慢性粒细胞白血病骨髓组织活检及临床意义

目的 为探讨慢性粒细胞性白血病（ＣＧＬ）骨髓组织活检分型及其与临床分期,预后的关系。方法 按Ｂａｒｔｌ及Ｆｒｉｓｃｈ分型及参照Ｈａｍｎｏｖｅｒ分类法,分析组织学特征与临床的关系。结果 粒细胞／巨核细胞（ＧＲＡＮ／ＭＥＧ）发生纤维化（ＭＦ）比率高,中位生存期２２个月,比粒细胞型（ＧＲＡＮ）４８个月明显要短。出现幼稚前体细胞异位（ＡＬＩＰ）９例,其中８例为加速期及慢性晚期。结论 骨髓活检可作为临床分期     

慢性粒细胞白血病80例骨髓活检分析

目的:对慢性粒细胞白血病骨髓活检进行分析,以便全面了解慢性粒细胞白血病的骨髓情况,有助于诊断及治疗。方法:用塑料包埋法制片,然后进行HGF,Gomori染色,观察各项指标。结果:80例病人中78例(97％)骨髓增长明显活跃;19例(61％)伴有不同程度的纤维化;19例(23％)可见3～10个原幼细胞簇。结论:骨髓活检可以全面了解慢性粒细胞白血病的骨髓增生情况、骨髓纤维化程度及原幼细胞簇数量,对判断分期及预后,指导治疗有较重要的意义。     

骨髓细胞学检查对恶性淋巴瘤病理诊断、临床分期及预后价值

[目的]探讨骨髓细胞学检查对恶性淋巴瘤病理诊断和临床分期的价值.[方法]总结回顾101例恶性淋巴瘤患者的骨髓细胞学检查和临床分期结果.[结果]霍奇金淋巴瘤(HL)24例;非霍奇金淋巴瘤(NHL)77例.NHL分型:B细胞型49例,T细胞型26例和NK细胞型2例.恶性淋巴瘤的骨髓侵犯(BMI)32例(31.68%),其中恶性淋巴瘤性白血病(MLL)8例.HL的淋巴细胞削减型和混合细胞型;NHL的小淋巴细胞淋巴瘤,前B淋巴母细胞淋巴瘤和T淋巴母细胞淋巴瘤BMI多见.10例无明显浅表淋巴结肿大的NHL患者经骨髓活检确诊为BMI,分期则由原Ⅱ、Ⅲ期升为Ⅳ期.恶性淋巴瘤发展至MLL的间期＜3.5年,生存期＜28个月,预后不良.[结论]骨髓细胞学检查对恶性淋巴瘤的诊断和临床分期有重要价值,尤其对无淋巴结病理证据的患者可提供诊断依据,伴有BMI患者为临床晚期,可能进展为白血病.     

评价全身FDG-PET/CT在诊断淋巴瘤患者骨髓浸润中的价值

目的:本研究旨在评价PET-CT和骨髓涂片、骨髓活检、免疫分型结果诊断淋巴瘤的一致性和相关性。方法:收集临床确诊淋巴瘤患者的详细临床信息,包括姓名、性别、年龄、淋巴瘤细胞起源、病理分型、临床分期、行为状态、有无B症状、血LDH水平、血β2微球蛋白水平、骨髓涂片结果、免疫分型结果、骨髓活检结果以及详细的PET-CT影像学描述等。根据不同临床信息为患者进行详细分层,评价影响PET-CT中骨髓摄取葡萄糖的因素、影响淋巴瘤骨髓浸润的因素。设定骨髓涂片、骨髓活检、免疫分型阳性为对照,探究PET-CT在诊断淋巴瘤患者骨髓浸润中的价值。分别探讨PET-CT对于诊断不同病理类型淋巴瘤患者骨髓浸润的差异。结果:在性别、病理类型、细胞起源、有无B症状及骨髓浸润等不同分层中,只有淋巴瘤骨髓浸润与PET-CT中骨髓葡萄糖摄取有密切相关性(P=0.002)。而骨髓浸润与年龄(P=0.017)密切相关。设定骨髓涂片、骨髓活检、免疫分型阳性为对照,PET-CT检测淋巴瘤总体骨髓浸润的敏感度为54.3％、特异度为80.5％、准确度为74.5％,并且在不同病理类型中差异显著。PET-CT可以与骨髓涂片、骨髓活检、免疫分型共同指导淋巴瘤临床分期。结论:PET-CT中的骨髓葡萄糖摄取对淋巴瘤骨髓浸润及临床分期有一定的指导意义。不同病理类型的淋巴瘤中,PET-CT与骨髓涂片、骨髓活检、免疫分型的一致性不尽相同。PET仍不能完全取代骨髓涂片、骨髓活检、免疫分型。     

