液基细胞学检测对痰脱落细胞诊断的研究

为探讨液基细胞学检测系统在痰脱落细胞学诊断中的效果,我们使用国产手工液基细胞学系统对118例临床可疑为肺癌的痰标本进行了液基细胞学涂片法处理并与传统细胞涂片方法对比。应用液基薄层细胞涂片法在痰标本中查到恶性肿瘤细胞39例,可疑瘤细胞3例,传统涂片19例被漏诊。液基细胞涂片法诊断灵敏度提高了24.5%。初步研究结果提示,痰液基细胞学涂片质量明显优于常规涂片。初次开展者可将其与传统检查方法对照应用。     

肺癌异质性的细胞学观察

肿瘤异质性是肿瘤（特别是恶性肿瘤）的重要特征之一。本文通过对８３例原发性肺癌的痰检、纤支镜检查、胸水细胞学涂片检查的回顾性观察，发现１６例肺癌的细胞具有异质性。其异质性癌细胞的检出率为１９．３％（１６／８３），其中以腺癌复合鳞癌（或鳞癌复合腺癌）最多见，占６２．５％（１０／１６）；小细胞癌复合鳞癌（或鳞癌复合小细胞癌）次之，占３７．５％（６／１６）。说明肺癌的异质性在其细胞学涂片中亦能观察到。如果     

痰脱落细胞学检查的敏感性及其影响因素

目的探讨痰细胞学检查的敏感性,分析肿瘤部位、组织学类型、肿瘤分期、送检次数和制片方法等因素对敏感性的影响。方法收集2005年1~12月于我院行痰细胞学检查的肺癌住院患者743例,所有患者被要求连续送痰三次,其中第一次痰标本应用传统涂片（CP）和 ThinPrep液基制片（TP）两种制片方法,第二次和第三次痰标本仅应用传统涂片。最后收集患者的临床病理资料,分析细胞学检查的敏感性及其相关因素。结果痰细胞学检查总的敏感性为34.7%,其中,中央型肺癌为45.6%,周边型肺癌为26.9%;鳞状细胞癌为46.3%,小细胞癌为31.3%,腺癌为27.0%;Ⅰ~Ⅳ期肺癌的敏感性分别为21.6%、31.9%、42.6%和41.3%。另外,有560例患者的第一次痰标本同时应用了TP和CP两种制片方法,TP的敏感性为30.4%,CP的敏感性为19.3%。CP 的敏感性随送检次数的增加而增加,三次CP的累计敏感性达33.8%。结论痰细胞学检查的敏感性较低,并且受肿瘤部位、组织学类型和肿瘤分期等因素的影响。增加痰检次数和采用ThinPrep液基制片可在一定程度上提高痰细胞学检查的敏感性。     

肺癌异质性的细胞学观察

肿瘤异质性是肿瘤（特别是恶性肿瘤）的重要特征之一。本文通过对８３例原发性肺癌的痰检、纤支镜检查、胸水细胞学涂片检查的回顾性观察，发现１６例肺癌的细胞具有异质性。其异质性癌细胞的检出率为１９．３％（１６／８３），其中以腺癌复合鳞癌（或鳞癌复合腺癌）最多见，占６２．５％（１０／６）；小细胞癌复合鳞癌（或鳞癌复合小细胞癌）次之，占３７．５％（６／１６）。说明肺癌的异质性在其细胞学涂片中亦能观察到。如果能将检出结果在日常诊断工作中反映出来，这对临床客观的估计预后及设计合理的治疗方案都具有重要意义。     

超声雾化下液基薄层细胞学检测痰脱落细胞在肺癌诊断中的应用

目的探讨在超声雾化和护理指导方法下使用液基薄层细胞学检测（TCT）方法和传统涂片方法检测痰脱落细胞对肺癌诊断的意义。方法在超声雾化和护理指导方法下对375例痰标本进行TCT方法和传统涂片方法检测。结果应用TCT方法在痰脱落细胞中检出恶性肿瘤细胞106例，其中腺癌44例，鳞状细胞癌54例，小细胞癌8例，可疑癌细胞34例。传统细胞涂片检查有2例鳞状细胞癌细胞为阴性，4例腺癌细胞为阴性，TCT涂片法诊断灵敏度提高了7．125％。结论在痰标本检测肺癌细胞时TCT涂片方法和传统涂片方法联合应用能提高检测的灵敏度并降低假阴性率。     

