Comparative Study of Cell Findings by Conventional Smear and Liquid-Based Cytology for Oral Exfoliative Cytology

Background: Liquid-based cytology (LBC) is a method of manufacturing cyto-diagnostic specimens. Improved accuracy is expected from standardizing specimen production and use of this method is rapidly spreading in oral cytology. On the other hand, LBC reportedly requires training to show peculiar cell findings compared to those of conventional smear cytology (CVC). Few studies have compared detailed cell findings for oral CVC and LBC. Objectives: The aim of this study was to compare cytological findings between CVC and LBC using cytomorphological image analysis. Materials and Methods: Cytological specimens were collected from 20 patients (negative for squamous neoplasia in 10, dysplasia in 5, squamous cell carcinoma in 5) and 5 controls of the tongue between January 2017 and December 2018. Two different preparation techniques were investigated cytomorphologically for CVC and LBC (BD CytorichTM). Results: LBC showed significantly higher cell numbers than CVC for all lesions. LBC-to-CVC ratio ranged from 9.52 (hyperkeratosis) to 1.87 (deep cells in oral squamous cell carcinoma (OSCC)). Nuclear area of normal, hyperkeratosis, and inflammation were significantly higher in LBC than those of CVC. Hyperchromasia was significantly more frequent with CVC than with LBC for hyperkeratosis, inflammation, dysplasia and OSCC. There was no significant difference in circularity between CVC and LBC among all lesions. Conclusion: Only one cytomorphological disadvantage was seen with LBC, in the form of decreased hyperchromasia. Further clarification of the advantages and disadvantages of LBC is needed, including management of precision and screening practices.

Vaginal Intraepithelial Neoplasia Detected with Cervical Liquid-Based Cytology: Old Concerns or New Facilities?

Background: The detection of vaginal intraepithelial neoplasia (VAIN) in cervical samples is not a common finding. Therefore, we aimed to report VAINs detected in liquid-based cytology (LBC) from women examined at Hospital das Clínicas of Faculty of Medicine, Sao Paulo State University. Materials and Methods: We evaluated LBC samples from women referred to gynecology examination for different reasons (previous abnormal PapTest, follow up of treated cervical lesion, ecc) and women examined for regular screening proposals, and compared with biopsy diagnoses, including the controversial diagnoses of vaginal intraepithelial neoplasia (VAIN). Results: From 1866 patients, 1423 (76.3%) cases were negative and 443 (23.7%) were positive for any cellular alteration. Age of patients ranged from 12 to 86 years. We detected 25 histologically confirmed VAIN (1.3% p = 0.0002 by Fisher’s exact test IC 95% 0.0090 - 0.0198) and 1.1% VAIN (p = 0.0031 by Fisher’s exact test IC 95% 0.0077 - 0.0179). Conclusion: The identification of VAIN in routine is feasible;the professionals involved with cytological examination should be aware of these lesions in Pap test samples.

Promoter Methylation, BRAF Mutation Analysis and Topoisomerase IIa Expression for the Detection of Endometrial Carcinoma in Liquid Based Cytology Samples

Cancer of the corpus uteri remains the most common gynecological related cancer in developed countries. Cytology, after the induction of liquid based cytology, has reemerged as a possible first line non-interventional diagnostic procedure with promising results. Apart from slide preparation for cytology diagnosis, LBC allows the application of elaborate molecular tests on the residual material. Samples from 74 symptomatic women were collected in ThinPrep?PreservCyt medium, from witch immunocytochemical and molecular tests were performed. Final diagnosis of 39 endometrioid carcinomas, 20 non-endometrioid carcinomas and 15 non-malignant was set after hysterectomy. Topoisomerase IIa expression was common (42%) in both types of cancer. Promoter methylation analysis revealed that hMLH1 is commonly methylated in cancers (52.7%), CDKN2A and MGMT less often (27.1%) and RARB rarely methylated (8.4%). BRAF activating mutation V600E was a rare event (8.4%) only found in low grade endometrioid carcinomas. Topoisomerase IIa expression correlated with BRAF mutations, hMLH1 and to lesser extent with CDKN2A methylation. Almost none of the biomarkers were positive in cytological negative or hyperplastic without atypia samples. Detection of methylation in any gene displayed sensitivity, specificity, PPV and NPV similar to cytology of cancer. However, inclusion of cytology diagnosis of hyperlasias with atypia increased sensitivity and NPV of cytology outperforming methylation of any gene. Further evaluation of the panel of promoter methylation, especially in cytology diagnoses of hyperplasia with or without atypia should be evaluated since initial results are promising. Even though methylation of MGMT and RARB are rare events, some patients could be benefit from specific chemotherapeutics that target either of them or the more frequently expressed topoisomerase IIa.

