Of the remaining 28 cases, the biopsy grade proved to be identical in 21 (75%). Grade 1 or 2 ureteroscopic specimens had a low-stage (T(0), T(a), or T(1)) tumor in 17 of 25 (68%); in contrast, 3 of 5 (60%) high-grade specimens had invasive tumor (T(2) or T(3)). For patients with grade 2 ureteroscopic specimens, combining exfoliated cell cytology and biopsy grade improved the accuracy in predicting high-stage and high-grade disease. CONCLUSIONS: This study confirms previous findings that ureteroscopic inspection and biopsy provides accurate information regarding the grade and stage of upper-tract TCC. Combining exfoliated cell cytology improves the predictive power of biopsy grade 2 disease for high-risk specimen grade and stage. Our data suggest that ureteroscopic findings may predict muscle invasion.     

Zytologische Klassifikation unreifer Keimzellen im luftgetrockneten Ejakulatausstrich beim spermatologischen "Syndrom" der vermehrten Desquamation von Zellen der Spermatogenese (vDZS)

The spermatological phenomenon of increased exfoliation of immature germ cells (IGC) not commonly known until now, can be defined quantitatively as a number of above 4% IGC in relation to the sperm count. The variable aspect of premature germ cells may be confusing and their degenerative alterations complicate definite classification. Items for the classification of IGC have been elaborated employing comparative cytological studies. Based on these criteria exfoliated IGC within the ejaculate can be grouped into: cells reliably allied to spermatogenesis; cells probably allied to spermatogenesis; cells not exactly classifiable by conventional cytology. Analysing the ejaculates of 20 patients with increased exfoliation of IGC (16-50%), we mainly found cells exfoliated from the adluminal cell compartment of seminiferous tubules (spermatocytes II and spermatids). During conventional light microscopy about one third of the "round cells" in ejaculate smear preparations remained unclassifiable. Pathogenetic reasons of increased output of IGC are unclear so far. This phenomenon, usually accompanied by asthenozoospermia as well and mild to severe teratozoospermia, is very often also combined with decreased sperm counts (5-20 mio/ml ejaculate).