中性粒细胞及乳酸脱氢酶水平对食管鳞癌患者同步放化疗的预后判断价值

摘 要：［目的］ 探讨中性粒细胞和乳酸脱氢酶(LDH)水平对食管鳞癌(ESCC)患者预后的预测价值,并建立预后风险评分模型来预测ESCC患者的预后。［方法］ 回顾性收集接受放射治疗的189例 ESCC患者资料,分析LDH和中性粒细胞水平与临床病理特征的关系,并确定ESCC患者的预后影响因素。以多因素分析结果为基础,建立预后风险评分模型,并对其在亚组中的预测能力进行验证。［结果］ （1）189例患者的LDH中位值为208.0 U/L,中性粒细胞的中位值为4.8×109/L,利用ROC曲线确定二者预测完全缓解率(CR)的最佳临界值分别为220 U/L和4.5×109/L。（2）根据临界值,将患者分别分为LDH≤220 U/L组(n=116) 和LDH>220 U/L组(n=73);中性粒细胞≤4.5×109/L组(n=83)和中性粒细胞>4.5×109/L组(n=106)。患者N分期与LDH水平明显相关(P＜0.05);患者性别、T分期、N分期、TNM分期对中性粒细胞水平有明显影响(P＜0.05)。（3）多因素分析显示,性别、T分期、N分期、LDH水平和中性粒细胞计数是影响患者无复发生存率(RFS)、总生存率(OS)的独立性危险因素。（4）根据多因素分析结果,构建一个基于性别、T分期、N分期、LDH水平和中性粒细胞计数的预后风险模型。在该模型中,低风险组(n=14)：无预后不良因素或有1个预后不良因素;中等风险组(n=141)：有2~3个预后不良因素;高风险组(n=34)：有4~5个不良预后因素。低、中、高风险组患者的中位OS分别为101.20个月、18.00个月和10.05个月,差异有统计学意义(χ2=27.38,P＜0.001)。［结论］ 基线LDH水平和中性粒细胞计数与行放射治疗ESCC患者的预后密切相关,构建的包含LDH、中性粒细胞计数在内的预后模型有助于判断患者预后。     

骨髓活检对PET-CT分期结外NK/T细胞淋巴瘤鼻型的诊断及预后价值

目的评估骨髓活检对基于疗前PET-CT分期结外NK/T细胞淋巴瘤鼻型(ENKTCL)的诊断及预后价值。方法回顾分析2013—2021年福建医科大学附属协和医院初诊ENKTCL的186例完成骨髓活检及骨髓穿刺的患者资料, 分为骨髓穿刺+骨髓活检组(186例)、PET-CT分期+骨髓活检组(139例), 比较组间灵敏度、特异度、阳性预测值与阴性预测值, 对数据进行分析绘图并采用Kaplan-Meier法和log-rank检验进行生存分析。结果全组患者中骨髓活检阳性45例(24.2%), 其中骨髓穿刺阳性30例。141例骨髓活检阴性的患者中骨髓穿刺也均为阴性。139例患者同时完成疗前PET-CT分期与骨髓活检, 30例PET-CT诊断骨髓阳性患者中22例经骨髓活检确诊, 109例PET-CT骨髓阴性患者中虽有5例骨髓活检阳性, 但均因同时有其他远处部位转移而被诊为Ⅳ期。PET-CT对于骨髓受侵的诊断灵敏度为81.5%, 特异度为92.9%, 阳性预测值为73.3%, 阴性预测值为95.4%。其中PET-CT诊断的早期(Ⅰ-Ⅱ期)患者, 骨髓活检均为阴性(阴性预测值为100%)。在Ⅳ期患者(5...     