Liquid Based Cytology of Cell Remnants in Needles Used for Breast Fine Needle Aspiration

This study examined cells contained in needles used for the collection of breast fine needle aspirates for the detection of malignant cells trapped in the needles. Remnants of cells contained in 50 needles used for the collection of scanty breast fine needle aspirates were examined by the liquid based cytology technique and compared with the conventional cytological technique of specimens in the corresponding syringes. The breast specimens were collected with clean sterile needles attached to the syringes. Smears were made and stained by the conventional method. The needles were removed from the syringes and a fixative was withdrawn into the syringes and the syringes were recapped with the needles. The fixative containing the specimen was then completely discharged into a centrifuge tube through the needles and treated by the liquid based cytology technique. The study revealed that cells were found trapped in all the needles used for the collection of breast FNA. 6% of them were positive for malignancy, similar to results obtained in the conventional method. Needles used for the collection of breast FNA should be examined before malignancy is completely ruled out particularly in extremely scanty specimens with a clinical suspicion of malignancy.

HPV检测、液基细胞学及p16/Ki-67三重检测在宫颈高级别病变筛查中的诊断价值研究

目的探讨HPV检测、液基细胞学及p16/Ki-67三重检测在宫颈高级别病变筛查中的诊断价值。方法收集2021-2023年北京天坛医院病理科宫颈活检病例共1839例,回顾性分析HPV检测、液基细胞学(LBC)及p16/Ki-67三重检测的CIN2+检出率,并对比组间的差异,探讨高效而特异的检测方法。结果1839例宫颈活检病例中,CIN2+的总检出率为29.6%;仅HPV阳性、HPV及LBC双检阳性、HPV、LBC及p16/Ki-67三重检测阳性CIN2+检出率依次升高,分别为20.1%、32.3%、54.1%;亚组分析显示HPV16/18阳性,3组的CIN 2+检出率分别是24.4%、45.7%、70.4%;其他12种高危HPV阳性,3组的CIN 2+阳性检出率分别是14.6%、27.4%、45.3%。总体及亚组分析均显示HPV、LBC及p16/Ki-67三重检测的CIN 2+检出率最高,差异具有统计学意义(P<0.001)。结论本研究认为对于HPV阳性的女性,建议进行HPV、LBC及p16/Ki-67三重检测,提高CIN2+阳性检出率,减少漏诊,提升阴道镜的利用效率。

HPV阳性女性中宫颈液基细胞学、DNA倍体分析及P16/Ki-67双染检测对宫颈癌前病变的分流效果研究

目的探讨在HPV阳性女性中,液基细胞学、DNA倍体分析及P16/Ki-67双染检测对宫颈癌前病变的分流作用。方法回顾性分析2021年5月至2022年12月在我院妇科行阴道镜及宫颈活检的妇女590例。患者高危人乳头瘤病毒(human papilloma virus,HPV)检测阳性,且行液基细胞学(liquid-based cytology,LBC)、DNA倍体分析、P16/Ki-67双染3种检查,对上述3种方法的灵敏度、特异性、受试者工作特征(receiver operating characteristic,ROC)曲线进行统计分析。结果液基细胞学、DNA倍体分析和P16/Ki-67双染3种筛查方法对宫颈癌前病变的灵敏度分别为84.2%、77.5%、76.4%,特异性分别为40.7%、49.2%、70.1%,曲线下面积(area under the curve,AUC)分别是0.625、0.634、0.733,其中,P16/Ki-67双染检测显著优于液基细胞学检查及DNA倍体分析(P<0.0001)。结论本研究认为,在HPV阳性女性中,P16/Ki-67双染检测的分流效果最佳。

