氟标记氟代脱氧葡萄糖正电子发射断层扫描用于卵巢癌术后监测的探讨

目的 评价^18F-FDG(18氟标记氟代脱氧葡萄糖)PET(正电子发射断层扫描)在卵巢癌术后病情监测中的临床应用价值。方法 1999年6月至2002年3月对21例卵巢癌术后随访的患者行^18F-FDG PET检查，结果 判定采用目测法和半定量分析法(标准化摄取值，SUV)。结果 9例临床完全缓解的卵巢癌Ⅰ期患者于术后12～15个月进行了全身PET检查，未发现病灶，继续随访观察12～21个月，临床无复发征象。12例临床检查疑为复发者，11例PET检查为阳性，1例为阴性，6例PET结果阳性者及1例阴性者进行了手术探查，手术病理证实7例均为复发，PET、B超与病理结果符合率分别为85．7％、71．4％。21例患者中，2例CA125升高而B超结果为阴性者，PEr显像除见局部复发灶外，还同时探测到横结肠和(或)乙状结肠转移灶，均经病理证实为复发灶，病灶最小直径约0．8cm；1例PET检查结果为阴性者，B超及CT检查均为阳性，病理证实为透明细胞癌复发。结论 ^18F-FDG PET检查对卵巢癌术后随访、确认肿瘤复发以及探测全身各部位尤其肠道转移灶有良好的临床应用价值，对肠道转移病灶的定性和定位诊断优于B超，对透明细胞癌的诊断缺乏准确性。     

MRI在卵巢癌定性诊断及其分期中的应用价值

目的:探讨磁共振成像(MRI)对卵巢癌的定性诊断及其分期的价值,以指导手术难度的估计及预后的判断.方法:对B超检查考虑为盆腔恶性肿瘤的31例患者进行MRI检查,分析其MRI表现,将所得的MRI分期与术后的病理结果及分期进行比较.结果:31例考虑盆腔恶性肿瘤的患者中,经MRI诊断为卵巢癌31例,病理证实2例为MRI误诊,MRI在卵巢癌的定性诊断方面的准确率为93.5%(29/31).MRI分期Ⅰ期2例,Ⅱ期4例,Ⅲ期17例,Ⅳ期1例.手术病理分期Ⅰ期2例,Ⅱ期5例,Ⅲ期17例.另有3例根据病史诊断为卵巢癌术后复发和2例诊断为转移性卵巢癌.MRI分期的准确性为91.7%(22/24).结论:MRI对卵巢癌的定性诊断有较高的准确性,其分期与手术病理分期具有良好的一致性,术前行MRI检查可以初步确定卵巢癌的分期,估计手术范围及是否具有手术的可能性,术后可以评价手术或其他治疗的效果及监测复发.     

正电子发射体层显像-CT检查联合CA125连续检测诊断早期无症状的复发性卵巢上皮性癌的价值

目的评估正电子发射体层显像（PET）-CT检查联合CA125连续检测在早期无症状的复发性卵巢上皮性癌（卵巢癌）诊断中的价值。方法对26例在山东省肿瘤医院初治、手术病理分期为Ⅱ-Ⅵ期的卵巢癌患者,在接受肿瘤细胞减灭术并经多疗程化疗达到完全缓解后又出现可疑复发者进行PET-CT检查。此类患者CA125水平已降至正常值（即35kU／L）以下并稳定一段时间后,连续3次测定均呈持续升高趋势,但CT检查未能发现可疑病灶,或虽发现可疑病灶但病变范围不能确定。其中,16例给予再次化疗和（或）放疗,10例接受再次肿瘤细胞减灭术。结果（1）26例患者中,17例CA125水平≥35kU／L,其中14例CT检查显示盆腹腔存在复发灶的患者中,PET-CT检查发现10例病变范围与CT检查一致,4例除盆腹腔病灶外尚伴有远处转移;3例CT检查未发现明确病灶者中,PET-CT检查均提示存在盆腹腔复发,1例发现骨转移。另9例CA125水平〈35kU／L,其中3例CT检查和PET-CT检查均发现盆腹腔复发灶,6例CT检查未发现明确病变者中PET-CT检查均发现1处以上可疑复发或转移灶。（2）10例再次手术者中,CA125水平≥35kU／L者6例,〈35kU／L者4例;4例CT检查发现可疑病灶及6例CT检查阴性者中,PET-CT检查均提示存在至少1处代谢异常部位（病灶数为1～5个）。（3）10例再次手术者中,CT检查发现的可疑病灶,术后病理检查均证实为转移灶;PET-CT检查提示的异常代谢部位手术后病理检查也证实均为转移灶。（4）再次手术后1个月,4例术前CA125水平〈35kU／L者,术后CA125水平均明显下降,其中位数水平降低了3．2倍;6例术前CA125水平≥35kU／L者,4例术后CA125水平〈35kU／L,1例化疗2个疗程后降至〈35kU／L,1例持续升高。结论PET-CT检查能发现临床前期的复发灶或常规辅助检查未能发现或明确的复发灶,PET-CT检查联合CA125连续检测诊断复发性卵巢癌的准确性高,是诊断卵巢癌早期复发的可靠手段。PET-CT检查引导下可以提高再次肿瘤细胞减灭术的准确性和彻底性。     