小细胞肺癌骨髓转移29例临床分析

目的探讨小细胞肺癌(SCLC)骨髓转移的临床特征、治疗方法及预后影响因素。方法回顾性分析29例SCLC骨髓转移病例的临床资料,应用SPSS10.0软件包分析其预后影响因素。结果29例SCLC患者中位年龄为52岁。诊断为局限期(LD)11例,广泛期(ED)18例。出现临床症状到确诊为SCLC的中位时间是2个月,诊断SCLC后到确诊骨髓转移的中位时间是20天。全组患者中位生存期为6个月(2～19个月),确诊骨髓转移后中位生存期为5个月(10天～18个月)。患者生存期与临床分期、发病部位、转移部位数目、含铂类化疗方案及骨髓缓解无关。采用含足叶乙甙(VP16)的化疗方案、联合放疗与患者生存期密切相关。结论SCLC骨髓转移后生存期短,治疗仍以化疗为主的综合治疗。采用含VP16的化疗方案、联合放疗对SCLC骨髓转移的预后较好。     

30例小细胞肺癌骨髓嗜酸性粒细胞值改变的探讨

小细胞肺癌(Small Cell Lang Cancer——ScLc)骨髓象中嗜酸性粒细胞(Eosin-ocyte——Ec)值对临床疗效、预后问题上的价值及其关系,国内外文献尚缺乏报导,本文对未治疗前30例 ScLc 患者骨髓象中E C 值改变与疾病分期、预后的关系作一探讨。     

骨髓活检对PET-CT分期结外NK/T细胞淋巴瘤鼻型的诊断及预后价值北大核心CSCD

目的评估骨髓活检对基于疗前PET-CT分期结外NK/T细胞淋巴瘤鼻型(ENKTCL)的诊断及预后价值。方法回顾分析2013—2021年福建医科大学附属协和医院初诊ENKTCL的186例完成骨髓活检及骨髓穿刺的患者资料,分为骨髓穿刺+骨髓活检组(186例)、PET-CT分期+骨髓活检组(139例),比较组间灵敏度、特异度、阳性预测值与阴性预测值,对数据进行分析绘图并采用Kaplan-Meier法和log-rank检验进行生存分析。结果全组患者中骨髓活检阳性45例(24.2%),其中骨髓穿刺阳性30例。141例骨髓活检阴性的患者中骨髓穿刺也均为阴性。139例患者同时完成疗前PET-CT分期与骨髓活检,30例PET-CT诊断骨髓阳性患者中22例经骨髓活检确诊,109例PET-CT骨髓阴性患者中虽有5例骨髓活检阳性,但均因同时有其他远处部位转移而被诊为Ⅳ期。PET-CT对于骨髓受侵的诊断灵敏度为81.5%,特异度为92.9%,阳性预测值为73.3%,阴性预测值为95.4%。其中PET-CT诊断的早期(Ⅰ-Ⅱ期)患者,骨髓活检均为阴性(阴性预测值为100%)。在Ⅳ期患者(55例)中,骨髓活检或PET-CT提示骨髓阳性的患者(35例)与其他器官受累的Ⅳ期患者(20例)对比,1年总生存率分别为28.7%和42.0%(P=0.13),1年无进展生存率分别为23.2%和23.3%(P=0.94)。结论基于PET-CT分期的早期ENKTCL常规骨髓活检不改变原有分期;晚期患者中骨髓阳性患者生存率有更差的趋势,骨髓活检仍有一定价值。     