胸部CT、纤维支气管镜及痰脱落细胞联合检查在中央型肺癌诊断中的价值

目的：评价胸部CT、纤维支气管镜及痰脱落细胞联合检查对中央型肺癌的诊断价值。方法：回顾分析130例经病理证实的中央型肺癌,全部病例均有胸部CT、支气管镜检查及痰脱落细胞检查,其中40例分别于纤支镜检查前后送检痰脱落细胞,对各种检查结果进行对照分析。结果：痰脱落细胞学检查、胸部CT、纤维支气管镜对中央型肺癌的诊断符合率分别为34.6%、83.7%、89.2%,纤支镜术后痰脱落细胞学检查的诊断符合率可达到43.1%。胸部CT与纤维支气管镜、痰脱落细胞学检查结合诊断符合率达100%。组织学类型以鳞癌、小细胞未分化癌多见,分别为62.4%、35.9%。结论：胸部CT、纤维支气管镜及痰脱落细胞联合检查可提高诊断阳性率。     

(膜式)液基薄片技术在痰脱落细胞学中的应用探讨

目的 探讨液基薄片技术在痰脱落细胞学检查中的应用效果。方法 90例痰标本采用(膜式)液基薄片和传统涂片方法平行进行检查,并对结果进行比较分析。结果 经纤支镜、肺穿刺活检及术后组织病理学检查确诊肺癌55例,液基薄片法和传统涂片法检出肺癌的灵敏度分别为54.5%(30/55)和40.7%(22/55),经χ²检验,两者灵敏度相比差异有统计学意义(P＜0.05);特异度分别为100%(35/35)、97.2%(34/35),两者特异度相比无统计学意义。结论 液基薄片脱落细胞学检查在标本处理和诊断上优于传统涂片,灵敏度高,制片背景清晰,提高了恶性肿瘤细胞检出率。     

经皮细针肺穿刺细胞学检查对肺癌的诊断价值

目的：对初步诊断为肺癌的非手术病例行经皮细针肺穿刺术，寻求病理支持。方法：CT定位应用7号细长针取材，涂片送细胞学检查。结果：76例中确诊肺腺癌45例。鳞癌6例，小细胞癌3例，未定型癌16例，不能确诊6例，阳性率为92．1％(70／76)。结论：经皮细针肺穿刺细胞学检查诊断肺癌阳性率高，有推广价值。     

肺癌痰涂片分型诊断与涂片背景的相关关系研究

在细胞学领域中 ,痰细胞学是历史最悠久的分支之一[1] 。随着肺癌发病率逐年增高 ,痰脱落细胞学检查已成为筛查肺癌和分型诊断必不可少的工具[1～ 3] 。但由于肺癌细胞类型复杂多样 ,有时确切分型困难 ,需要结合涂片背景进行诊断。因此本研究观察了不同类型痰涂片内癌细胞形态及其背景出血、坏死等情况 ,试图寻找二者的相应关系 ,旨在进一步提高肺癌细胞学分型诊断的准确率 ,为临床诊治肺癌提供更多的信息。1　材料与方法随机选择档案中具有分型诊断的 2 4 0例肺癌痰细胞学涂片标本 ,其中高分化鳞癌、低分化鳞癌、高分化腺癌、低分化腺癌、…     