~(99m)Tc(V)-DMS SPECT显像与B超诊断卵巢癌的比较研究

探讨锝标记二巯基丁二酸钠 [99mTc(V) -DMS]单光子发射计算机断层显像 (SPECT)对卵巢癌的诊断价值 ,并与B超检查结果比较。方法 :对 37例疑为卵巢癌的患者 ,静脉 1次注射99mTc(V) -DMS进行SPECT显像 ,观察病灶区放射性浓聚情况 ,并与B超及手术病理结果对比。结果 :SPECT显像对卵巢癌诊断的灵敏度、特异度和准确度分别为 91 3%、71 4 %和 83 8% ,灵敏度和准确度均明显高于B超检查 (P <0 0 5) ,特异度之间差异无显著性。结论 :99mTc(V) -DMSSPECT对卵巢癌诊断的灵敏度和准确度明显优于B超 ,有助于鉴别卵巢肿瘤的良恶性质及早期诊断卵巢癌 ,对卵巢癌的术前临床分期也有一定的价值。     

放射免疫显像在恶性滋养细胞疾病诊断中的应用

目的 探讨放射免疫显像用于恶性滋养细胞疾病诊断的效果。方法 应用＾１３１Ｉ标记的小鼠抗人绒毛膜促性腺激素单克隆抗体,对２１例恶性滋养细胞疾病患者进行２４例次放射免疫显像、观察其对病灶的定位效果。结果 ２４例次放射免疫显像中,阳性１３例次（其中假阳性１例次）,阴性１１例次（其中假阴性２例次）。病灶定位的敏感性为８５．７％,特异性为９０．０％,准确性为８７．５％,在８例手术患者中,放射免疫显像所见与病     

卵巢癌患者单克隆抗体放射免疫显像对生存率的影响

用相同方法治疗两组卵巢癌患者并追踪观察。一组在治疗过程中曾在单克隆抗体放射免疫显像，共２２例，另一组未作过放免显像，共１５例。两组的年龄分布，病理分类、临床分期及手术治疗、术后化疗等情况均基本相同，仅显像组Ⅲ期患者１４例，对照组Ⅲ期患者８例。     

卵巢癌再分期手术的临床意义

目的 探讨卵巢癌再分期手术的价值及其及其并发症的发生情况。方法 42例患者均为本院1986例1月至1996年1月收治的外院初次手术时未进行全面探查而诊断为Ⅰa-Ⅱa期的卵巢癌患者。其中,Ia期28例,Ⅰb期1例,Ⅰc期12例,Ⅱa期1例;卵巢上皮性癌26例,恶性生殖细胞肿瘤9例颗粒细胞肿瘤7例。外院初次手术仅行患侧附件切除术40例。结果 42例患者中12例（28.6%)患者经再分期手术证实期别提高,其中8例（19.0%)实际应为Ⅲ期患者。12例再分期手术阳性患者（指再分期手术时发现有残存肿瘤者）中,腹水或腹腔冲洗液细胞学检查有癌细胞者3例,结肠旁沟转移4例;大网膜转移2例。30例再分期手术阴性患者（指再分期手术时没有发现残存肿瘤者）中,3年和5年生存率分别为96.7%和86.7%;12例再分期手术阳性患者的3年和5年生存率分别为12例中7例和12例和12例中3例。再分期手术的主要并发症是出血（100.0%,出血量为50-1100ml,平均280ml）和淋巴囊肿(7.1%),无围手术期死亡病例。结论 对初步诊断为早期卵巢癌的患者应进行全面的分期探查手术,初次手术时未进行全面的分期探查手术者应进行再分期手术。再分期手术阴性者预后好,易于治愈。再分期手术无严重并发症。     