格拉斯哥预后评分在鼻咽癌预后评估中的作用

目的 探讨格拉斯哥预后评分(GPS)在鼻咽癌患者预后评估中的作用。方法 回顾性分析2012—2013年间在江南大学附属医院接受根治性放疗的129例鼻咽癌患者,收集患者临床病理特征包括性别、年龄、TNM分期、病理分型、治疗方案等,计算患者放疗前及放疗结束后3个月GPS。生存率计算采用Kaplan-Meier法,Cox模型预后因素分析。利用受试者工作特征(ROC)曲线下面积(AUC)评价临床指标对预后的预测能力。结果 中位随访时间89.0个月(5.1~104.6个月),129例患者5年无进展生存率(PFS)79.8%,5年总生存率(OS)84.5%。放疗后3个月GPS 0、1、2分组5年PFS率分别为85.6%、61.1%、33.3%,5年OS率分别为90.4%、66.7%、33.3%(P<0.01)。放疗后3个月GPS、临床分期(Ⅰ-Ⅲ期∶ⅣA期)及是否同步化疗均与患者PFS、OS相关(均P<0.01)。ROC曲线显示放疗后3个月GPS及临床分期预测OS的AUC值分别为0.694和0.815,两者联合AUC值达0.860。结论 放疗后3个月,高GPS是鼻咽癌患者独立预后不良因子,GPS联合临床分期可更加准确预测鼻咽癌患者预后。     

骨髓涂片免疫组织化学与骨髓活组织检查诊断非霍奇金淋巴瘤骨髓浸润的比较

目的：比较骨髓涂片免疫组织化学和骨髓活组织检查在检测非霍奇金淋巴瘤（NHL）骨髓受累中的优缺点。方法收集60例初治NHL患者,应用骨髓涂片免疫组织化学法和骨髓活组织检查检测是否骨髓受累,并将患者的年龄、临床分期、结外受累、B症状等临床因素与两种检测方法结果进行相关性分析。结果骨髓涂片免疫组织化学和骨髓活组织检查检测出的NHL骨髓受累阳性率分别为10.0%（6／60）、3.3%（2／60）（P＝0.008）;B细胞来源时,两者阳性率分别为6.6%（4／60）和3.3%（2／60）（P＝0.007）,T细胞来源时,阳性率分别为3.3%（2／60）、0（0／60）。经相关性分析,两种检测方法与患者性别、年龄、Karnofsky评分、B症状、结外累及、乳酸脱氢酶、血小板数、血红蛋白含量、中性粒细胞数、淋巴细胞数、分期均无关（均P＞0.05）。结论骨髓涂片免疫组织化学法检测NHL骨髓受累的阳性率高于活组织检查,进一步分析B细胞或T细胞来源时,骨髓涂片免疫组织化学法仍有相对优势。     

Immunohistochemical analysis of cyclin D1 and p53 in multiple myeloma: relationship to proliferative activity and prognostic significance

Conflicting data are reported on the clinical significance of cyclin D1 deregulation in multiple myeloma. The aim of this study was to evaluate the incidence and prognostic significance of cyclin D1 expression and p53 mutations in multiple myeloma, as well as the relationship of their expression with selected clinical data, histological features, and proliferative activity of myeloma cells. We analyzed bone marrow biopsy specimens obtained from 59 patients with newly diagnosed multiple myeloma. Expression of cyclin D1 and p53 was analyzed using standard immunohistochemical method of B5-fixed and routinely processed paraffin-embedded bone marrow specimens. Cyclin D1 was overexpressed in 14/59 (27%) and p53 in 5/59 (8.5%) specimens. There was no significant correlation between cyclin D1 overexpression and age, gender, clinical stage (Durie-Salmon classification), extent of osteolytic lesions, type of monoclonal protein, hemoglobin concentration, platelet count, serum concentration of creatinine, calcium, C-reactive protein, and beta2-microglobulin. No association was observed between the expression of cyclin D1 and the extent of bone marrow infiltration, histological grade, proliferative activity index (measured with Ki-67 immunoreactivity) and response to therapy. No significant difference was observed regarding overall survival between cyclin D1 positive and cyclin D1 negative patients (29 vs 36 mo, p = 0.76). Results of this study did not revealed prognostic significance of cyclin D1 overexpression in multiple myeloma. Mutations of p53 gene are rare events in myeloma, suggesting their limited role in the pathogenesis of the disease.     