细针穿刺细胞学检查联合V-Raf鼠肉瘤病毒癌基因同源体B基因检测在甲状腺乳头状癌诊断中的应用价值

目的探讨联合检测V-Raf鼠肉瘤病毒癌基因同源体B(BRAF)基因在甲状腺细针穿刺细胞学检查样本中对甲状腺乳头状癌诊断的价值,并联合检测甲状腺功能血清学指标,以期提高甲状腺乳头状癌在术前的诊断准确性和检出率,以及在预后评价中的作用。方法收集柳州市人民医院2022年8月至2023年12月入院的455例甲状腺结节患者,行甲状腺细针穿刺活检、液基细胞学检查、BRAF基因检测以及甲状腺功能血清学检测促甲状腺激素(TSH)、甲状腺受体抗体(TRAb)、甲状腺球蛋白抗体(TgAb),探讨以上方法联合检查与甲状腺乳头状癌患者临床病理特征的相关性。结果甲状腺结节的诊断通过3种方法:超声检查、液基细胞学检查及BRAF基因检测,并与手术后取得的病理组织结果进行比较,超声检查的敏感性为98.44%,在单一诊断方法中最高;BRAF基因检测的特异性最高、表现最优;对术前甲状腺结节患者行血清学指标检测,甲状腺乳头状癌(PTC)组中TSH水平(4.8±2.0)mU/L高于良性组(3.9±2.0)mU/L,组间差异有统计学意义(P=0.013),PTC组的TRAb水平(3.7±2.0)U/L高于良性组(2.3±1.2)U/L,差异有统计学意义(P=0.010)。结论在单方法学的诊断中,BRAF基因检测的诊断效能最优;超声检查、液基细胞学检查、BRAF基因检测方法的两两联合的诊断效能均高于任何一种单方法学。同时行血清学指标检查,更有利于甲状腺结节良恶性的判断。

2020-2022年度对泰州市海陵区宫颈癌筛查结果分析

目的:分析2020—2022年度泰州市海陵区的适龄女性宫颈癌筛查结果。方法:选取2020—2022年度泰州市海陵区的47445名女性作为研究对象,实施宫颈癌筛查工作,对筛查结果异常者进行随访、复诊,追踪最终组织病理检查结果。结果:2020—2022年度泰州市海陵区人乳头瘤病毒(HPV)总阳性率为11.19%,HPV阳性合并阴道炎占HPV阳性的37.11%。液基薄层细胞学检测(TCT)总参与率为95.79%,2020、2021、2022年分别为94.59%、95.02%、97.54%,参与率逐年提高。TCT检查总异常率为26.34%,异常分型总例数前3位由高到低依次为意义不明确的非典型鳞状细胞、低度鳞状上皮内病变、不除外高度鳞状上皮内病变。阴道镜检查总参与率为95.20%,2020、2021、2022年分别为90.94%、96.01%、97.96%,参与率逐年升高。阴道镜检查总异常或可疑率为88.69%,2020—2022年阴道镜检查异常或可疑率逐年提高。阴道镜总活检阳性率为54.66%。结论:宫颈癌的筛查可提高二级预防水平,泰州市海陵区应关注下生殖道感染筛查管理,加强筛查工作的精细化管理及阴道镜评估水平。

Effectiveness of Co-Testing in Cervical Cancer Screening Program in Macao SAR

Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introduced HPV DNA testing alongside cytology (co-testing) as the primary screening method in 2019. This study evaluates the effectiveness of co-testing in identifying cervical precancerous lesions (CIN2+) compared to cytology alone. Methods: We conducted a retrospective analysis of women aged 30 - 65 years who participated in the routine cervical cancer screening program in Macao SAR Primary Healthcare Centers from 2019 to 2022. Data from over 70,000 women were analyzed, comparing the detection rates of CIN2+ through co-testing and cytology alone. Women with abnormal cytology or positive HPV results were referred for colposcopy. Results: The introduction of co-testing led to a significant increase in the detection of CIN2+, particularly in women with atypical squamous cells of undetermined significance (ASCUS) or negative for intraepithelial lesion or malignancy (NILM) cytology results. Between 2019 and 2022, the percentage of women with ASCUS/NILM and any high-risk HPV (hrHPV) positive who were diagnosed with CIN2+ after colposcopy were 24%, 13%, 10% and 7.5% respectively. This highlights the ability of co-testing to identify high-risk individuals who would have been missed by cytology alone. Discussion: Our findings demonstrate the effectiveness of co-testing in improving the sensitivity of cervical cancer screening in Macao SAR. The inclusion of HPV DNA testing allows for better risk stratification of women with ASCUS/NILM cytology, leading to more targeted referrals for colposcopy and timely detection of precancerous lesions. The initial high positive rate in 2019 (24%) might be attributed to the small sample size and potentially reflects a backlog of undiagnosed cases prior to co-testing implementation. Conclusion: The implementation of co-testing in Macao SAR’s cervical cancer screening program significantly improves the early detection of precancerous lesions, particularly in women with ambiguous cytology results. This proactive approach contributes to reducing cervical cancer morbidity and mortality and improving women’s health outcomes in Macao SAR.