卵巢癌放射免疫显像和导向治疗研究的进展

自杂交瘤和单克隆抗体技术创立以来,放射免疫显像技术已有了很大进展,不仅用来探测原发癌灶,还可确定有无肿瘤转移灶和术后复发灶及判断疗效。该技术尤适用于卵巢癌的诊断。卵巢癌放射免疫导向治疗也在研究之中,将对卵巢痛的早期诊断和治疗带来重大突破和进展。     

应用^99m锝标记抗癌胚抗原单克隆抗体行卵巢肿瘤放射免疫显…

应用放射性核素锝标记抗癌胚抗原单克隆抗体放射免疫显像，对１３例卵巢恶性肿瘤、４例卵巢癌手术、化疗后无复发的病人以及１３例卵巢及盆腔内其他良性病变的病人，在注射标记抗体后第１８、２４小时进行盆腹腔前后位平面显像观察。结果：卵巢恶性肿瘤ＲＩＩ的阳性检出率为１００％（１３／１３），卵巢癌手术，化疗后无复发和卵巢及其他良性病变的阴性预测率为９４％（１６／１７），肿瘤转移灶的检出率为６３％（１０／１６）。提     

卵巢癌CT诊断的临床价值

目的：探讨卵巢癌的CT诊断价值，提高诊断准确率。方法对经手术、病理证实为卵巢瘤的36例病例，与临床病理分期对照，分析其各期CT表现，并行CT分期。结果卵巢癌的CT表现有一定的特征性，术前CT诊断与手术病理诊断符合率达94．4％，肿瘤分期准确率为83．3％。结论cT检查在卵巢癌诊断及分期中具有重要价值。     

Clinical evaluation of radioimmunoimaging with 131I-C0C183B2 monoclonal antibody against ovarian carcinoma by intraperitoneal injection.

Forty-eight cases subjected to radioimmunoimaging (RII) by intraperitoneal injection with 131I-C0C183B2 monoclonal antibody (MAb) prepared in our laboratory were studied. Thirteen of 14 cases of proved primary ovarian carcinoma were positive. In 11 follow-up cases of ovarian carcinoma after initial surgery and chemotherapy, 5 recurrences were positive and 6 cases without recurrence were negative; all were confirmed histopathologically after a second operation. One false negative was ovarian mucinous adenocarcinoma, which also negatively stained with C0C183B2 by the peroxidase anti-peroxidase method. Twenty of 23 cases of nonepithelial or metastatic carcinoma of the ovary, benign tumors, and benign diseases were negative. The sensitivity and specificity were 94.7 and 89.7%, respectively. If patients had complications with ascites, the MAb which positively stained with the cancer cells in the ascites was chosen for RII. For follow-up cases PAP staining with the tumor tissue from the initial surgery and the MAb should be done before RII. These are the principal factors that increase the positive rate and accuracy of RII. The intraperitoneal route seems to be a valuable method for clinical staging and tumor localization as well as for follow-up use.     

Update on the surgical management of ovarian neoplasms in children and adolescents: analysis on 32 cases

This study analyzes updated clinical, diagnostic, and surgical directions for the treatment of ovarian neoplasms in children and adolescents, comparing them with a retrospective analysis of 32 cases treated in two Pediatric Surgery University Institutions. From January 2005 to December 2015, 32 pediatric patients were surgically treated for 32 ovarian tumors: 28 (87.5%) benign and 4 (12.5%) malignant neoplastic lesions. Median age at surgery was 11.2 years (12.8 years in patients with benign neoplasms, 7.25 years in patients with malignant ones). All patients with malignant and 25% of patients with benign ovarian lesions had elevated serum level of tumors markers. The surgical approach was laparotomic in 62.5% and laparoscopic in 37.5%; 81.2% surgeries were performed in elective surgery and 18.8% in emergency. Intraoperative frozen section analysis was performed in 18.75% of patients. The most frequent surgery (96.8%) was unilateral oophorectomy. After a median follow-up of 76 months (range 6–132 months), 31/32 patients are alive and disease-free. In case of malignant tumors, fertility-sparing surgery with accurate staging must be performed. Laparoscopic multiport is the gold standard approach for benign pediatric ovarian neoplasms, but the use of laparoscopy in full respect of oncological principles also for early stage malignant tumors is currently increased.     

