OBJECTIVE: We sought to estimate the incidence and clinical significance of a negative therapeutic loop electrosurgical excision procedure (LEEP) and to evalu ate patient specimens for limiting histologic features ass...OBJECTIVE: We sought to estimate the incidence and clinical significance of a negative therapeutic loop electrosurgical excision procedure (LEEP) and to evalu ate patient specimens for limiting histologic features associated with a negativ e LEEP. METHODS: We identified 674 patients with biopsy-confirmed high-grade c ervical dysplasia who were treated with LEEP from 1991 through 2001. The results of these LEEP procedures were reviewed for the absence of dysplasia or the pres ence of cervical intraepithelial neoplasia stages 1-3. Computerized pathology f iles of patients were then reviewed through July 2002 to determine whether dyspl asia recurred. Slides of negative LEEP specimens were reviewed to confirm the ab sence of dysplasia and to search for histologic features that may have limited o ur interpretation of the specimen. RESULTS: Ninety-three (14%)of LEEP specimen s reviewed were completely negative for dysplasia. Clinical follow-up was avail able on 75 of the 93 patients, with a median follow-up time of 2 years. Eightee n (24%) patients had subsequent positive follow-up, including carcinoma (n = 2 ), high-grade squamous intraepithelial lesions (n = 8), low-grade squamous int raepithelial lesion (n = 6), and atypical squamous cells of undetermined signifi cance (n = 2). Patients with negative LEEPs had a recurrence rate similar to pat ients with positive LEEPs (24%versus 27%). Limiting histologic features were m ore commonly identified in negative LEEPs as compared with LEEPs containing dysplasia (16% versus 5%, P < .001). CONCLUSION: A negative LEEP is not an uncommon finding, o ccurring in 14%(95%confidence interval 11-17%) of specimens at our instituti on. Negative LEEPs are more likely to contain histologic features that limit pat hology interpretation. A negative LEEP is not a reassuring finding and was assoc iated with a recurrence rate similar to those of a positive LEEP. Both negative and positive populations should be carefully followed.展开更多
Objective. To assess the role of hybrid PET/CT in the evaluation of patients with cervical cancer. Methods. 75 patients divided into 3 groups. Group 1 consisted of 16 patients prior to radical surgery. Group 2 consist...Objective. To assess the role of hybrid PET/CT in the evaluation of patients with cervical cancer. Methods. 75 patients divided into 3 groups. Group 1 consisted of 16 patients prior to radical surgery. Group 2 consisted of 31 patients prior to pelvic radiotherapy. Group 3 had 28 patients who underwent the examination secondary to suspected recurrent disease. Whole body PET and CT were performed respectively on the same device 1 h after injection of 10 mCi FDG. PET/CT results were correlated to histological, radiological and clinical follow- up data. Only women with >6 months follow- up were included. Results. In 33 patients, pathohistological ex aminations for extra cervical lesions were obtained. Correlation with PET/CT examination revealed levels of sensitivity (60% ), specificity (94% ), positive (90% ) and negative predictive values (74% ). The examination indicated 21 patients with extra pelvic and/or metastatic disease. The follow- up data of this group revealed that 20 patients either died or were alive with active disease, and only one patient was in clinical remission. PET/CT yielded an improved diagnosis for both PET and CT in 43% of the cases by providing better localization and definition of abnormal FDG uptake. Conclusions. Hybrid PET/CT was found to be of value for detection of cervical cancer metastases, decision- making and planning of irradiation therapy. Using this modality may reduce unnecessary surgical interventions, help modify radiation fields and change therapeutic approaches. Detection of advanced diseases on PET/CT correlates with poor prognosis. However, this examination is less accurate in detecting microscopic diseases and lesions smaller than 1.5 cm.展开更多
2016年，在综合了肾肿瘤最新的病理特点、流行病学特征和基因学改变之后，世界卫生组织（world health organization，WHO）对2004年肾肿瘤分类系统进行了重新修订。其中，充足的分子学和病理学资料、临床随访资料是一种肿瘤纳入新分类...2016年，在综合了肾肿瘤最新的病理特点、流行病学特征和基因学改变之后，世界卫生组织（world health organization，WHO）对2004年肾肿瘤分类系统进行了重新修订。其中，充足的分子学和病理学资料、临床随访资料是一种肿瘤纳入新分类系统的必要条件。展开更多
文摘OBJECTIVE: We sought to estimate the incidence and clinical significance of a negative therapeutic loop electrosurgical excision procedure (LEEP) and to evalu ate patient specimens for limiting histologic features associated with a negativ e LEEP. METHODS: We identified 674 patients with biopsy-confirmed high-grade c ervical dysplasia who were treated with LEEP from 1991 through 2001. The results of these LEEP procedures were reviewed for the absence of dysplasia or the pres ence of cervical intraepithelial neoplasia stages 1-3. Computerized pathology f iles of patients were then reviewed through July 2002 to determine whether dyspl asia recurred. Slides of negative LEEP specimens were reviewed to confirm the ab sence of dysplasia and to search for histologic features that may have limited o ur interpretation of the specimen. RESULTS: Ninety-three (14%)of LEEP specimen s reviewed were completely negative for dysplasia. Clinical follow-up was avail able on 75 of the 93 patients, with a median follow-up time of 2 years. Eightee n (24%) patients had subsequent positive follow-up, including carcinoma (n = 2 ), high-grade squamous intraepithelial lesions (n = 8), low-grade squamous int raepithelial lesion (n = 6), and atypical squamous cells of undetermined signifi cance (n = 2). Patients with negative LEEPs had a recurrence rate similar to pat ients with positive LEEPs (24%versus 27%). Limiting histologic features were m ore commonly identified in negative LEEPs as compared with LEEPs containing dysplasia (16% versus 5%, P < .001). CONCLUSION: A negative LEEP is not an uncommon finding, o ccurring in 14%(95%confidence interval 11-17%) of specimens at our instituti on. Negative LEEPs are more likely to contain histologic features that limit pat hology interpretation. A negative LEEP is not a reassuring finding and was assoc iated with a recurrence rate similar to those of a positive LEEP. Both negative and positive populations should be carefully followed.
文摘Objective. To assess the role of hybrid PET/CT in the evaluation of patients with cervical cancer. Methods. 75 patients divided into 3 groups. Group 1 consisted of 16 patients prior to radical surgery. Group 2 consisted of 31 patients prior to pelvic radiotherapy. Group 3 had 28 patients who underwent the examination secondary to suspected recurrent disease. Whole body PET and CT were performed respectively on the same device 1 h after injection of 10 mCi FDG. PET/CT results were correlated to histological, radiological and clinical follow- up data. Only women with >6 months follow- up were included. Results. In 33 patients, pathohistological ex aminations for extra cervical lesions were obtained. Correlation with PET/CT examination revealed levels of sensitivity (60% ), specificity (94% ), positive (90% ) and negative predictive values (74% ). The examination indicated 21 patients with extra pelvic and/or metastatic disease. The follow- up data of this group revealed that 20 patients either died or were alive with active disease, and only one patient was in clinical remission. PET/CT yielded an improved diagnosis for both PET and CT in 43% of the cases by providing better localization and definition of abnormal FDG uptake. Conclusions. Hybrid PET/CT was found to be of value for detection of cervical cancer metastases, decision- making and planning of irradiation therapy. Using this modality may reduce unnecessary surgical interventions, help modify radiation fields and change therapeutic approaches. Detection of advanced diseases on PET/CT correlates with poor prognosis. However, this examination is less accurate in detecting microscopic diseases and lesions smaller than 1.5 cm.