Lung cancer detection by a RT-nested PCR using MAGE A1--6 common primers

BACKGROUND: Since the mortality of lung cancer patients remains very high, the development of a sensitive detection method remains an urgent task. The authors have designed common melanoma antigen gene (MAGE) primers that enable the detection of MAGE A1 to A6 subtypes simultaneously. These primers were applied to the detection of lung cancer using sputum specimens. METHODS: The study involved, 53 cancer patients and three non-cancer groups (193 healthy people, 235 lung cancer screening group and 140 patients with benign lung diseases) were investigated. One hundred and thirty-six respiratory specimens (55 random sputa, 33 induced sputa, 40 broncho-alveolar lavage (BAL) fluids, and 8 pleural fluids) from different lung cancer patients were blindly tested. The MAGE assay was performed by RT-nested PCR, and the results obtained from sputum were compared with those obtained by telomerase assay and conventional cytology. RESULTS: In the sputum of the non-cancer groups, the positive rates were less than 2.1%, while the detection rates were 83.3% in the cancer tissues and 54.3% in the sputa of lung cancer patients. For the random sputum samples of lung cancer patients, the detection rate was 47.5%, but in the induced sputum, BAL and pleural fluids, the detection rate was up to over 70.0%. The MAGE assay produced a higher detection rate than the telomerase assay and conventional cytology. CONCLUSIONS: MAGE A1-6 RT-PCR, which showed high sensitivity and specificity, provides an effective means for the lung cancer detection in sputum.     

Fluorescence bronchoscopy in the detection of preinvasive bronchial lesions in patients with sputum cytology suspicious or positive for malignancy

BACKGROUND: A new strategy in the treatment of squamous cell carcinoma of the tracheobronchial tree is the detection and eradication of preinvasive bronchial lesions before they become invasive cancers. It is, however, difficult to detect preinvasive lesions by conventional white-light bronchoscopy alone. PURPOSE: we conducted a detailed investigation on the use of fluorescence bronchoscopy in the detection of preinvasive bronchial lesions in patients with sputum cytology suspicious or positive for malignancy. METHODS: 64 participants with sputum cytology suspicious or positive for malignancy were examined with both white light and fluorescence bronchoscopy (LIFE group). Earlier to this study, before fluorescence bronchoscopy became available in our institute, 48 participants having sputum cytology suspicious or positive for malignancy were examined with white light bronchoscopy alone (control group). Biopsy specimens for pathological examinations were taken of all abnormal areas discovered by white light or fluorescence bronchoscopy examination. RESULTS: In sputum cytology suspicious or positive for malignancy, the diagnosis of preinvasive bronchial lesions was greatly enhanced in the LIFE group as compared with the control group (45 vs. 7 lesions). The percentage of participants with preinvasive bronchial lesions was also significantly higher in the LIFE group than in the control group (40.6 vs. 12.5%, P = 0.00087, respectively). CONCLUSIONS: Our study suggests that the use of fluorescence bronchoscopy in addition to conventional white-light examination could greatly enhance the detection and localization of preinvasive bronchial lesions in patients with sputum cytology suspicious or positive for malignancy.     

Premalignant and malignant cells in sputum from lung cancer patients

BACKGROUND:

The objective of this study was to assess the frequency of premalignant and malignant cells in sputum from patients with lung cancer and to measure the dependence of these cells on cancer stage, histologic type, tumor size, and tumor location.

METHODS:

This analysis included 444 patients with lung cancer. First, all patients were asked to produce sputum spontaneously; then, they underwent sputum induction. Slide preparations of the sputa were screened for the presence of abnormal cells.

RESULTS:

Of all patients with lung cancer who had produced adequate specimens, 74.6% had sputum that was positive for premalignant or worse cells, whereas 48.7% had sputum that was positive for malignant cells alone. Surprisingly, the presence of premalignant or worse cells in sputum depended only moderately on disease stage (82.9% of stage IV cancers vs 65.9% of stage I cancers), tumor size (78.6% of tumors >2 cm vs 64.7% of tumors ≤2 cm), and location (83.3% of central lesions vs 68% of peripheral lesions) and was found to be independent of histologic tumor type (78.4% of squamous cell carcinomas vs 71.5% of adenocarcinomas, 74.5% of small cell carcinomas, and 75% of large cell carcinomas).