Diagnostic value of telomerase activity in gynecologic malignancies

Nagai N, Murakami J, Oshita T, Ohama K, Tahara H. Diagnostic value of telomerase activity in gynecologic malignancies. Int J Gynecol Cancer 1998; 8 : 481–488.
We investigated the diagnostic significance of telomerase activity in gynecological malignancies. Tissue samples were obtained from 24 cervical cancers, 27 uterine cancers (22 endometrial cancers and five sarcomas), 33 ovarian cancers (31 epithelial tumors and 2 germ cell tumors), and 11 benign ovarian tumors. In addition, cervical cytology specimens were obtained from 30 squamous intraepithelial lesions (13 low grade and 17 high grade), and from 22 normal females. Telomerase activity was detected using the TRAP assay, and the relative telomerase activity was obtained using the BioMax DNA image analysis system. Telomerase activity was detected in 22/24 (91.7 %) cervical cancers, 23/27 (85.2%) uterine tumors and 30/33 (90.9%) ovarian cancers. Weak telomerase activity was detected in two mature cystic teratomas and also found in 9/17 (52.9%) high grade SIL and 2/13 (15.4%) low grade lesions. Telomerase activity showed no relationship with tumor histology or clinical stage, and there was no statistically significant difference between patients with uterine cancer and ovarian cancer. Relative telomerase activity showed a correlation with the dilution assay, and significantly higher telomerase activity was found in uterine cervical cancer compared with precancerous lesions and in ovarian cancer compared with benign ovarian tumors. After establishment of an assay for telomerase, it may be useful for cancer diagnosis and identification of high-risk groups.     

Differential diagnosis of ovarian cancer, benign ovarian tumor and endometriosis by a combination assay of serum sialyl SSEA-1 antigen and CA125 levels

We used a combination assay of serum sialyl SSEA-1 antigen (SLX) and CA125 levels, and evaluated the clinical usefulness of this technique for a differential diagnosis of ovarian cancer, benign ovarian tumor and endometriosis. In 82 patients with ovarian tumors, the sera of 20 (64.5%) of 31 with ovarian cancer and 15 (48.4%) of the 31 with endometriosis (endometrial cyst) were positive for both SLX and CA125, but serum SLX level was 5 U/ml or less in these 14 SLX- and CA125-positive patients with endometriosis. The sera of 16 (80.0%) patients with benign ovarian tumor were negative for both tumor markers. The sera of 3 (9.7%) of 31 with ovarian cancer and the sera of 2 (6.5%) of 31 with endometriosis were negative for both markers. The diagnostic accuracy (true positive rate X true negative rate) of the combination assay for ovarian cancer was 49.0% when the cutoff value of the serum SLX was 38 U/ml but improved to 78.5% when the value was set at 50 U/ml. When the cutoff value of serum SLX was set at 50 U/ml and that of serum CA125 at 35 U/ml, 27 of 37 patients who were positive only for CA125 had endometriosis. From the above observations, a combination assay of serum SLX and CA125 is a promising method for the differential diagnosis of malignant and benign ovarian tumors. Our results also suggest that to improve the diagnostic accuracy, the cutoff value of the serum SLX level should be 50 U/ml for ovarian tumors alone.     

