胸壁、纵隔（071305～071311）

071305 FCM-DNA倍体分析、AgNOR染色及hTERT、PC-NA表达在良恶性胸腹水鉴别诊断中的帷床意义；071306 Ⅱ期胸腺癌放疗范围的初步探讨；071307 胸腹水脱落细胞流式细胞法DNA倍体分析的临床诊断价值；071308 流式细胞术在恶性胸腹水中的诊断价值；071309 超声引导下胸腔置管顺铂联合干扰素治疗恶性胸腔积液……[第一段]     

DNA倍体分析在胸腹水诊断中的价值

目的探讨流式细胞术(FCM)DNA倍体分析对恶性胸腔积液及腹水的诊断价值.方法以57例患者的胸水或腹水作流式细胞术DNA倍体分析和脱落细胞学检测,比较二者之间的敏感性和特异性.结果FCM、脱落细胞学检测在良恶性胸腔积液或腹水中的阳性率分别为6.67%,62.96%;3.33%,48.15%.二种方法均有非常显著性差异(P＜0.01).FCM、脱落细胞学检测在恶性胸腔积液或腹水中敏感性分别为62.96%,48.15%,二者无显著性差异(P＞0.05).特异性分别为93.33%,96.67%,二者无显著性差异(P＞0.05).结论流式细胞术分析胸腔积液及腹水细胞的DNA异倍体,对于恶性肿瘤的细胞学诊断有重大意义.     

流式细胞术用于良恶性胸腔积液鉴别诊断的研究--DNA倍体分析和突变型p53蛋白检测

目的研究流式细胞术DNA倍体和细胞周期分析、突变型p53检测用于良恶性胸腔积液鉴别诊断的临床可行性.方法 24例标本(12例恶性,12例良性)采用流式细胞术细胞内抗原检测的直接免疫荧光标记法检测胸腔积液细胞中表达突变型p53的阳性细胞百分率和p53表达的平均荧光强度,并且通过PI染色分析细胞倍型和周期分布.结果流式细胞术DNA倍体分析用于恶性胸腔积液诊断的敏感性为66.7%,特异性100%.倍体分析和细胞学检查联合应用能将诊断的敏感性提高到100%,特异性仍为100%.良性胸腔积液和恶性胸腔积液p53表达有显著性差异.以p53阳性细胞百分率＞90%为阳性标准,p53用于良恶性胸腔积液鉴别诊断的敏感性和特异性分别为83.3%和91.7%.联合p53阳性细胞百分率和DNA倍体分析对恶性胸腔积液诊断的敏感性能提高到91.7%,特异性91.7%.细胞周期SPF(S期时相百分比)在良恶性胸腔积液之间没有显著差异.结论流式细胞术DNA倍体分析和突变型p53检测可以作为临床良恶性胸腔积液鉴别诊断的辅助手段,结合细胞学检查更有意义.     

AgNOR检测在胸腹水细胞学诊断中的意义

胸腹水涂片中细胞学诊断较困难的问题是增生间皮细胞与不典型的恶性肿瘤细胞的鉴别,因此寻找一种较客观的形态学诊断指标是十分重要的。晚近,国外报道用银染新技术显示石蜡组织切片上核仁组成区嗜银蛋白(Ag-staining nuclcolar organizerRegion,AgNOR)鉴别良恶性肿瘤获得成功,我们应用AgNOR染色技术对胸腹水涂片中的反应性增生间皮细胞及癌细胞进行形态定量检测,探讨鉴别二者的可能性。     

胸腹腔液端粒酶活性检测的临床意义

目的:通过对39例胸腹水和腹腔液标本及12例胃肠癌端粒酶活性的检测,结合脱落细胞学检查,探讨端粒酶活性检测在胸腹水和腹腔液良恶性判别中的临床应用价值。方法:采用PCR-TRAP技术检测端粒酶活性,同时进行常规脱落细胞学检查。结果:39例胸腹水及腹腔液标本中端粒酶阳性10例,占25.6%,端粒酶活性与脱落细胞检查符合率为87.2%(34/39),两种检查方法具有一致性(χ2=12.54,P<0.005)。端粒酶检查胸腹腔液的敏感性为85.7%(6/7),特异性为87.5%(28/32)。12例胃肠癌端粒酶活性均为阳性,腹腔液的端粒酶活性与原发灶浸润深度及淋巴结转移有关(u=2.38,P<0.05)。结论:端粒酶检测与脱落细胞检查联合应用有助于提高诊断的敏感性及确诊率。     

流式细胞术-DNA倍体分析在胃癌手术患者腹腔脱落肿瘤细胞检测中的应用效果

目的 探讨流式细胞术(FCM)-DNA倍体分析在胃癌手术患者腹腔脱落肿瘤细胞检测中的应用效果.方法 对68例胃癌手术患者进行FCM-DNA倍体分析和腹腔冲洗细胞学(PLC)检测,比较FCM-DNA与PLC检测的阳性率,比较不同临床特征胃癌患者的FCM-DNA和PLC检测阳性率.采用受试者工作特征(ROC)曲线评估FCM...     

