肺癌术中胸腔冲洗液细胞学的临床意义

目的：研究术中胸腔冲洗液细胞学检测对肺癌患者的预后价值。方法：无恶性胸腔积液的100例肺癌患者，剖胸后及术毕胸膜腔冲洗，冲洗液行病理细胞学检查，术后患者随访。结果：冲洗液细胞学检测：术前阳性8例．术后阳性5例。3年生存率随访：冲洗液细胞学阳性者为20％，阴性者为60％。冲洗液阳性的相关因素包括：病理分期、细胞类型、肿瘤大小、胸膜侵犯程度。结论：术中胸膜腔冲洗液细胞学检查可提示胸膜腔的微转移，是一个重要的预后因素。     

肺癌患者胸腔冲洗液细胞学检查对预后的预测价值

目的:证明无胸水肺癌患者胸腔内存在游离癌细胞,探讨其相关因素及对预后的预测价值.方法:对172例无胸水肺切除肺癌患者进行了胸腔冲洗液细胞学检查(PLC).于开胸探查前冲洗,收集后立即细胞学检查.结果:阳性47例(27.3%),与细胞类型、原发肿瘤、淋巴结转移、胸膜受侵程度有关,并具有腺癌＞鳞癌、T4＞T3＞T2＞T1、N3＞N2＞N1＞N0、P3＞P2＞P1＞P0、Ⅲ＞Ⅱ＞Ⅰ的特点.PLC阳性患者的5年生存率为26.1%,阴性为49.2%.结论:无胸水肺癌患者胸腔内有游离癌细胞存在,与细胞类型、T、N、P因素相关,PLC结果是一项重要的预测患者预后的指标.     

胸段食管癌术中胸腔冲洗液脱落细胞学检查的临床意义

食管癌生长过程中是否有胸膜腔内癌细胞的脱落种植 ,文献报道甚少。 1997年 12月至 1999年 11月 ,我们对 10 0例行开胸手术的食管癌患者进行了胸膜腔冲洗液细胞学检查 (ｐｌｅｕ ｒａｌｌａｖａｇｅｃｙｔｏｌｏｇｙ ,ＰＬＣ) ,现报告如下。1　材料和方法1.1　一般资料10 0例食管癌中 ,男性 83例 ,女性 17例 ,年龄 2 6～ 74岁 ,中位年龄 5 6岁。所有病例均为胸段食管癌 ,均进行了开胸手术 ,3例术前行放射治疗 ,ＤＴ2 5 0 0～ 46 0 0ｃＧｙ ;1例行根治性放疗 ,ＤＴ70 0 0ｃＧｙ ,半年后复发。病变位于上段 3例 ,中段 75例 ,下段 2 2例。经左…     

支气管冲洗液细胞块免疫组化染色在肺癌病理诊断中的价值

目的:探讨支气管冲洗液细胞块HE切片及免疫组化染色在肺癌病理诊断与鉴别诊断中的应用价值。方法:用TCT检测筛选129例支气管冲洗液阳性（包括分型明确和不明确）病例,然后制成细胞块,行HE切片及免疫组化SP法染色。抗体选用TTF-1、CK7、CK5/6、p63、Syn、CD56、Ki-67,分析两种方法分型诊断率的差异。结果:TCT检测分型诊断率为59.7%(77/129)。细胞块及免疫组化法分型诊断率为87.6%(113/129),其中鳞状细胞癌62例、腺癌29例、小细胞癌22例。细胞块HE切片及免疫组化法明显优于单纯TCT,两种方法诊断分型率具有显著性差异(P<0.01)。结论:支气管冲洗液细胞块HE切片及免疫组化染色对肺癌的分型诊断具有一定的价值。     

肺癌术中冲洗液细胞学检查与腔内温热灌注化疗疗效研究

目的:检测无胸水肺癌患者胸膜腔内在术前或术后是否存在游离癌细胞并探讨术中低渗水热灌注化疗和低渗热灌注治疗对生存期的影响.方法:对380例无胸水肺癌患者术中均在开胸后和关胸前用500ml生理盐水冲洗胸腔,然后留取冲洗液作细胞学检查.阳性者随机分为A组、B组和C组,A组关胸前应用43℃蒸馏水500ml加顺伯(80mg)灌注化疗,B组应用43℃蒸馏水500ml温热灌注,C组未给予治疗常规关胸.结果:阳性患者108例(28.6％),其中腺癌73.2％,磷癌16.7％,其它10.1％,Ⅰ期、Ⅱ期、Ⅲ期的比例分别为2.8％、7.4％、89.8％.A组、B组与C组1、3、5生存率分别为97.4％、76.3％、57.9％;94.4％、69.4％、44.4％;97.1％、38.2％、20.6％.结论:无胸水肺癌患者胸膜腔内在术前或术后有游离癌细胞存在,以腺癌和Ⅲ期的患者居多.术中低渗热灌注化疗和低渗热灌注治疗能提高阳性肺癌患者的3年、5年生存率,但两种治疗方法统计学无显著差异.     