卵巢恶性肿瘤组织谷胱甘肽S转移酶的表达及其与化疗耐药的关系

目的检测卵巢肿瘤组织中谷胱甘肽Ｓ转移酶（ＧＳＴ－π）的表达,并探讨其与化疗耐药的关系。方法采用免疫组化ＳＰ法对５３例卵巢恶性肿瘤、２０例卵巢良性肿瘤和１７例正常卵巢组织进行ＧＳＴ－π检测,并对相关的临床病理因素进行分析。结果（１）卵巢恶性肿瘤组织中ＧＳＴ－π表达阳性率为６０．４％,卵巢良性肿瘤组织中ＧＳＴ－π表达阳性率仅为１０．０％,而正常卵巢组织中则无一例ＧＳＴ－π表达阳性;（２）不同病理类型、临床分期和术后残留灶大小的恶性肿瘤组织中ＧＳＴ－π表达阳性率相比较,差异无显著性;（３）恶性肿瘤中,初治和复发的ＧＳＴ－π表达阳性率分别为４７．２％和８８．２％;（４）ＧＳＴ－π表达阳性的患者对化疗的有效率低于ＧＳＴ－π表达阴性的患者,前者为３７．５％（１２／３２）,而后者为７６．２％（１６／２１）;（５）ＧＳＴ－π表达阳性的患者治疗后１年及３年生存率低于ＧＳＴ－π表达阴性者。结论卵巢恶性肿瘤组织中ＧＳＴ－π表达与其化疗耐药有关。ＧＳＴ－π表达的检测对临床判断化疗敏感性和预后有一定的参考价值。     

腹腔镜在附件包块治疗中的价值和安全性(附2083例报道)

目的:评价腹腔镜在附件包块治疗中的价值及安全性。方法:回顾分析2000年1月至2003年12月北京协和医院术前诊断为良性附件包块2083例的腹腔镜手术治疗情况。患者平均33.4±8.9岁,绝经后妇女占1.8%。术中怀疑卵巢恶性肿瘤者送冰冻病理检查。计算腹腔镜术中诊断卵巢恶性肿瘤的敏感性(SEN)、特异性(SPE)、阳性预测值(PPV)及阴性预测值(NPV)。结果:2 083例患者中,2 067例为良性肿瘤,16例(0.77%)患者为卵巢交界性肿瘤(LMP)或卵巢癌,其中14例LMP及卵巢癌在术中确诊,2例卵巢癌术后确诊。55例(2.6%)患者术中可疑恶性送冰冻病理检查,检查结果为良性肿瘤41例(74.5%),LMP 8例(14.5%),卵巢癌6例(10.9%)。术后病理结果:良性肿瘤41例(74.5%),LMP 7例(12.7%),卵巢癌7例(12.7%)。术中冰冻与术后病理的符合率为98.2%。腹腔镜诊断卵巢恶性肿瘤的SEN为87.5%、SPE为98%、PPV为25.5%、NPV为99.9%。卵巢良性肿瘤2 067例,均进行了卵巢囊肿剔除术、附件切除术等。无中转开腹或围手术期并发症。16例LMP或卵巢癌患者中,7例行腹腔镜手术包括3例腹腔镜分期手术。16例患者术后平均随诊17.3月。1例LMP一侧附件切除术后4年对侧卵巢出现交界性肿瘤,行腹腔镜囊肿剔除术,其余病例均无复发征象。结论:腹腔镜可作为术前诊断为良性的附件包块的首选手术方式,术中意外发现卵巢LMP或者恶性肿瘤的机会较低。对可疑恶性的卵巢肿瘤,术中应进行冰冻病理检查。     

B7-H4 is over-expressed in early-stage ovarian cancer and is independent of CA125 expression

OBJECTIVE: This study characterizes the expression of the novel biomarker B7-H4 in ovarian cancer tissue, normal ovaries, and benign ovarian tumors, and evaluates its relationship to CA125. METHODS: Ovarian tissue lysates from 251 patients with ovarian carcinoma were assessed for the levels of B7-H4 and CA125 by ELISA assays. For comparison, ovarian tissues from patients with benign ovarian tumors (n=43) and patients with normal ovaries (n=32) were tested. The marker concentrations were correlated with CA125 expression, clinicopathological variables, and patient outcome. RESULTS: Using a cut-off based on the 95th percentile of B7-H4 or CA125 concentration in the control group, B7-H4 was over-expressed in 48% of patients with stage I cancer, 55% of patients with stage II cancer, and 67% of patients with late stage cancer. CA125 was elevated in 31% patients with early stage cancer. B7-H4 was elevated in tumors of 30 patients with early stage cancer that were negative for CA125. The combination of B7-H4 and CA125 identified 56 early stage cancer patients (65%) as positive. Correlation of marker expression to clinical outcome showed that high B7-H4 levels were correlated with poor prognosis. However, the effect was not significant when outcome was adjusted for other clinicopathological variables. CONCLUSION: B7-H4 expression was low in normal ovaries and in benign tumors while half of early stage and two-thirds of late stage cancers over-expressed B7-H4. The data are consistent with previous observations and support further investigation of B7-H4 in the detection of early stage ovarian cancer either alone, or in combination with CA125.     

