无精子症病人精液细胞学与睾丸针吸细胞学检查的相关性研究

６１例无精子症病人精液细胞学与睾丸针吸细胞学研究的结果显示，８７％的病人精液中检出生精细胞；精液细胞学与睾丸针吸细胞学检查总符合率为９１％（梗阻性无精子症除外）；经ｘ￣２检验二者显著相关（Ｐ＜０．００５），同一病人两种检查所反映的生精细胞发育水平一致。提示精液细胞学检查能反映睾丸生精状况，是一种比较理想的无创伤性检查方法。     

Usefulness of liquid-based preparation in urine cytology

OBJECTIVE: ThinPrep (TP), a liquid-based cytological and non-invasive technique to confirm the diagnosis of bladder cancer, is reported to be a better screening test than the conventional cytospin method. This study compared the new MonoPrep2 (MP), a liquid-based cytological technique, with TP for diagnosing bladder cancer. MATERIALS AND METHODS: Between January 2003 and June 2004, urine samples from 284 patients were processed using the TP and MP methods. The cytological diagnosis and the determination of specimen quality were performed separately. The cytological diagnoses were classified into four categories: unsatisfactory, benign, borderline, and malignant. A subsequent biopsy was performed in 73 patients. The cytological diagnoses were compared with the biopsy results to evaluate the sensitivity and specificity of the two methods. RESULTS: Considering all the features examined, the overall specimen quality was comparable between the MP and TP techniques in the majority of cases. The rate of satisfactory specimens was 100% for TP and 98.6% for MP. The diagnostic capacity was similar between MP and TP. The overall sensitivities with MP and TP were 58.6 and 62.0%, respectively, and the specificities were 100 and 97.7%; the differences were not significant (P > 0.05). CONCLUSIONS: MP and TP produced comparable results in diagnosing bladder cancer. As MP is less expensive than TP, we recommend MP as an alternative liquid-based cytology method for use in bladder cancer screening.     

Urine cytology after flexible cystoscopy

OBJECTIVE

To correlate urine cytology findings before and after flexible cystoscopy.

PATIENTS AND METHODS

A total of 153 patients undergoing surveillance for bladder tumour provided voided urine for cytology before and immediately after flexible cystoscopy.

RESULTS

Of the 153 patients, 116 had negative urine cytology before and after (96%) a visibly normal cystoscopy and 37 had positive urine cytology before and after cystoscopy that showed recurrent tumour.

CONCLUSIONS

Urine cytology immediately after flexible cystoscopy correlates well with results of urine cytology before cystoscopy.

     

妊娠期宫颈细胞学异常的处理

妊娠期宫颈细胞学异常在产后转阴率高,极少进展为浸润癌。多数指南建议,除怀疑宫颈浸润癌者外均可以随诊,待产后6周再复查。怀疑宫颈浸润癌者最好在孕20周前进行宫颈诊断性切除。妊娠期宫颈上皮内瘤变进展与否与分娩方式无关,应根据产科指征决定分娩方式。妊娠期宫颈细胞学异常在产后复查或治疗后恢复正常者,仍属高危人群,需要与非妊娠期患者一样严密随访。     

Diagnosis of breast lesions by aspiration biopsy cytology

From November 1981 to the end of August 1984, 456 patients with breast lesions underwent aspiration biopsy cytology (A.B.C.). This study includes 109 for whom the diagnosis was histologically confirmed at surgical biopsy. Seventy-five lesions were histologically proven to be malignant and 34 were benign. The accuracy of diagnoses with A.B.C. was; true positive 86.7 per cent (65/75) of the time, true negative 82.6 per cent (28/34) of the time, false negative 5.3 per cent (4/75) of the time and false positive 5.7 per cent (2/34) of the time. Unsatisfactory or inadequate aspirated tissue made A.B.C. diagnosis difficult in 5.5 per cent (6/109) of the cases. Three out of 7 with malignant tumors, who were wrongly diagnosed as benign by A.B.C., had tumors with a diameter of 1.0 cm or less. Two benign cases which were falsely diagnosed as malignant also had small tumors about 1.0 cm in diameter. Although A.B.C. is more reliable than other conventional supplementary diagnostic techniques (mammography, ultrasonography, etc.), it is important to carefully follow clinically questionable cases which appear negative, using A.B.C.     