CONCLUSIONS:

The findings of the current study suggested the important potential of sputum cytology for lung cancer detection and risk assessment across all stages, histologic types, tumor sizes, and locations. However, the high sensitivities in this study were achieved with a level of scrutiny not feasible in the laboratory routine. The diagnostic potential of sputum cytology may be exploited better through the standardization and automation of sputum preparation and analysis. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.     

The value of chest CT scan and tumor markers detection in sputum for early diagnosis of peripheral lung cancer

1　IntroductionThemostimportantmeanstorevealanddiagnoseperipherallungneoplasmareX rayphotographyandotherimagingstudies.It’swellknownthatitiseasytofindanoduleoramass ,butdifficulttomakethediag nosisbyradiography .Evencomputertomography (CT)andmagneticresonanceimage (MRI)technologycouldhardlymakeprecisejudgementofasolitarypulmonarynodule (SPN) .Investigatorshavecometorealizethatthealterationsofoncogenesandanti oncogenesareim portantfactorsintheoncogenesisand progressionofneoplasm ,sopeoplet…     

检测诱导痰中端粒酶活性对肺癌的诊断价值

目的:探讨检测诱导痰中端粒酶活性对肺癌的诊断价值。方法:肺癌患者48例,肺部良性疾病患者26例,两组患者均收集常规痰和诱导痰标本,采用TRAP-ELISA法测定端粒酶活性。结果:肺癌组患者常规痰液中端粒酶活性阳性检出率为47·9%,诱导痰中端粒酶活性阳性检出率为75·0%,两者差异有统计学意义,P=0·0181。肺癌组两种方法的标本端粒酶水平均高于对照组;而不同病理类型的肺癌端粒酶活性水平差异无统计学意义,P=0·6717。结论:诱导痰技术无创、简便,检测诱导痰中端粒酶活性对肺癌的临床诊断有一定价值。     

改良Saccomanno法用于肺癌患者痰标本处理的应用体会

目的 探讨新的痰标本收集和保存方法用于肺癌的辅助诊断。方法 分别用常规法和改良Ｓａｃｃｏｍａｎｎｏ法（以下简称改良Ｓ法）,对１２５例经细胞或组织病理学确诊的肺癌患者的痰标本进行处理。部分标本尚进行了ｐ５３突变基因检测和流式细胞术测定ｐ５３和ｐ２１蛋白。结果 用改良Ｓ法获得的痰标本涂片未癌细胞形态完整,背景杂质少,更易辨认。１２５例患者常规法涂片发现肺癌细胞阳性者３５例,改良Ｓ法发现６９例,阳性率分     

CT扫描与痰液肿瘤标志物检测对周围型肺癌的早期诊断价值

目的 :研究CT扫描与肺活检后痰液脱落细胞的端粒酶活性和p16甲基化检测对早期周围型肺癌的诊断意义。方法 :用PCR TRAP ELSA半定量及PCR TRAP银染定性法、甲基化相关的PCR法 ,前瞻性检测 5 5例经CT扫描而发现的肺部孤立性结节 (直径≤ 30mm)、并疑诊为早期周围型肺癌的患者 (T1N0 M0 ) ,行CT导向肺活检 (纤维支气管镜肺活检 33例 ,经皮肺针刺活检 2 2例 )后 2 4h内痰液脱落细胞端粒酶活性及p16甲基化状态 ,并将检测结果与组织病理进行对照研究。结果 :CT扫描对周围型肺癌诊断的敏感性为 10 0 % ,但特异性只有 6 1 8% (34/ 5 5 )。端粒酶活性的敏感性为 79 4 % ,特异性为 90 5 % ,准确性为 83 6 % ;p16甲基化的敏感性为 32 4 % ,特异性为 10 0 % ,准确性为 5 8 2 % ,3者联合检测的敏感性为 86 1% ,特异性为 90 5 % ,准确性为 87 3%。对照组端粒酶阳性率 9 5 % (2 / 2 1) ,无1例检测到p16甲基化。结论 :CT扫描与端粒酶活性、p16甲基化联合可弥补痰液的细胞学检查的不足 ,提高肺癌痰检的敏感性 ,有助于周围型肺癌早期诊断和肺部孤立性结节的鉴别诊断