Prognostic features at diagnosis of chronic myeloid leukaemia with special emphasis on histological parameters

A clinicopathological study was performed on 115 patients (56 males, 59 females; median age 48 yr) with chronic myeloid leukaemia (CML) to reveal initial clinical, but particularly histomorphological features of predictive value for survival. All patients had a trephine biopsy of the bone marrow and entered this study without prior selection. Overall survival was 36 +/- 27 months. In addition to multiple interactions between various disease features, multivariate regression analysis showed that of the clinical parameters age, liver size and level of LDH were primarily and most closely associated with prognosis. Of the histomorphological variables, megakaryocytes greater than 60 mm-2 bone marrow area and fibrosis displayed an unfavourable impact on survival on univariate calculation. On multivariate analysis, however, only pseudo-Gaucher cells remained significant, i.e. exerted an independent and favourable influence on prognosis. Histological features of predictive value were reviewed together with the different categories of a histopathological classification proposed for chronic myeloproliferative diseases by Georgii and co-workers.     

Accuracy of Immunohistochemistry and Flow Cytometry in Estimating the Proportion of Leukemic Cells in S Phase in Chronic Myeloid Leukemia Patients

We compared the proportion of S phase cells in bone marrow and peripheral blood samples obtained from 17 patients with chronic myeloid leukemia (CML). Before sampling all patients received a one hour IV infusion of iododeoxyuridine (IdUrd). The proportion of S phase cells was studied by immunohistochemistry (IHC) in bone marrow biopsies, and by flow cytometry (FCM) in bone marrow aspirates and peripheral blood samples. The IdUrd labelling index (LI) in bone marrow biopsy sections (27.5 ± 1.8%) was significantly higher than the proportion of IdUrd labelled cells in bone marrow aspirate (15.1 ± 2.0%). The percentage of S phase cells in peripheral blood was approximately the same as that in the aspirate (12.4 ± 1.3%) and was correlated with that of bone marrow aspirate indicating a high degree of the aspirate dilution by peripheral blood. It is likely that the differences in % S phase cells in the aspirate and the biopsy result from this dilution. Estimates of the % S phase cells in the peripheral blood study by IHC and FCM were essentially the same. Samples labelled for one hour in vitro resulted in 1.5 fold higher LI than the same samples labelled in vivo. We conclude that estimates of the 8% S phase cells in the bone marrow of patients with CML should be made by infusing patients with IdUrd or BrdUrd with immunohistochemical evaluation of a marrow biopsy. Additionally in vitro labelling is not reflective of the percent S phase cells in vivo in patients.     

Immunohistochemical analysis of cyclin D1 and p53 in multiple myeloma

Conflicting data are reported on the clinical significance of cyclin D1 deregulation in multiple myeloma. The aim of this study was to evaluate the incidence and prognostic significance of cyclin D1 expression and p53 mutations in multiple myeloma, as well as the relationship of their expression with selected clinical data, histological features, and proliferative activity of myeloma cells. We analyzed bone marrow biopsy specimens obtained from 59 patients with newly diagnosed multiple myeloma. Expression of cyclin D1 and p53 was analyzed using standard imunohistochemical method of B5-fixed and routinely processed paraffin-embedded bone marrow specimens. Cyclin D1 was overexpressed in 14/59 (27%) and p53 in 5/59 (8.5%) specimens. There was no significant correlation between cyclin D1 overexpression and age, gender, clinical stage (Durie-Salmon classification), extent of osteolytic lesions, type of monoclonal protein, hemoglobin concentration, platelet count, serum concentration of creatinine, calcium, C-reactive protein, and beta₂-microglobulin. No association was observed between the expression of cyclin D1 and the extent of bone marrow infiltration, histological grade, proliferative activity index (measured with Ki-67 immunoreactivity) and response to therapy. No significant difference was observed regarding overall survival between cyclin D1 positive and cyclin D1 negative patients (29 vs 36 mo, p=0.76). Results of this study did not revealed prognostic significance of cyclin D1 overexpression in multiple myeloma. Mutations of p53 gene are rare events in myeloma, suggesting their limited role in the pathogenesis of the disease.     

