乳腺癌核芯针穿刺印片与组织学诊断的比较研究

目的 探讨印片细胞学(TIC)与组织病理诊断以及印片免疫细胞化学与免疫组织化学检测结果的一致性,评价在乳腺癌新辅助化疗前TIC诊断的临床应用价值.方法 收集行核芯针穿刺组织TIC诊断的乳腺肿物患者289例,其中287例有核芯针活检(CNB)病理结果对照,190例有术后病理结果对照.289例中,64例行印片的雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER-2)免疫细胞化学检测,其中52例有CNB免疫组织化学检测结果,43例有术后病理免疫组织化学检测结果.结果 TIC诊断良性22例,恶性263例,不满意标本4例.假阴性率和不满意率均为1.4%,假阳性率为0.35%.与术后病理结果比较,TIC和CNB诊断乳腺癌的敏感性分别为96.2%和95.0%(P=0.601),特异性分别为87.5%和100%(P=0.471),准确率分别为95.8%和95.3%(P=0.804),差异均无统计学意义.ER、PR和HER-2印片免疫细胞化学检测结果与CNB的免疫组织化学检测结果的符合率分别为86.5%、75.0%和78.8%,与术后病理免疫组织化学检测结果的符合率分别为88.4%、74.4%和75.6%,CNB与术后病理免疫组织化学检测结果的符合率分别为83.7%、74.4%和76.5%,三者差异无统计学意义(P＞0.05).结论 TIC诊断乳腺癌的敏感性、特异性和准确率较高,与CNB组织病理诊断无明显差异,可以辅助CNB为乳腺肿物患者提供快速的细胞学诊断.印片免疫细胞化学方法可以辅助CNB作为新辅助化疗前检测乳腺癌患者受体水平的手段之一.     

Modified core wash cytology (CWC), an asset in the diagnostic work-up of breast lesions

Aim

A quick and reliable preliminary diagnosis is essential in the management of a same-day breast clinic. In a preclinical study we developed an alternative method of core wash cytology (CWC). This study is an evaluation of this new CWC method introduced into the clinical setting.

Methods

From April 2008 to April 2009, biopsies were taken from lesions in the breast. CWC was obtained from core needle biopsy (CNB) with a modified technique and classified into the categories: malignant, suspicious for malignancy, atypical, benign and inadequate. CWC and CNB diagnoses were correlated with the histopathology of subsequently obtained resection specimens. The sensitivity and specificity were calculated.

Results

CWC was obtained from 226 breast lesions. In 167 of these cases subsequent resection of the lesion was performed revealing 149 carcinomas and 18 benign lesions.Of the 149 malignant cases, 136 were considered as either malignant or suspicious for malignancy by CWC, 7 as atypical, 4 as benign and 2 as inadequate. None of the 18 benign lesions were classified as suspicious or malignant on CWC. Eight out of 149 resected carcinomas were not recognized as malignant by histological analysis of the CNB, while 7 of these cases the CWC was considered malignant. The sensitivity and specificity were 97% and 100%, respectively.

Conclusions

In the vast majority of patients the modified CWC technique can provide a quick and reliable diagnosis of malignant breast lesions. Furthermore, combining CWC with CNB histology can improve adequate, preoperative recognition of the malignant character of breast lesions.     

Population-Based Cervical Screening Outcomes in Turkey over a Period of Approximately Nine and a Half Years with Emphasis on Results for Women Aged 30-34

Purpose: To appraise the frequency of cervical cytological abnormalities in a population at normal risk viaanalysing the archive records of cytology for the period of approximately 9,5 years, comparing them with patientdemographic charecteristics, and discuss the results for women under age of 35. Materials and Methods: A totalof 32,578 cases of Pap smears were retrieved and analysed from our archive included the Pap tests performedbetween January 2001 and April 2010 at the Early Cancer Screening, Diagnosing and Education Center by theconsent of three pathologists via utilizing the Bethesda System Criteria 2001 and the results were comparedwith some demographical characteristics. Results: Our rate of the cervical cytological abnormality was 1.83%,with ASCUS in 1.18%, LSIL in 0.39, HSIL in 0.16%, AGUS in 0.07%, squamous cell carcinoma in 0.02%, andadenoarcinoma in 0.006%. Cytological abnormalities were detected mostly in those with higher age, lower parity,and premenopausal period whereas the smoking status was without influence. Bacterial vaginosis (5.6%) wasthe most frequent infectious finding (Candida albicans 2.7%; Actinomyces sp. 1.3%; and Trichomonas vaginalis0.2%) detected on the smears. The rate of abnormal cervical cytology was 9.5% among the women aged between30-34. Conclusions: Early detection of the cervical abnormalities by means of the regular cervical cancer screeningprogrammes is useful to attenuate the incidence, mortality, and morbidity of cervical cancer. Our prevalence ofthe cytological abnormalities was much lower than the one in Western populations in general but very similarto those reported from other Islamic countries that may be explained by the conservative lifestyle and the lowerprevalence of HPV in Turkey. A remarkable rate of abnormal cervical cytology of women aged 30-34 was pointedout in the present study.     