食管癌胸腔冲洗液细胞学检查的结果分析

目的　探讨术前无胸腔转移表现的食管癌病人手术时胸腔冲洗液细胞学检查 (PleuralLavageCytology ,PLC)的阳性率及其相关因素。方法　 10 9例食管癌病人在行根治术时 ,分别于开胸后未作任何胸内操作前 (简称前次 )及切除病变断端食管吻合完毕后 (简称后次 )两种不同的时机冲洗胸腔 ,并用一次性病变细胞采集器收集细胞 ,HE染色 ,光镜观察。结果　前、后两次PLC阳性率分别为 72 .48% (79/ 10 9)、43 .12 % (4 7/ 10 9)。PLC阳性与肿瘤的大小、部位、分化程度、浸润深度等均无相关性 ,而与冲洗时机的不同有明显相关。结论　选择开胸后未作任何胸内操作前进行PLC检查更为合理 ,行食管癌根治术同时多次反复进行胸腔冲洗可以减少脱落癌细胞数目。PLC检查结果可以作为食管癌的一个辅助分期和预后因素 ,同时也可作为一个术后辅助治疗的选择指标。     

乳头溢液导管冲洗液细胞学检查在乳腺癌诊断中的价值

我院于 196 8～ 1998年对 2 8例乳头溢液、导管冲洗液进行脱落细胞检查 ,诊断早期乳腺癌 2 7例 ,总结报告如下。1　临床资料1.1　一般资料本组 2 8例均为女性。年龄 19～ 6 0岁 ,平均年龄 35 .5岁。溢液 :血性 19例 ,浆液血性 6例 ,粘稠混浊液体 3例。乳房均扪不到包块。1.2　取液方法乳头消毒按无菌操作 ,轻柔挤压乳头取溢液作为第一标本 ;用尖端磨平的 5～ 6号针头自开口缓慢插入溢液导管深 1～3ｃｍ ,缓慢注入生理盐水 1.5～ 5 .0ｍｌ ,注入时握紧乳头 ,以防盐水外溢 ,患者有明显肿胀感时抽出乳管内液 ,作为第二标本。作者单位 :阳谷县 (…     

肺癌术后胸腔积液的治疗体会

目的探讨肺癌术后胸腔积液的治疗。方法收集2006年1月—2009年6月期间在我院诊治的肺癌术后胸腔积液68例,通过纤维支气管镜吸痰、调整抗生素、经胸管胸腔内注入滑石粉、注入50%葡萄糖、胸腔清理同时行支气管残端心包或奇静脉包埋、胸腔注入顺铂、乳糜胸结扎胸导管治疗胸腔积液。结果只有2例未能拔除胸管,带管出院,其余均治愈。结论胸腔积液是肺癌术后一种常见的并发症,积极治疗,效果较好。     

流式细胞术检测胃癌患者腹腔冲洗液游离癌细胞的变化

目的:探讨胃癌手术对腹腔脱落癌细胞的影响. 方法:收集50例行胃癌手术患者胃癌切除前后腹腔冲洗液,以流式细胞学(FCM)方法检测腹腔冲洗液癌胚抗原(CEA)及角蛋白-19(CK-19),同时采用HE染色进行腹腔冲洗液细胞学(PLC)检查.结果:胃癌手术患者CEA检查手术前后阳性率分别为46%(23/50)和64%(32/50),CK-19检查手术前后阳性率为48%(24/50)和68%(34/50),两组之间差异有统计学意义(P＜0.05).PLC检查结果手术前后分别为20%(10/50)和36%(18/50)(P＜0.05).术前、术后PLC阳性者FCM均为阳性.结论:胃癌手术增加腹腔胃癌细胞的脱落.     

Modified intrapleural cisplatin treatment for lung cancer with positive pleural lavage cytology or malignant effusion

OBJECTIVES: We evaluate the efficacy and safety of the modified intrapleural cisplatin treatment for lung cancer patients with positive pleural lavage cytology or malignant effusion. METHODS: The treatment was performed for seven patients with malignant effusion and 18 patents with positive pleural lavage cytology. After pulmonary resection, the pleural cavity was filled with cisplatin with a normal saline solution for 30 min. Complications and survival of the patients were evaluated. RESULTS: The chest tube duration were significantly prolonged in the treatment (CDDP) group (5.7 +/- 3.6 vs. 2.8 +/- 2.6 days). We had one operative death that developed a bronchial fistula; however, the other complications were not severe. The mortality rate was 4% and the morbidity rate was 60%. We experienced two carcinomatous pleuritis in the CDDP group. The median survival time of the CDDP group was 47.0 +/- 11.1 months and the 3- and 5-year survival rate was 52.6% and 11.3%, respectively. CONCLUSIONS: We were able to perform this treatment for these advanced lung cancer patients, which had the preventive effect of carcinomatous pleuritis. This therapy shows the possibility of a treatment that might lead to an improvement in the prognosis of these patients, without causing severe complications.     