The efficacy of urinary cytology in the detection of urothelial tumours

Summary The sensitivity and specificity of urinary cytology in the detection of urothelial tumours using voided urine and applying simple smear preparation and staining techniques have been assessed. Of the 2704 patients under investigation 207 had urothelial tumours. The first urine analysis was positive in 66% of the patients with urothelial carcinoma; an additional 23% of the patients showed positive cytology in repeat smears, resulting in a sensitivity of 89%. The efficacy of urinary cytology depends on the tumour type: for grade 2 tumours, 79% were cytologically positive, 92% of grade 3 and 98% of the grade 4 tumours. The diagnostic efficacy in cases of carcinoma-in-situ, squamous cell carcinoma and adenocarcinoma was comparable with that of grade 4 carcinomas. Grade 0–1 tumours did not result in positive cytology. In eleven cases of lithiasis and in two cases of cyclophosphamide therapy the cytological diagnosis was positive but no neoplasm could be established histologically; these represent true false positive diagnoses. Thus, the false positive rate, 13 out of 165, was 7.88% and the false negative rate, 61 out of 207, was 29.4% when grades 0–1 were included, but 8.75% (14 out of 160) when grades 0–1 were excluded.     

Evaluation of intraoperative scrape cytology for sentinel lymph node biopsy in patients with breast cancer

The techniques for intraoperative evaluation of sentinel lymph nodes (SLNs) vary. The most common methods include frozen section, imprint cytology/touch preparation cytology, and scrape cytology (SC). The purpose of this study was to evaluate whether there is concordance between the intraoperative SC and the final pathology of SLNs in patients with breast cancer. From October 2001 to June 2005, sentinel lymph node biopsies were attempted in 181 patients with breast cancer using a combination of blue dye and radioisotope. A lymph node was considered an SLN when it was stained with blue dye, had a blue lymphatic afferent, had increased radioactivity, or was abnormal by palpation. SLNs were successfully identified in 180 patients, for an identification rate of 99.4%. Forty-five patients had positive SLNs. In 16 (35%) of those patients, the SLNs were negative intraoperatively by SC. All of the false negatives occurred in SLNs with micrometastases. Thus, SC is an excellent method for identifying macrometastases intraoperatively, but less successful for micrometastases.     

The influence of positive peritoneal cytology on survival in patients with pancreatic adenocarcinoma

The American Joint Committee on Cancer (AJCC) staging system for pancreatic adenocarcinoma classifies positive peritoneal cytology as stage IV disease. Data are limited with respect to the prevalence of positive peritoneal cytology and its influence on survival in patients with resectable, locally advanced, and metastatic disease. Four hundred sixty-two patients underwent staging laparoscopy for pancreatic adenocarcinoma between January 1995 and December 2005. Kaplan-Meier survival comparisons were performed to evaluate the significance of positive peritoneal cytology on overall survival (OS) in resected patients and patients with locally advanced and metastatic disease. Of the 462 patients, 47% (217/462) underwent a pancreatic resection. The 21% (95/462) with locally advanced disease and 32% (150/462) with metastatic disease did not undergo resection. Peritoneal cytology was positive in 17% (77/462), and was associated with stage of disease (metastatic, 37%; locally advanced, 11%; resected, 5%; P=0.01). Positive cytology was not associated with OS in patients with metastatic disease or locally advanced disease, but was in resected patients (median, 16 months vs. 8 months; P<0.001). Node-positive disease was present in 8 of 10 patients resected with positive cytology (2 years OS, 12% positive cytology vs. 23% negative; P=0.006). In this study, patients who underwent resection in the presence of positive peritoneal cytology and absence of other identifiable metastatic disease had a similar survival as other patients with stage IV disease. Presented at the Forty-Seventh Annual Meeting of The Society for Surgery of the Alimentary Tract, Los Angeles, California, May 20–24, 2006 (poster presentation).     

The impact of synoptic cytology reporting on fine-needle aspiration cytology of thyroid nodules

BACKGROUND: Fine-needle aspiration cytology (FNAC) is integral to the diagnosis and management of patients with thyroid nodules. We introduced synoptic cytology reporting for thyroid nodules in 2004. The aim of this study was to examine the effect of synoptic cytology reporting in our institution. METHODS: A comparative study of two 2-year periods (1 August 2002 to 1 August 2004 and 2 August 2004 to 2 August 2006) before and after the introduction of synoptic reporting was conducted from a prospectively collected database of patients presented with thyroid nodules. The only change during these periods was the format of FNAC reporting. We used the same radiological practice and cytopathology service throughout the study period. All patients are still being followed up. RESULTS: There were a total of 660 patients. Of these, 376 were operated and 284 non-operated. The female to male ratio was 7:1. Comparing the two periods, the overall FNAC sensitivities were 60% versus 79.1%; specificities, 83.7% versus 79.4%; accuracy, 76% versus 79.3%; false-positive result, 16.3% versus 20.6% and false-negative result, 40% versus 20.9%. The non-diagnostic rates were 7.4% versus 3.15%. FNAC prompted surgery in 66.7% versus 100% in carcinoma and 56.4% versus 73.6% in adenoma. A benign FNAC prompted surgery in 15% versus 19.8% of cases. There was no thyroid cancer detected in the current follow up. CONCLUSIONS: Synoptic cytology reporting has resulted in an overall improvement in all measures of the tests. It is a simple and effective tool to use. Synoptic cytology reporting is therefore recommended for all endocrine surgical units.     