Role of capsule endoscopy in inflammatory bowel disease

Videocapsule endoscopy(VCE) has revolutionized our ability to visualize the small bowel mucosa. This modality is a valuable tool for the diagnosis of obscure small bowel Crohn’s disease(CD), and can also be used for monitoring of disease activity in patients with established small-bowel CD, detection of complications such as obscure bleeding and neoplasms, evaluation of response to anti-inflammatory treatment and postoperative recurrence following small bowel resection. VCE could also be an important tool in the management of patients with unclassified inflammatory bowel disease, potentially resulting in reclassification of these patients as having CD. Reports on postoperative monitoring and evaluation of patients with ileal pouch-anal anastomosis who have developed pouchitis have recenty been published. Monitoring of colonic inflammatory activity in patients with ulcerative colitis using the recently developed colonic capsule has also been reported. Capsule endoscopy is associated with an excellent safety profile. Although retention risk is increased in patients with small bowel CD, this risk can be significanty decreased by a routine utilization of a dissolvable patency capsule preceding the ingestion of the diagnostic capsule. This paper contains an overview of the current and future clinical applications of capsule endoscopy in inflammatory bowel disease.     

Improved endoscopic retrograde cholangiopancreatography brush increases diagnostic yield of malignant biliary strictures

AIM: To determine if a new brush design could im-prove the diagnostic yield of biliary stricture brushings. METHODS: Retrospective chart review was performed of all endoscopic retrograde cholangiopancreatography procedures with malignant biliary stricture brushing between January 2008 and October 2012. A standard wire-guided cytology brush was used prior to proto-col implementation in July 2011, after which, a new 9 French wire-guided cytology brush(Infinity sampling device, US Endoscopy, Mentor, OH) was used for all cases. All specimens were reviewed by blinded pa-thologists who determined whether the sample waspositive or negative for malignancy. Cellular yield was quantified by describing the number of cell clusters seen. RESULTS: Thirty-two new brush cases were compared to 46 historical controls. Twenty-five of 32 (78%) cases in the new brush group showed abnormal cellular find-ings consistent with malignancy as compared to 17 of 46(37%) in the historical control group(P = 0.0003). There was also a significant increase in the average number of cell clusters of all sizes(21.1 vs 9.9 clusters, P = 0.0007) in the new brush group compared to his-torical controls. CONCLUSION: The use of a new brush design for brush cytology of biliary strictures shows increased di-agnostic accuracy, likely due to improved cellular yield, as evidenced by an increase in number of cellular clus-ters obtained.     

Prevalence of Abnormal Anal Cytology in HIV-Infected Women: a Hospital-Based Study

Background: To study the prevalence of abnormal anal cytology by Papanicolaou (Pap) technique in HIVinfected women who attended a HIV clinic at Prapokklao Hospital, Chanthaburi, Thailand. Materials and Methods: HIV-infected women who attended a HIV clinic at Prapokklao Hospital from March 2013 to February2014 were recruited for anal Pap smears. Participants who had abnormal results of equally or over “abnormal squamous/glandular cells of undetermined significance” (ASC-US) were classified as abnormal anal cytology. Results: A total of 590 anal Pap smears were performed at HIV clinic of Prapokklao Hospital during the study period. There were only 13 patients who had abnormal Pap tests, which were: 11 ASC-US and 2 HSIL (high grade squamous intraepithelial lesion). The prevalence of abnormal anal Pap smears in HIV-infected women who attended HIV clinic at Prapokklao Hospital was 2.2 percent. Percentage of high risk HPV in patients who had abnormal Pap test was 88.9 (8/9). Conclusions: The prevalence of abnormal anal Papanicolaou smears in HIV-infected women who attended the HIV clinic at Prapokklao hospital was quite low in comparison to theearlier literature.     

Relationship between minimally invasive hysterectomy,pelvic cytology,and lymph vascular space invasion: A single institution study of 458 patients

Objective

The aim of this study is to determine whether a minimally invasive approach to hysterectomy is associated with an increased rate of lymph vascular space invasion (LVSI) and/or malignant pelvic peritoneal cytology in endometrial cancer.

Methods

We performed a single institution analysis of 458 women with endometrial cancer who underwent either total abdominal hysterectomy (TAH) or minimally invasive hysterectomy (MIH) with use of a disposable uterine manipulator. All patients had endometrial cancer diagnosed by endometrial biopsy at a single academic institution between 2002 and 2012. Exclusion criteria were pre-operative D&C and/or hysteroscopy, uterine perforation or morcellation, and conversion to laparotomy. Multivariate logistic regression models to determine if type of hysterectomy predicts either LVSI or presence of abnormal cytology were controlled for grade, stage, depth of invasion, tumor size, cervical and adnexal involvement.