脱落细胞端粒酶活性检测在良恶性胸腹水鉴别中的应用

目的免疫组化方法检测脱落细胞端粒酶活性鉴别良恶性胸腹水.方法本文用免疫组化方法检测了48例胸腹水脱落细胞端粒酶活性,其中癌性胸腹水30例,肝硬化腹水10例,结核性胸水8例.结果30例癌性胸腹水22例检出端粒酶阳性细胞,阳性率73.3%显著高于脱落细胞病理学检查对肿瘤的诊断(阳性率为43.3%).结论免疫组化方法检测胸腹水脱落细胞端粒酶活性在良恶性胸腹水鉴别诊断中有重要价值.     

AgNOR定量分析在细胞学辅助诊断中的意义

目的利用核仁组成区技术(AgNOR)区分良性、中至重度不典型增生及恶性细胞,并探讨AgNOR分型与癌细胞类型的关系.方法应用胶银染色技术检测439例细胞学涂片.结果良性细胞均数(2.96±0.76)与恶性细胞均数(9.90±2.43)差异有极显著性(P＜0.001),说明产生假阳性机会很小.良性细胞与中度不典型增生细胞均数(3.90±0.66)和重度不典型增生细胞均数(5.88±0.98)差异有极显著性(P＜0.001),有助于识别可疑癌细胞.AgNOR在腺癌细胞中颗粒粗大、色深;在鳞癌及小细胞癌中颗粒多为弥散型,细小、色浅.AgNOR分型与癌细胞分型有显著相关性(P＜0.001).用AgNOR计算标准判断良恶性其敏感性为96.4%,特异性为95.5%.结论细胞学普通染色诊断困难时,AgNOR银染技术可以辅助诊断.     

AI细胞形态学联合DNA定量分析鉴别良恶性胸腹水的探讨

目的 探讨通过人工智能（AI）细胞学联合DNA定量分析（DNA-ICM）辅助诊断系统在良恶性胸腹水鉴别中的诊断价值。方法 用液基细胞学（LCT）、DNA-ICM、AI、AI联合DNA-ICM系统对360例胸腹水标本进行良恶性鉴别，比较几种检测方法的敏感度、特异性、准确度、Kappa值、约登指数及曲线下面积。结果 通过AI联合DNA-ICM检测良恶性胸腹水的敏感度、特异性、准确度分别为95.23%、94.12%、94.44%，高于其他三种单独检测方法，差异均具有统计学意义（P<0.05）。LCT、DNA-ICM、AI检测的Kappa值分别为0.646、0.642、0.586，约登指数分别为0.693、0.687、0.676,AUC分别为0.846、0.843、0.838；通过AI联合DNA-ICM的Kappa值为0.869，约登指数为0.893,AUC为0.947，均高于三种单独检测方法。结论 三种单独检测方法中LCT的可靠性、真实性、诊断价值最高，可为临床鉴别良恶性胸腹水的常用方法。通过AI联合DNA-ICM辅助诊断系统阅片，在鉴别良恶性胸腹水的诊断效能比三种单独检测方法好，可作...     

胸腹水涂片中良恶性细胞AgNOR的研究

目的探计AgNOR染色对胸腹水涂片中良、恶性细胞诊断和鉴别诈断的意义。方法应用银染方法对20例癌性胸腹水涂片和10例良性胸腹水涂片进行了AgNOR检测和观察。结果癌细胞核内的AgNOR颗粒平均数为7.2±1.38,明显高于增生间皮细咆核内的AgNOR平均数1.36±0.21,两组间差异有高度显著性(P<0.001);在形态上癌细胞颗粒大小不一,形态不规,畸形明显,以聚集型和弥散型为主,增生间皮细胞的颗粒形态规则。大小一致,以单一型为主。结论应用AgNOR颗粒计数结合颗粒形态观察分型综合分析对胸腹水中良、恶性细胞的鉴别诊断具有一定的实用价值。     