HPV-23分型、TCT联合P16表达检测在宫颈病变筛查中的应用

目的探讨分析HPV-23分型、TCT联合P16表达检测在宫颈病变筛查中的应用。方法选取2022年6月—2023年6月在本院参加宫颈癌筛查的妇女200例为研究对象,进行HPV-23分型、TCT、P16表达检测,以病理学结果为金标准,计算HPV-23分型、TCT、P16单项检测和联合检测的诊断灵敏度、特异度。结果HPV-23分型检测结果显示阳性病例33例,阴性病例62例;TCT检测结果显示阳性病例35例,阴性病例72例;P16检测结果显示阳性病例19例,阴性病例115例;联合检测结果显示阳性病例48例,阴性病例139例。在诊断效能方面,HPV-23分型、TCT、P16单项检测以及联合检测的诊断灵敏度分别为62.26%、66.04%、35.85%及83.02%,而特异度则分别为42.18%、48.98%、78.23%及89.80%。经过对比分析,联合检测在灵敏度和特异度方面均表现出最高的效能(P<0.05)。结论HPV-23分型、TCT联合P16表达检测用于宫颈病变筛查中的价值较高,可作为首选筛查手段。

P16/Ki-67双染、TCT细胞学、HPV联合检测技术在宫颈病变筛查中的应用价值分析

目的探讨与分析P16/Ki-67双染、液基薄层细胞学检查(Thinprep Cytologic Test,TCT)、人乳头状瘤病毒(Human Papilloma Virus,HPV)联合检测技术在宫颈病变筛查中的应用价值。方法收集2022年4月—2023年4月选择在酒钢医院自愿行宫颈病变筛查且后期进行宫颈组织活检的83例就诊人群为研究对象,所有人群都给予P16/Ki-67双染、TCT细胞学、HPV联合检测,分别记录检测阳性情况。同时所有人群都进行了病理组织检查,并以此为诊断金标准,判断诊断价值。结果在83例患者中,病理检查为正常组织21例、CIN 1级47例、CIN 2级12例、CIN 3级3例,其中高级别上皮内瘤变占18.07%。83例患者中,正常组织、CIN 1级、CIN 2级、CIN 3级患者的P16/Ki-67双染、TCT细胞学、HPV联合检测阳性率分别为4.76%、10.64%、66.67%、66.67%。P16/Ki-67双染、TCT细胞学、HPV检查单独检测与联合检测对宫颈病变的诊断敏感性分别为66.67%(10/15)、66.67%(10/15)、100.00%(15/15)、66.67%(10/15),诊断特异性分别为91.18%(62/68)、60.29%(41/68)、17.65%(12/68)、91.18%(62/68)。结论P16/Ki-67双染、TCT细胞学、HPV联合检测技术能更准确地发现潜在的高级别病变患者,提高宫颈病变检出率,有很好的应用价值。