The significance of bone marrow involvement in non-Hodgkin's lymphoma: the Eastern Cooperative Oncology Group experience

Data from four clinical trials conducted by the Eastern Cooperative Oncology Group (ECOG) were used to investigate the importance of bone marrow involvement as a prognostic factor in patients with non-Hodgkin's lymphoma (NHL). A total of 502 patients, 275 with nodular, poorly differentiated lymphocytic lymphoma (NLPD) and 227 with diffuse histiocytic lymphoma (DHL) or diffuse mixed-cell lymphoma (DML), were included in this analysis. Patients were separated into four categories: stage III, stage IV with bone marrow involvement (stage IV-M), stage IV without marrow involvement (stage IV-O), and stage IV with bone marrow and other organ involvement (stage IV-OM). Among the DHL and DML patients, the incidence of marrow involvement was 23%. However, stage IV-M patients had a prognosis that is similar to stage IV-O and stage IV-OM and worse than stage III patients. In contrast, the incidence of involvement with NLPD was 59% and patients with stage IV-M had a survival not different than stage III and not worse than stage IV-O and stage IV-OM. The results suggest that the current emphasis on bone marrow biopsy(s) as a routine diagnostic staging procedure for patients with NHL should be reevaluated. The necessity for this procedure in stage III patients with NLPD is not apparent from our data. One can still justify a bone marrow biopsy in stage I and II patients and can confirm the complete clinical response when all nodes have regressed in more advanced disease.     

If it is in the marrow,is it also in the blood? An analysis of 1,000 paired samples from patients with B-cell non-Hodgkin lymphoma

Background  

Staging of B-cell non Hodgkin's lymphoma (NHL) routinely involves bone marrow (BM) examination by trephine biopsy (BM-TB). The evidence of disease in the BM-TB results in a clinical stage IV classification affecting therapeutic strategies for NHL patients. BM immunophenotyping by flow cytometry (FC) is also used, although its clinical value is still under debate.     

不同骨髓检查在淋巴瘤诊断中的价值

探讨3种骨髓检查方法（骨髓涂片、活检、流式细胞术分析）对淋巴瘤骨髓浸润的诊断及分期价值。方法:对74例患者进行3种方法的骨髓检查,评估不同方法的检出率、对分期的影响以及各亚型中骨髓浸润的风险。结果:骨髓涂片阳性者12例（16.2%）,骨髓活检阳性10例（13.5%）,流式细胞术分析阳性23例（31.1%）,流式细胞术分析的阳性率显著高于涂片和活检检查（P<0.05）;骨髓涂片、活检、流式细胞术分析可互相修正淋巴瘤患者的临床分期;弥漫大B细胞淋巴瘤亚型骨髓浸润比例最高;对于无淋巴结、肝脾肿大者,骨髓检查具有明确诊断的作用。结论:骨髓涂片、活检及流式细胞术分析对淋巴瘤有重要的诊断及分期价值,三者互为补充,不能相互替代。      

骨髓涂片、骨髓活检对弥漫性大B细胞淋巴瘤临床分期的价值

目的:探讨骨髓涂片、骨髓活检对弥漫性大B细胞淋巴瘤(DLBCL)临床分期的价值.方法:对44例累及骨髓的病例回顾性分析骨髓涂片及骨髓活检切片,分别比较细胞学形态、组织形态、增生程度、纤维组织增生程度、检出率和敏感性.结果:骨髓涂片中可见中到大型的异型细胞骨髓,切片中瘤细胞以灶型最常见.按Manoharm改良法评估,骨髓切片中网状纤维含量有不同程度增多.骨髓涂片与骨髓切片增生程度的比较,差异有统计学意义(P＜0.05),切片组增生程度高于涂片组.骨髓涂片与骨髓切片检出率的比较,差异有统计学意义(P＜0.05),切片组检出率高于涂片组.骨髓涂片与骨髓切片敏感性的比较,差异有显著统计学意义(P＜0.01),切片组敏感性明显高于涂片组.结论:骨髓涂片简单易行,骨髓切片在骨髓组织状况、优势增生细胞等方面有优势,同时开展涂片和切片的检测,提高检出率,可以修正临床分期,如能同时进行流式细胞免疫表型分析,则更能提高检出率.