癌性胸水p16基因纯合性缺失检测的临床意义

研究癌性胸水Ｐ１６基因纯合性缺失检测的临床意义。方法：应用ＰＣＲ技术检测胸水Ｐ１６基因第一、二外显子纯合性缺失，并结合胸水脱落细胞学检测分析其在临床诊断中的意义。结果表明所检３１例肺癌所致癌性胸水标本中均无出现Ｐ１６基因第一外显子纯合性缺失，１２例有Ｐ１６基因第二外显子纯合性缺失，阳性率为３８．７１％。     

Ki-67在浆膜腔积液鉴别诊断中的应用

目的 :探讨 Ki- 6 7抗体对鉴别浆膜腔积液中良恶性细胞的价值 ,解决伴浆膜腔积液的疑难病例的诊断。方法 :用 Ki- 6 7单克隆抗体标记 4 7例浆膜腔积液涂片标本 ,每张涂片计数 10 0 0个细胞中的阳性细胞数 ,用百分率表示阳性指数 ,同时对涂片作 HE染色。结果 :恶性积液组 Ki- 6 7指数为 34.89% ,良性组为 0 .72 % ,两者差异具有显著性 (P<0 .0 0 5 )。结论 :浆膜腔积液涂片 HE染色诊断结合 Ki- 6 7标记 ,可提高恶性浆膜腔积液细胞学的阳性诊断率 ,可作为临床鉴别良恶性浆膜腔积液的参考指标。     

Nucleolar organizer region count and subjective AgNOR pattern assessment (SAPA) score in skin tumors.

OBJECTIVE: To study the argyrophilic nucleolar organizer region (AgNOR) count and subjective AgNOR pattern assessment (SAPA) score in cytologic and histologic specimens of various skin tumors. STUDY DESIGN: The study group consisted of 37 patients (14 benign and 23 malignant) of various skin tumors. In all cases, cytology by fine needle aspiration cytology (FNAC), and histological specimens were studied by conventional staining and silver staining for AgNOR. RESULTS: The mean count in benign tumors in cytologic specimens was 2.08 +/- 0.01, compared with 5.50 +/- 1.12 in malignant tumors (P<0.001). In histologic specimens, mean count was 2.13 +/- 0.51 in benign, compared with 5.38 +/- 1.10 in malignant tumors (P<0.001). The SAPA score in benign tumors (P<0.001) in cytologic specimens, was 6.07 +/- 0.83, compared with 10.65 +/- 1.27 in malignant tumors, and in histology, it was 6.07 +/- 0.87 in benign, compared with 10.83 +/- 1.15 in malignant tumors (P < 0.001). Melanoma showed the higher AgNOR count compared with squamous cell carcinoma and basal cell carcinoma. The parameters were statistically significant between the grade of tumor in squamous cell carcinoma and the positivity of lymph nodes as demonstrated by SAPA score. No correlation was found between the clinical stage and Clark level of melanoma. Although, AgNOR count and SAPA score showed similar results, the indicators of validity were higher in SAPA than AgNOR count. CONCLUSION: Although, AgNOR count and SAPA score gave similar results, but the indicators of validity were higher in SAPA score than AgNOR count.     

Diagnostic value of a second generation CA 15-3 antibody to detect adenocarcinoma in body cavity effusions

BACKGROUND: Detecting malignant cells in body cavity effusions can be diagnostically challenging. Several monoclonal antibodies have been studied to improve the diagnostic yield of effusion cytology but without widespread acceptance. The CA 15-3 antibody has demonstrated high sensitivity but limited specificity for breast carcinoma in surgical pathology. A second generation CA 15-3 antibody has been developed that has not been studied in serous effusions to the authors' knowledge. The authors examined this second generation CA 15-3 antibody for its diagnostic utility in detecting adenocarcinomas in this cytologic setting. METHODS: Cell block material from 114 cases of unequivocally benign or malignant body cavity effusions were studied. Slides were stained for CA 15-3 by using the avidin-biotin complex method. The percentage of cells exhibiting strong staining was estimated both for breast carcinoma and for all adenocarcinomas as a group. These results were compared with CA 15-3 staining exhibited by benign mesothelium. RESULTS: CA 15-3 was expressed in at least 10% of tumor cells in 97% of breast carcinoma cases and in 90% of adenocarcinomas overall. The highest sensitivity was observed in carcinomas of the breast, ovary, and lung. Of 40 cases of benign mesothelium, only 4 (10%) were positive (P < 0.001). The sensitivity of CA 15-3 was 97% for breast carcinoma and 91% for adenocarcinomas overall. Specificity was 95% for breast carcinoma and 91% for adenocarcinomas. CONCLUSIONS: CA 15-3 is an immunostain with high specificity and sensitivity for adenocarcinomas in cell block material from effusions. The antibody holds particular promise for detecting breast carcinoma. Cancer (Cancer Cytopathol) Copyright 2000 American Cancer Society.     