全自动免疫细胞化学染色P16/Ki-67双染在宫颈病变筛查的价值

目的探讨与分析全自动免疫细胞化学染色P16/Ki-67双染在宫颈病变筛查的价值。方法选取2022年4月—2023年6月在酒钢医院进行宫颈病变筛查的120例患者作为研究对象,所有患者都给予液基薄层细胞学(thinprep cytologic test,TCT)检查、病理检查、HPV检测与全自动免疫细胞化学染色P16/Ki-67双染检查,判定筛查结果。结果在120例患者中,P16/Ki-67双染阳性28例,总阳性率为23.3%。液基薄层细胞学检查判断为良性反应性细胞改变67例、宫颈未明确诊断意义的非典型鳞状上皮细胞37例、低级别宫颈鳞状上皮内病变12例、高级别宫颈鳞状上皮内病变4例,其P16/Ki-67双染阳性率分别为16.4%、21.6%、41.6%、100.0%。在120例患者中,病理检查判断:正常16例,宫颈上皮内瘤变Ⅰ级85例、宫颈上皮内瘤变Ⅱ级14例、宫颈上皮内瘤变Ⅲ级4例、宫颈癌1例,其P16/Ki-67双染阳性率分别为6.2%(1例)、15.3%(13例)、71.4%(10例)、75.0%(3例)、100.0%(1例),差异有统计学意义(P<0.05)。以病理检查结果作为金标准,全自动免疫细胞化学染色P16/Ki-67双染在宫颈病变中的敏感性与特异性分别为73.7%(14/19)、86.1%(87/101)。ROC曲线分析显示全自动免疫细胞化学染色P16/Ki-67双染在宫颈病变筛查的曲线下面积为0.872,Kappa值为0.824。结论全自动免疫细胞化学染色P16/Ki-67双染在宫颈病变筛查诊断宫颈癌的敏感性与特异性都比较高,具有很好的临床应用价值。

基于液基细胞学的hWAPL蛋白检验在高危型人乳头瘤病毒感染患者宫颈癌筛查中的价值研究

目的:探讨基于液基细胞学的人半翼(hWAPL)蛋白检验在高危型人乳头瘤病毒(HR-HPV)感染患者宫颈癌筛查中的价值。方法:选取300例HPV感染女性为研究对象。采用杂交捕获技术进行常规HPV-DNA检测,阴道镜下取宫颈组织标本行组织病理学检查,并进行液基细胞学检查。采用免疫细胞化学技术检测液基细胞hWAPL蛋白表达。采用Kappa检验分析单独液基细胞学检查、液基细胞hWAPL蛋白检测与组织病理学检查结果的一致性,并比较单独液基细胞学检查和液基细胞hWAPL蛋白检测对HR-HPV感染患者宫颈癌的筛查效能。结果:300例宫颈液基细胞学标本中,共检测到18种HR-HPV亚型和5种低危型HPV亚型,其中HR-HPV感染患者236例,感染率为78.67%。组织病理学检查结果显示,阳性64例,阳性率为27.12%。单独液基细胞学检查结果显示,50例患者为阳性,阳性率为21.19%,与组织病理学检查一致性较高(Kappa=0.655,P<0.05)。液基细胞hWAPL蛋白检测结果显示,58例患者为阳性,阳性率为24.58%,与组织病理学检查一致性极好(Kappa=0.890,P<0.05)。与单独液基细胞学检查比较,液基细胞hWAPL蛋白检测筛查宫颈癌的敏感度、准确率、阳性预测值、阴性预测值升高,漏诊率降低(均P<0.05)。结论:基于液基细胞学的hWAPL蛋白检验对HR-HPV感染患者宫颈癌的筛查效能较高。

宫颈液基细胞学检查对宫颈病变的筛查价值-附38088例分析

目的:探讨液基细胞学检查(Thinprep cytology test,TCT)对宫颈病变的筛查价值。方法:回顾性分析2003年7月至2007年7月在重庆医科大学附属第一医院妇科38 088例TCT结果,阳性者定期复查或行阴道镜检查,必要时在阴道镜引导下定位活检。对有完整资料的1 556例病理结果按年龄进行分组分析,并对TCT与活检组织病理结果的相关性进行统计学分析。结果:38 088例TCT检测中,异常者2 462例,有明确阴道镜活检病理结果者1 556例,病理证实CINⅠ、CINⅡ、CINⅢ、宫颈癌及HPV感染病例分别为279、314、365、75例和94例。TCT与病理结果符合率为60.35%,TCT筛查宫颈病变的灵敏度为84%,特异度为53%,阳性预测值为83%,阴性预测值为56%。30～39岁为宫颈上皮内瘤变和人乳头瘤病毒的高发年龄段、宫颈癌的高发年龄段为30～49岁。TCT阳性者发生CINⅠ、CINⅡ和CINⅢ的相对危险度分别为:非典型鳞状细胞为11.11、13.21、8.19,鳞状上皮内低度病变为22.60、20.72、13.66,鳞状上皮内高度病变为10.33、25.45、54.65。结论:TCT筛查宫颈病变的阳性率、阳性预测值与活检病理结果符合率均较高,对病理结果有一定的预测价值,TCT阳性者宫颈病变的危险较一般人群明显升高。