Results

LVSI was identified in 39/214 (18%) MIH and 44/242 (18%) TAH (p = 0.99). Pelvic washings were malignant in 14/203 (7%) MIH and 16/241 (7%) TAH (p = 1.0). Washings were atypical or inconclusive in 16/203 (8%) MIH and 6/241 (2.5%) TAH (p = 0.014). In multivariate analyses, type of hysterectomy was not a significant predictor of either LVSI (p = 0.29) or presence of malignant washings (p = 0.66), but was a predictor of atypical or inconclusive washings (p = 0.03).

Conclusion

Minimally invasive hysterectomy with use of a uterine manipulator for endometrial cancer is not associated with LVSI or malignant cytology. Algorithms that better determine the etiology and implications of inconclusive or atypical pelvic cytology are needed to inform the possible additional risk associated with a minimally invasive approach to endometrial cancer.     

原发性输卵管癌诊断方法

原发性输卵管癌(PFTC)是恶性程度很高的妇科肿瘤,具有症状隐匿、发病率低、诊断符合率低等特点。文章总结了当前应用于PFTC术前诊断的影像学特征及分子标记物等方法,并探讨了     

Application of Human Papillomavirus in Screening for Cervical Cancer and Precancerous Lesions

Cervical cancer is a commonly-encountered malignant tumor in women. Cervical screening is particularlyimportant due to early symptoms being deficient in specificity. The main purpose of the study is to assess theapplication value of cervical thinprep cytologic test (TCT) and human papillomavirus (HPV) detection in screeningfor cervical cancer and precancerous lesions. In the study, cervical TCT and HPV detection were simultaneouslyperformed on 12,500 patients selected in a gynecological clinic. Three hundred patients with positive resultsdemonstrated by cervical TCT and/or HPV detection underwent cervical tissue biopsy under colposcopy, andpathological results were considered as the gold standard. The results revealed that 200 out of 12,500 patientswere abnormal by TCT, in which 30 cases pertained to equivocal atypical squamous cells (ASCUS), 80 casesto low squamous intraepithelial lesion (LSIL), 70 cases to high squamous intraepithelial lesion (HSIL) and 20cases to squamous cell carcinoma (SCC). With increasing pathological grade of cervical biopsy, however, TCTpositive rates did not rise. Two hundred and eighty out of 12,500 patients were detected as positive for HPVinfection, in which 50 cases were chronic cervicitis and squamous metaplasia, 70 cases cervical intraepithelialneoplasia (CIN) Ⅰ, 60 cases CIN Ⅱ, 70 cases CIN Ⅲ and 30 cases invasive cervical carcinoma. Two hundred andthirty patients with high-risk HPV infection were detected. With increase in pathological grade, the positive rateof high-risk HPV also rose. The detection rates of HPV detection to CIN Ⅲ and invasive cervical carcinoma aswell as the total detection rate of lesions were significantly higher than that of TCT. Hence, HPV detection is abetter method for screening of cervical cancer at present.     

人端粒酶反转录酶对人胚胎皮质神经元损伤的保护

背景：端粒酶可维持端粒长度,避免细胞复制性衰老和凋亡,其催化亚基端粒酶反转录酶还具有抗凋亡和调节细胞生存的作用。目的：观察人端粒酶反转录酶对β淀粉样蛋白1-40引起的人胚胎皮质神经元损伤的影响。方法：分离和培养12-16周龄人胚胎皮质神经元,将人端粒酶反转录酶基因重组腺病毒转染至神经元。免疫细胞化学法检测人端粒酶反转录酶基的表达,端粒重复序列扩增酶联免疫吸附法检测端粒酶活性。转染后第3天,给予10 μmol/L β淀粉样蛋白1-40作用24 h后,应用MTT检测细胞活力。荧光探针2’ 7’-二乙酰二氯荧光素标记检测细胞内活性氧水平,比色法测定细胞匀浆中谷胱甘肽含量。结果与结论：转染后第3天,人端粒酶反转录酶的表达最高,并重建了其端粒酶活性;10 μmol/L β淀粉样蛋白1-40显著降低神经元的细胞活力和谷胱甘肽的含量(P < 0.05和P < 0.01),升高活性氧水平(P < 0.05)。转染了人端粒酶反转录酶基因的神经元能显著对抗β淀粉样蛋白1-40的毒性作用,增加细胞的活力和谷胱甘肽含量(P < 0.05和P < 0.01),降低活性氧水平(P < 0.05)。结果表明,人端粒酶反转录酶对β淀粉样蛋白1-40引起的人胚胎皮质神经元的损伤有明显保护作用。