增殖细胞核抗原与AgNOR检测在前列腺癌临床中的意义

目的研究前列腺癌中增殖细胞核抗原（ＰＣＮＡ）表达及ＡｇＮＯＲ计数的意义。方法应用免疫组织化学方法和银染色技术检测前列腺癌和良性前列腺增生组织中ＰＣＮＡ表达和ＡｇＮＯＲ计数。结果ＰＣＮＡ增殖指数与ＡｇＮＯＲ计数在癌组织中均明显高于良性前列腺增生组织（Ｐ均＜０．００１）,且两者均与肿瘤组织学分级和预后有密切关系（Ｐ均＜０．０１和Ｐ均＜０．００１）;前列腺癌ＰＣＮＡ增殖指数与ＡｇＮＯＲ计数间存在非常显著的正相关（Ｐ＜０．０１）。结论ＰＣＮＡ增殖指数和ＡｇＮＯＲ计数结合分析,在鉴别前列腺良恶性病变和判断前列腺癌的恶性程度及预测患者预后方面具有十分重要的意义。     

肾上腺皮质肿瘤增殖活性检测及预后意义

 目的：探讨细胞增殖活性检测对肾上腺皮质肿瘤的诊断价值和预后。方法：采用DNA含量测定、AgNOR和PCNA染色对正常肾上腺皮质、皮质增生、腺瘤和癌进行细胞增殖活性检测。结果：正常肾上腺与皮质增生DNA含量、AgNOR计数、PCNA指数均值相接近(P>0.05),DNA倍体主要呈二倍体。腺瘤较增生组相比三种指标均值相差显著(P<0.01)。结论：提示细胞增殖活性检测对肾上腺皮质肿瘤诊断和预后判断有较大参考价值。     

Diagnostic Value of Claudin-4 and EZH2 Immunohistochemistry in Effusion Cytology

Background: Metastatic adenocarcinoma (MAC) accounts for most cases of malignant effusions. Sometimes, it can be difficult to distinguish MAC from reactive mesothelial cells (RMC) in cytologic specimens. Our aim was to assess the diagnostic performance of a novel immunohistochemical panel composed of claudin-4 and EZH2 in differentiating MAC from RMC in effusion cytology. Methods: A total of 80 cases of serous effusions (48 MAC and 32 RMC) were included. Immunohistochemistry using claudin-4 and EZH2 was performed on cell block sections of these cases. Assessment of staining patterns, intensity and percentage of target cells stained was done. Results: Claudin-4 showed membranous staining in 46/48 of MAC and 1/32 of RMC. High EZH2 (≥ 50% of target cells) was detected in 42/48 MAC and 2/32 RMC. For the discrimination between MAC and RMC, claudin-4 exhibited 95.8% sensitivity and 96.9% specificity, high-EZH2 exhibited 87.5% sensitivity and 93.8% specificity, while the combination of both claudin-4 and high EZH2 showed 100% sensitivity and 90.6% specificity. Conclusion: Claudin-4 shows high sensitivity and specificity in differentiation between MAC and RMC in effusion cytology, and might be useful as a solitary marker for MAC. Adding EZH2 to claudin-4 increases the sensitivity to 100%. However, the interpretation of EZH2 results can be challenging due to its focal expression in RMC and inflammatory cells.     

An immunocytochemical study of ras and myc oncoproteins and EGFr expression in pleural effusion smears

Pleural effusion smears from 112 patients with either benign or malignant lung disease were investigated for the expression of EGFr and the oncogene proteins myc p64 and ras p21. The streptavidin-biotin peroxidase technique was used. In the studied malignant group of effusions both EGFr and ras have greater sensitivity in the detection of a malignant process than does routine cytological examination though EGFr was less specific. The combination of positive cytology and 3 positive markers is highly specific for a malignant process (90%). Myc and ras had a 100% sensitivity in squamous cell carcinomas but an overall specificity of only 67.3% and 66.6% respectively. The differences in myc and ms positivity, between squamous cell and adenocarcinoma effusion smears were highly significant (p <0.005). All effusion smears associated with undifferentiated carcinomas were ras positive and 2 of them were myc and EGFr positive.