卵巢癌胸苷磷酸化酶及其mRNA的表达及临床意义

目的 :研究卵巢肿瘤中胸腺嘧啶脱氧核苷磷酸化酶 (TP)及其mRNA的表达与微血管密度 (MVD)的关系及其临床意义。方法 :卵巢良性肿瘤 2 1例 ,卵巢癌 35例。术后肿瘤组织用免疫组化法检测TP及factorⅧ的表达 ,计算MVD ;用原位杂交 (ISH)法检测TPmRNA。结果 :卵巢癌TP、TPmRNA的阳性率分别为 71.4 %和 4 8.5 % ,明显高于良性者的 38.0 %和 2 8.0 % (P <0 .0 0 1,P <0 .0 5 )。有淋巴结转移者TP、TPmRNA的表达率分别为10 0 %和 77% ,明显高于无淋巴结转移者的 65 .3%和 38.4 % (P <0 .0 5 )。卵巢癌TP、TPmRNA表达与病理组织类型、细胞分化程度、临床期别、患者腹水多少无关。卵巢癌的MVD平均为 2 8.2 7± 2 2 .34,明显高于良性者的 12 .5 3± 16.5 8(P <0 .0 1)。TP与MVD具有相关性 ,TP阳性者MVD明显增高。结论 :TP和TPmRNA在卵巢癌中表达增强 ,是卵巢癌重要的促血管生成因子 ,TP表达与淋巴结转移、患者预后有关     

Occurrence of CA 125 and CA 19-9 tumor-associated antigens in sera of patients with gynecologic, trophoblastic, and colorectal tumors

The present study was undertaken to test the parallel detectability of ovarian cancer antigen CA 125 and gastrointestinal cancer antigen CA 19-9 in the sera of patients with malignant ovarian tumors, benign ovarian tumors, endometrial cancers, cervical cancers, colorectal cancers, and trophoblastic tumors and in early 1st-trimester pregnant as well as in healthy nonpregnant controls. In all kinds of gynecologic and colorectal tumors raised concentrations of both antigens were found with the exception of malignant nonepithelial ovarian tumors where neither of the antigens showed positive reaction. The most positive cases were found in the group with epithelial ovarian cancers. Of the two antigens CA 125 was the more responsive. No positive cases were found with either of the antigens in nonpregnant healthy controls or in patients with benign ovarian tumors. The parallel determination of the two antigens gives us a better opportunity to recognize pelvic tumors and further may enable us to distinguish ovarian and colorectal tumors.     

Three-dimensional ultrasound and three-dimensional power Doppler in the assessment of ovarian tumors.

OBJECTIVE: To determine preoperative method that predicts nature of ovarian tumors. METHODS: Fifty patients with complex pelvic masses assessed preoperatively with two-dimensional ultrasound (2DUS), two-dimensional power Doppler (2DPD), three-dimensional ultrasound (3DUS), three-dimensional power Doppler (3DPD), color Doppler. RESULTS: All patients underwent exploration, 19 (38%) had benign tumors, 31 (62%) had ovarian cancer. 2DUS identified 29 cases suspicious for malignancy giving sensitivity, specificity, PPV and accuracy of 80%, 78%, 86%, and 80%. 2DUS with 2DPD identified 28 suspicious cases giving sensitivity, specificity, PPV and accuracy of 80%, 84%, 89%, and 82%. 3DUS identified 31 suspicious cases including 28 cancers giving sensitivity, specificity, PPV and accuracy of 90%, 84%, 90%, and 88%. 3DUS with 3DPD, identified 34 suspicious cases including all 31 cancers giving sensitivity, specificity, PPV and accuracy of 100%, 84%, 91%, and 94%. Color Doppler RI of 0.48 identified 28 cases of 31 cancers giving sensitivity of 90%. CONCLUSION: Evaluation by 3DUS with 3DPD improves diagnostic accuracy of ovarian tumors.