p16/Ki-67双染在宫颈癌及癌前病变初筛中的应用价值研究

目的:评价采用p16/Ki-67双染检测技术作为宫颈癌及癌前病变初筛方法的效果及应用价值。方法:对重庆市万州区982例年龄35~64岁有性生活的妇女进行宫颈癌筛查。每位妇女均接受了人乳头瘤病毒DNA(HPV DNA)检测、Thin Prep液基细胞学检查、p16/Ki-67双染检测,对结果异常者进行阴道镜检查,阴道镜下在可见病变处直接取活检,无可见病变时,行宫颈管搔刮术(ECC)。比较3种方法分别作为初筛手段识别宫颈癌前病变(高级别鳞状上皮内病变)及浸润癌的灵敏度、特异度、阳性预测值和阴性预测值等指标,以受试者工作特征(ROC)曲线下面积(AUC)综合分析3种方法作为宫颈癌初筛手段的应用价值。结果:最终966例妇女进入研究,共检出高级别鳞状上皮内病变及浸润癌患者42例。HPV DNA检测、液基细胞学检查和p16/Ki-67检测对宫颈癌及癌前病变患者的灵敏度分别为97.6%、88.1%、92.9%;特异度分别为84.1%、78.8%、82.8%;阳性预测值分别为21.8%、15.9%、19.7%;阴性预测值分别为99.9%、99.3%、99.6%。p16/Ki-67检测的AUC分别与HPV DNA检测、液基细胞学检查相比,差异均无统计学意义(P>0.05)。结论:p16/Ki-67双染检测初筛宫颈癌及癌前病变的效果与HPV DNA检测及液基细胞学检查相似,因其具有简便、客观、高效、易于重复的特点,p16/Ki-67双染检测为宫颈癌及癌前病变的有效初筛提供了一种新选择。

p16INK4a和Ki-67免疫细胞化学染色在宫颈液基细胞学中的应用价值

目的探讨液基细胞学检测（LCT）剩余细胞学标本中p16INK4a、Ki-67的免疫细胞化学染色筛查宫颈鳞状细胞癌和宫颈癌前病变的价值。方法采用免疫细胞化学和免疫组化法对194例细胞学标本和91例组织活检标本进行p16INK4a、Ki-67检测。结果p16INK4a、Ki-67表达阳性率随着宫颈病变程度的加重而升高,与病变级别呈正相关。Ki-67的标记指数（LI）在HSIL组最高,与其他各组间均数的差异显著（P〈0.05）。LSIL及其以上病变细胞学p16INK4a和Ki-67与组织学诊断符合率分别为87.3%和80.95%。宫颈脱落细胞学Ki-67、p16INK4a的免疫细胞化学染色检出高级别病变及鳞癌病变的敏感度、特异度分别为83.6%、86.7%和87.1%、100%。结论利用LCT液基细胞学涂片中p16INK4a、Ki-67的免疫细胞化学染色作为辅助诊断指标应用于宫颈癌高危人群筛查,具有重要意义。

结合恶性胸腔积液中脱落细胞探讨上皮细胞-间质转化与非小细胞肺癌的相关性

目的探讨恶性胸腔积液(malignant pleural effusion,MPE)中非小细胞肺癌(non-small cell lung cancer,NSCLC)上皮细胞-间质转化(epithelial-mesenchymal transition,EMT)相关分子标志物的表达及意义。方法对823例胸水标本进行液基细胞薄层检测(thinPrep cytology test,TCT),结合活检结果确诊107例NSCLC标本,随机分成NSCLC细胞组、NSCLC活检组及NSCLC癌旁组织组三组,对其中39例NSCLC细胞组胸水标本进行沉渣后包埋、切片,采用免疫组化SP法检测三组中vimentin、E-cadherin、N-cadherin、β-catentin的表达,并进行对比分析。结果E-cadherin、β-catentin阳性/异常阳性率在NSCLC细胞组、活检组均明显低于癌旁组织组(P<0.05)。NSCLC细胞组、活检组N-cadherin、vimentin的阳性率均明显高于癌旁组织组(P<0.05)。同时亦发现,在NSCLC细胞组中,E-cadherin表达与分化程度和淋巴结转移有关(P<0.05),β-catentin异常阳性与分化程度有关(P<0.05),N-cadherin与vimentin表达与淋巴结转移有关(P<0.05)。以上4个抗体表达/异常表达均与患者年龄、性别、吸烟史和组织学分型无关(P>0.05)。结论MPE中NSCLC细胞具备EMT表型,从细胞学角度进一步证实EMT现象存在于NSCLC,为新的靶向治疗药物的研究和治疗靶点提供新思路。