术前诊断为胰腺癌术中细针穿刺细胞学检查阴性结果病例分析

目的 探讨术前诊断为胰腺癌术中细针穿刺细胞学（FNAC）检查阴性结果病例的临床意义和提高诊断准确性的方法。方法 回顾性分析1995年12月至2006年6月中国协和医科大学肿瘤医院术前诊断为胰腺癌，术中FNAC结果阴性的33例病人的临床特点、影像表现、实验室检查结果和随访资料。结果33例均获得随访，时间3个月至8年，其中30例为真阴性病例，肿物为慢性肿决型胰腺炎所致；3例为假阴性病例，术后出现肿决增大，肿瘤多发转移。结论慢性胰腺炎（CP）是出现阴性结果的主要因素，肿瘤体积大小、生长方式和术者取材技术决定FNAC的准确性。应提高对慢性胰腺炎临床特点的认识及术前诊断的准确性，改进穿刺取材和制片技术可以降低假阴性率。     

Role of fine-needle aspiration cytology in the evaluation of parotid tumours

BACKGROUND: The aim of this study was to evaluate the accuracy of fine-needle aspiration cytology in the diagnosis of parotid tumours. METHODS: A retrospective review was conducted to examine the preoperative cytological and final histological results of patients who underwent parotidectomies at our institution. RESULTS: Sensitivity and specificity for diagnosing malignant and benign tumours were 80%, 100%, and 98.5%, 87.5%, respectively, and 85.1% of benign tumours were accurately typed on fine-needle aspiration cytology compared with only 40% in the malignant group. Using the clinical parameters of associated facial nerve palsy or presence of cervical lymphadenopathy to indicate the presence of malignancy, the diagnostic yield was only 30%. CONCLUSION: Fine-needle aspiration cytology is useful in the preoperative assessment of parotid tumours as it is more reliable than clinical examination to diagnose malignant parotid tumours. Although it may not accurately type the malignant tumours, the diagnosis of malignant tumours preoperatively may allow for appropriate surgical planning by the surgeon.     

Adequacy of urine cytology specimens: an assessment of collection techniques

The objective of this study was to determine whether the method of urine collection impacts the adequacy and cell counts of cytology specimens in a low-risk population. Voided, post-cystometrogram (CMG), and bladder irrigant specimens were collected and evaluated for cytologic adequacy and average cell count by a single cytopathologist masked to the source of each sample. Data were analyzed to detect differences in specimen adequacy and cell counts based on method of collection. Both the voided and post-CMG specimens (97.3%, 93.7% respectively) were significantly more likely to be adequate compared to the bladder irrigant specimen (11.7%, p < 0.0001). The spontaneously voided specimen (211.4 ± 100.1) had significantly higher cell counts than both the post-CMG specimen (85.9 ± 86.6) and the cystoscopy specimen (6.4 ± 19.6, p < 0.0001). In a multivariate linear model, collection method and specimen adequacy were associated with increased cell count/hpf (p < 0.001), as was the presence of hematuria on urine dipstick (p = 0.03). No cytologic abnormalities were diagnosed. Whereas both spontaneously voided and post-CMG specimens were consistently adequate for interpretation, spontaneous voided specimens were optimal with regard to maximizing cell count/hpf.     

Rapid urinary cytology by phase contrast microscopy a preliminary report

Summary Phase contrast microscopy offers a method for very rapid cytological examination of urine deposits. To test its reliability, results obtained by phase contrast microscopy were compared with those of standard cytological methods using Papanicolaou or Giemsa-stained smears. As only 1.4% false positives and 5.2% false negatives were obtained, phase contrast microscopy can be recommended as a routine office procedure.     