支气管肺泡灌洗液联合TCT在周围型肺癌诊断中的应用

目的:探讨支气管肺泡灌洗液联合TCT在周围型肺癌诊断中的应用价值.方法:纳入2014年12月至2015年12月收治的123例周围型肺癌患者,所有患者支气管镜检查未发现病灶,遂同时获得支气管肺泡灌洗液和支气管镜刷片标本,同时采用TCT和直接涂片法检测,比较四种方法的敏感度.并对支气管镜检查结果与术后病理结果进行比较,分析支气管镜检查结果的特异性.结果:支气管肺泡灌洗液联合TCT的敏感度显著高于支气管肺泡灌洗液直接涂片法检测的敏感度(36.6% vs 17.9%,P<0.05);支气管镜刷片联合TCT的敏感度亦显著高于支气管镜刷片直接涂片法检测的敏感度(14.6% vs 8.1%,P<0.05);而且四种方法中支气管肺泡灌洗液联合TCT的敏感度最高(P<0.05).支气管镜检查结果与术后手术组织病理结果比较的特异性为100%.支气管肺泡灌洗液联合TCT的分类诊断和手术病理组织学诊断的符合率为84.4%.结论:支气管肺泡灌洗液联合TCT能提高周围型肺癌的检出诊断率,支气管肺泡灌洗液联合TCT可推广应用于临床.     

Prognostic significance of pleural lavage cytology in patients with lung cancer: a meta-analysis

OBJECTIVE: Cytologic approaches such as pleural lavage cytology (PLC) are considered as possible aids to assessing prognosis of lung cancer patients. We aimed to comprehensively review the evidence for use of PLC to predict prognosis of lung cancer. METHODS: Fifteen studies, including 6391 patients, were found to be eligible for the present meta-analysis. A meta-analysis was done on the log hazard ratios and their variances in these studies. RESULTS: Four studies dealt with pleural lavage before lung resection, six studies dealt with pleural lavage after lung resection, and five studies had PLC data from both before and after lung resection examination. For before lung resection studies, combined hazard ratios showed that positive PLC results had an unfavorable impact on survival: 3.96 (95% confidence interval 2.48-6.33), 4.55 (2.95-7.04), 5.00 (3.39-7.36), 5.67 (3.81-8.43), and 7.06 (5.04-9.90), for 1-, 2-, 3-, 4- and 5-year, respectively. For after lung resection studies, combined hazard ratios showed that positive PLC results had an unfavorable impact on survival: 6.02 (3.74-9.71), 6.64 (4.53-9.72), 7.06 (4.93-10.12), 7.29 (5.18-10.25), and 8.47 (6.12-11.73), for 1-, 2-, 3-, 4- and 5-year, respectively. Totally, the combined hazard ratio was 5.61 (3.98-7.90), showing a worse survival when PLC was positive. These findings could be overestimated because of publication and reporting bias. CONCLUSIONS: PLC is a strong prognostic factor for survival in patients with lung cancer.     

Percutaneous computed tomography‐guided lung biopsy and pleural dissemination

BACKGROUND:

Percutaneous computed tomography (CT)‐guided needle biopsy remains one of the most important diagnostic tools in the management of lung nodules; however, it carries a risk of intrapleural dissemination of cancer cells.

METHODS:

CT‐guided lung biopsy was performed before surgery in 171 (34.8%) of 491 patients. A coaxial biopsy system was used that comprised a 19‐gauge introducer needle and a 20‐gauge core biopsy needle. A total of 412 (83.9%) of the 491 patients underwent intraoperative pleural lavage cytology just after thoracotomy. Intraoperative pleural lavage cytology was performed immediately after opening the thorax, after the pleural cavity was gently washed with 50 mL of saline.

RESULTS:

No patients had implantation of cancer cells in the chest wall after a median follow‐up of 20.2 months. Intraoperative pleural lavage cytology results were positive for 5 (2.9%) of the 171 patients who underwent CT‐guided biopsy before surgery, in contrast to 13 (5.4%) of the 241 patients who did not undergo biopsy before surgery. The difference between the biopsy and nonbiopsy groups was not statistically significant. When the analysis was limited to patients with stage IA disease, intraoperative pleural lavage cytology results were positive for 1 (0.8%) of the 128 patients who underwent CT‐guided biopsy, in contrast to 3 (2.7%) of the 110 patients who did not undergo biopsy. This difference was also not statistically significant.