HC2-HPV检测法联合液基细胞学在宫颈癌及癌前病变筛查中的临床意义

目的探讨HC2-HPV检测法联合液基细胞学在筛查宫颈癌及癌前病变中的意义。方法应用HC2-HPV检测法联合液基细胞学技术对体检的患者进行免费宫颈癌及癌前病变的筛查。对不典型增生患者或(和)HC2-HPV检测阳性的患者行阴道镜下宫颈活检。结果液基细胞学检查对宫颈高度病变的检出率为11.0%(11/100);HC2-HPV检测对宫颈高度病变的检出率为27.2%(22/81),对宫颈癌的检出率高达100.0%。HC2-HPV检测法联合液基细胞学检测阳性与病理检查阳性符合率为64.2%(52/81),显著优于TCT(52.0%)单独检查时的阳性符合率(P<0.05,χ2=11.39)。结论 HC2-HPV检测法联合液基细胞学检测对宫颈癌及癌前病变的筛查具有重要的临床推广价值。

宫颈液基细胞中转录因子Brn-3a表达对宫颈病变的早期诊断价值

目的:探讨宫颈液基细胞中转录因子Brn-3a表达及其早期诊断宫颈病变的临床价值。方法:选择我院病理科有活检或手术切除标本病理诊断的液基细胞学检查(TCT)患者192例,并均行阴道镜下活组织检查。将入选病例剩余TCT标本进行Brn-3a蛋白免疫细胞化学染色,并与组织病理学结果进行对照。结果:TCT残留标本中Brn-3a蛋白表达的阳性率随宫颈病变严重程度加重而增高,且各级细胞学诊断间比较差异具有统计学意义(P<0.05)。单纯TCT的病理诊断符合率为SCC 96.8%(30/31),HSIL80.5%(33/41),LSIL76.9%(30/39),而TCT联合Brn-3a的病理诊断符合率为SCC 97.1%(30/31),HSIL78.6%(33/42),LSIL76.9%(30/39)。与单纯TCT的病理诊断符合率比较,TCT联合Brn-3a对HSIL、LSIL的病理诊断符合率明显高于单纯TCT(P<0.05)。结论:TCT联合Brn-3a检测对早期诊断宫颈病变具有一定的临床价值。

LCT联合HR-HPV检测在宫颈上皮内瘤变Ⅲ级LLETZ术后随访中的价值

目的:评价HR-HPV(high-risk human papillomavirus)检测在CINⅢ(cervical intraepithelial neoplasia gradeⅢ)行宫颈移行区大环切除术(LLETZ)后随访中的价值。方法:采用临床病例分析的方法,选取北京大学深圳医院2003年5月至2009年5月间诊断为CINⅢ接受LLETZ(large loop excision of the transformation zone)手术的567例患者,术后3、6个月及以后每6～12个月随访1次,以LCT(liquid-based cytologic test)及HCⅡ(hybrid captured-Ⅱ)法HR-HPV DNA检测作为随访的监测指标,评估LCT联合HR-HPV检测在术后随访中的价值。结果:1)术后LCT预测病变残留灵敏度60.00%,特异度88.15%,阳性预测值8.30%,阴性预测值99.19%;HPV预测病变残留灵敏度100%,特异度85.64%,阳性预测值11.11%,阴性预测值100%;LCT预测病变复发灵敏度63.64%,特异度92.27%,阳性预测值14.00%,阴性预测值99.23%;HPV预测病变复发灵敏度72.73%,特异度85.97%,阳性预测值9.30%,阴性预测值99.38%。2)术后HPV持续阳性患者复发几率高于非HPV持续感染患者,差异有统计学意义(P<0.05)。术后复发率在HPV持续阳性组与再次感染组为高,HPV持续阴性组术后无复发。结论:术后LCT联合HR-HPV检测预测残留或复发有重要价值,是一种有效的随诊方法。术后HPV感染状态与复发相关,临床需严密随访。