肝囊腺癌的细针吸取细胞学诊断及文献复习

目的 探讨肝内胆管囊腺癌的穿刺方法 ,结合文献复习并总结其术前细胞学诊断特点.方法 2例肝脏囊实性占位患者在B超引导下行细针吸取细胞学(fine needle aspiration cytology,FNAC)检查,抽取囊液离心涂片,实质区吸取组织颗粒涂片,常规HE染色,部分吸取组织制作细胞蜡块,切片行HE染色及黏液AB染色,光镜观察,并与术后组织切片对照.结果 2例患者均未出现出血、感染等并发症,两者均抽出多量淡咖啡色及淡黄色黏稠液体,囊液未找到肿瘤细胞;实质区穿刺涂片细胞丰富,上皮细胞形成团状或乳头状,核大深染、重叠拥挤.可见细胞异型.细胞蜡块切片可见腺管状、乳头状、团状的腺上皮,细胞排列杂乱无极性,AB染色显示背景及胞质内淡蓝色黏液的存在.结合影像学及临床资料.2例FNAC诊断考虑为胆管黏液性囊腺癌(例1结合细胞蜡块切片考虑黏液性乳头状囊腺癌).穿刺诊断与术后组织切片基本一致.结论 结合影像学及临床资料,B超引导下的肝脏FNAC是术前诊断肝囊腺癌的一种安全有效的检查方法 ,制作细胞蜡块有利于诊断的进一步完善.有关肝囊腺癌与囊腺瘤的FNAC的鉴别有待进一步积累资料.     

细针穿刺细胞学检查对乳腺癌的诊断意义

目的 探讨细针穿刺细胞学检查对乳腺癌的诊断意义。方法 用带7号针头的一次性塑料5～10ml注射器，对439例病人的乳腺和腋下肿物进行细针穿刺细胞学检查，并与术后诊断作比较，观察其准确率。结果 本组病例作细针穿刺细胞学检查的准确率达97．2％。结论 细针穿刺细胞学检查安全、方便、准确率高，可作为乳腺癌的一种常规检查手段。     

Peritoneal cytology in colorectal cancer: incidence and prognostic value

BACKGROUND: The value of peritoneal washing cytology on prognosis is not clear yet. The aims of our prospective study were to consider the incidence and prognostic value of peritoneal cytology. METHODS: From 1996 to 2003, washing cytology was performed in 88 patients who underwent surgery for colorectal cancer. Before exploration and manipulation of the tumor, each of the peritoneal cavities next to the tumor site, subhepatic and rectovesical recesses, were irrigated with 50 mL saline, and then the aspirates were taken for cytological evaluation. RESULTS: Thirteen (14.7%) of 88 patients had positive cytology. Although necrosis, depth of invasion, differentiation of the tumor, macroscopic peritoneal dissemination, and ascites were correlated with positive cytology; multivariate analyses revealed the depth of invasion, presence of necrosis, and differentiation of the tumor as the factors affecting the cytology. The disease-free and overall-survival times in patients with positive and negative peritoneal washing cytology were 56.36, 61.40 and 52.08, 63.94 months, respectively (P > .05). CONCLUSION: The presence of free malignant cells in the peritoneal cavities of patients who underwent curative resection for colorectal cancer provides no further prognostic value over the current staging systems.     

The role of exfoliative cytology in the management of bladder carcinoma

Summary Cytological analyses of bladder washings from 974 patients with disorders of the urinary tract are reported. The cytological findings were compared with the clinical and histological diagnoses. The histological grading of bladder tumours was based on the classification proposed by Bergkvist et al. No false positive diagnosis of malignancy was made in the 320 patients without tumour growth. The five cases with positive cytology had histologically verified carcinoma in situ. The frequency of cytological diagnosis of cancer increased with the histological grade of malignancy in the 428 patients with bladder neoplasm. Carcinoma was graded in smears according mainly to the degree of epithelial atypia. A comparison with the histological grading was attempted. Of 226 cases of bladder carcinoma treated with supervoltage irradiation, 108 had persistence or recurrence of carcinoma. The clinical diagnosis was cytologically confirmed in 92 per cent of these cases.     

细针穿刺细胞学诊断甲状腺癌价值及评价

细针穿刺细胞学检查（FNA）仍是目前评价甲状腺结节最为准确且具有高性价比的检查方法。虽然甲状腺FNA难以区分滤泡性肿瘤的良恶性,但仍可首选用于甲状腺肿瘤的筛选,大幅削减需手术处理的甲状腺结节数量,提高甲状腺手术发现的恶性肿瘤比例,从而减少不必要的手术给病人带来的损伤,更合理地应用有限的医疗资源。