CONCLUSIONS:

No significant association was observed between percutaneous CT‐guided lung biopsy and intraoperative pleural lavage cytology results, even in patients with stage IA disease. Percutaneous CT‐guided lung biopsy with a coaxial needle does not seem to cause pleural dissemination. Cancer 2009. © 2009 American Cancer Society.     

Prognostic significance of peritoneal lavage cytology in gastric cancer in Singapore

Background Peritoneal lavage cytology has been included as part of the staging process in the 13th edition of the Japanese Classification of Gastric Cancer. However, this procedure has neither been studied nor established in our population. We aimed to evaluate its prognostic relevance among our patients with gastric cancer. Methods A total of 142 consecutive patients with gastric carcinoma were recruited prospectively. All had histologically proven gastric carcinomas and had undergone laparotomy and intraoperative peritoneal lavage for cytological examination at Singapore General Hospital. The fluid recovered was centrifuged and stained by the Papanicolau method. All patients were followed up with endpoints of cancer recur-rence and mortality. Results There were 91 men and 51 women; 36 patients (25.4%) had positive peritoneal lavage. Patients with advanced macroscopic features, presence of vascular invasion, nodal involvement, advanced depth of tumor invasion and metastatic disease tended to have positive lavage, by univariate logistic regression analysis. Despite curative resections, patients with positive cytology had a more dismal disease-free survival (mean, 27 months vs 53 months; P < 0.0001 by log rank test) and higher recurrence rate (54.5% vs 19.3%; P = 0.007 by log rank test). There was also a trend towards earlier recurrences (median, 8 months vs 11 months; P = 0.37). By multivariate Cox regression stepwise analysis, advanced depth of tumor invasion and positive lavage cytology were found to be independent poor prognostic factors for disease-free survival. Conclusion Positive peritoneal lavage cytology correlated well with advanced features of gastric cancer. It is an independent poor prognostic factor and the procedure should be routinely performed. Integration of lavage status into our current staging systems may serve as a guide for adjuvant therapeutic options to improve the survival of gastric cancer in our population.     

胸腔内注射榄香烯治疗肺癌恶性胸腔积液疗效的系统评价

目的:系统评价榄香烯治疗肺癌恶性胸腔积液的疗效及安全性。方法:计算机检索PubMed、Cochrane Library、EMbase、SCI、中国学术期刊全文数据库、中国生物医学文献数据库等数据库,搜索年限从建库到2017年3月。纳入榄香烯治疗肺癌恶性胸腔积液疗效与安全性方面的随机对照研究。使用 Cochrane 手册5.1.0版的质量评价标准对纳入研究进行质量评价,使用 Review Manager 5.3软件进行数据分析。结果:共纳入15篇文章,包含1 004例患者。Meta分析结果表明榄香烯可显著提高恶性胸腔积液患者近期治疗疗效（RR=1.36,95%CI:1.15～1.60,P=0.000 3）。亚组结果表明,榄香烯治疗恶性胸腔积液的有效率显著高于顺铂组（RR=1.46,95%CI:1.14～1.87,P=0.003）。榄香烯并不显著增加胸痛及发热等不良反应的发生（P＞0.05）。结论:胸腔内注射榄香烯可提高肺癌恶性胸腔积液治疗有效率,安全性良好。由于纳入研究的质量欠佳,该结论仍需大样本随机对照试验进一步证实。     

Comparison of pleuropneumonectomy and limited surgery for lung cancer with pleural dissemination

The role of surgery in the management of lung cancer with pleural dissemination is controversial. We performed a retrospective analysis of our patients with lung cancer and pleural dissemination who were treated surgically. Between 1973 and 1993, 1,206 patients with lung cancer underwent pulmonary resection at Kanazawa University Hospital. Among them, 40 (3.3%) had pleural dissemination without pleural effusion. The 1-, 3-, and 5-year survival rates for 38 patients (except 2 patients undergoing exploratory thoracotomy alone) were 51.5%, 19.4%, and 19.4%, respectively. The 1-year survival rate in the 10 patients who underwent pleuropneumonectomy was only 20%, and 9 of these patients died within 18 months postoperatively (1 patient has survived for 25 months). In contrast, the 1-, 3-, and 5-year survival rates for the 14 patients who underwent resection of the primary tumor plus parietal pleurectomy were 85.1%, 35.5%, and 35.5%, respectively, a significantly better outcome (P < 0.01). Seven patients are still alive (the longest survival time is 65 months with the disease). The average survival time in the seven fatal cases was 18 months. In patients with lung cancer accompanied by pleural dissemination, it is quite possible that local excision plus pleurectomy will be justified. © 1996 Wiley-Liss, Inc.