妇科癌症作为遗传性非息肉性结肠直肠癌综合征妇女的“前哨癌”

OBJECTIVE: Women with hereditary nonpolyposis colorectal cancer syndrome have a 40 - 60% lifetime risk for colon cancer, a 40 - 60% lifetime risk for endometrial cancer, and a 12% lifetime risk for ovarian cancer. A number of women with hereditary nonpolyposis colorectal cancer syndrome will have more than one cancer in their lifetime. The purpose of this study was to estimate whether women with hereditary nonpolyposis colorectal cancer syndrome who develop 2 primary cancers present with gynecologic or colon cancer as their “ sentinel cancer." METHODS: Women whose families fulfilled Amsterdam criteria for hereditary nonpolyposis colorectal cancer syndrome and who developed 2 primary colorectal/gynecologic cancers in their lifetime were identified from 5 large hereditary nonpolyposis colorectal cancer syndrome registries. Information on age at cancer diagnoses and which cancer (colon cancer or endometrial cancer/ovarian cancer) developed first was obtained. RESULTS: A total of 117 women with dual primary cancers from 223 Amsterdam families were identified. In 16 women, colon cancer and endometrial cancer/ovarian cancer were diagnosed simultaneously. Of the remaining 101 women, 52 (51% ) women had an endometrial or ovarian cancer diagnosed first. Forty- nine (49% ) women had a colon cancer diagnosed first. For women who developed endometrial can- cer/ovarian cancer first, mean age at diagnosis of endometrial cancer/ovarian cancer was 44. For women who developed colon cancer first, the mean age at diagnosis of colon cancer was 40. CONCLUSION: In this large series of women with hereditary nonpolyposis colorectal cancer syndrome who developed 2 primary colorectal/gynecologic cancers, endometrial cancer/ovarian cancer was the "sentinel cancer," preceding the development of colon cancer, in half of the cases. Therefore, gynecologists and gynecologic oncologists play a pivotal role in the identification of women with hereditary nonpolyposis colorectal cancer syndrome.

林奇综合征相关子宫内膜癌研究进展

林奇综合征(Lynch syndrome,LS)是错配修复基因缺陷引起的常染色体显性遗传病,多系统恶性肿瘤易感是其主要特征,LS相关子宫内膜癌(LS associated endometrial cancer,LS-EC)是LS最常见的肠外前哨癌。精准医学时代,LS-EC的早期筛查对于预防LS相关其他恶性肿瘤的发生具有重要意义。本文就LS-EC的筛查手段及预防研究进展进行综述,以期为LS相关肿瘤患者精准诊疗及预防提供参考。

在固定解剖位置进行乳癌前哨淋巴结活检初探

目的证明乳癌前哨淋巴结(SLN)有固定的解剖位置,无需借助淋巴示踪技术亦能检出。方法Ⅰ～Ⅱ期乳癌术中,先于腋毛区最下缘作一2cm左右横切口,在该区域内找到1～3粒淋巴结,定义为SLN,与继后腋窝清扫所得的非前哨淋巴结(NSLN)进行病理结果对比分析。结果SLN阳性者占总检测者的55.6%(20/36);前哨淋巴结活检(SLNB)的准确率、灵敏度、阳性和阴性预测值分别为91.7%、94.7%、90.0%、93.8%。1例SLN病检阴性而NSLN阳性,假阴性率为2.8%(1/36)。结论无需借助淋巴示踪技术,在腋毛区最下缘检出的SLN可准确反映乳癌患者腋窝状况,故腋毛区最下缘是SLN的固定解剖位置。

冰冻诊断中关于乳腺微小浸润癌前哨淋巴结转移的探讨

目的:探讨乳腺微小浸润癌的冰冻切片诊断方法与效果。方法:2015年10月至2016年10月选择在我院诊治的26例乳腺微小浸润癌患者作为研究对象,都进行冰冻切片单独检测、冰冻切片与快速免疫组化法联合检测。结果:所有患者均分离出前哨淋巴结,经冰冻切片法检测出前哨淋巴结癌转移者3例,转移率为11.54%;经冰冻切片与快速免疫组化法联合检测出前哨淋巴结癌转移者9例,转移率为34.62%,对比差异明显(P<0.05)。结论:乳腺微小浸润癌的冰冻切片诊断有一定的作用,通过多剖面、多点取材,可提高前哨淋巴结癌转移的检出率,有很好的应用价值。

染色法前哨淋巴结活检与淋巴结状况的对照研究

目的：探讨淋巴染色对于癌前哨淋巴结活检的影响。方法：采用亚甲蓝染色法对45例术前乳腺癌患者行腋窝蓝染淋巴结活检，后行常规腋窝淋巴结清扫，两标本均送病理检查。结果：检出率为88．9％，SLN检查结果准确率为97．5％（39／40）；灵敏度为87．5％（7／8）。结论：SLN转移情况基本可以反映乳癌腋窝淋巴结转移情况。

螺旋CT间接淋巴造影及多期增强扫描在卵巢癌前哨淋巴结诊断中的评估价值

目的探讨螺旋CT间接淋巴造影及多期增强扫描在卵巢癌前哨淋巴结诊断中的评估价值。方法选取2015年12月-2016年12月在该院接受诊治的86例卵巢癌前哨淋巴结患者作为研究对象,均接受螺旋CT间接淋巴造影、多期增强扫描检查,并经手术病理确诊。观察并比较卵巢癌、前哨淋巴结检出率。结果在T0-T3时间点螺旋CT间接淋巴造影、多期增强扫描、螺旋CT间接淋巴造影联合多期增强扫描、病理活检检出卵巢癌比较,差异无统计学意义(P>0.05);在T4时间点两者联合检出率明显高于螺旋CT间接淋巴造影、多期增强扫描单独检测,差异有统计学意义(P<0.05);N1、N2时螺旋CT间接淋巴造影、多期增强扫描、联合检查、活检对前哨淋巴结检出率均显示高度差异(P<0.05)。结论螺旋CT间接淋巴造影及多期增强扫描在卵巢癌前哨淋巴结诊断中具有一定评估价值,能为临床诊治卵巢癌前哨淋巴结提供参考依据,便于明确卵巢癌分期、淋巴结侵及情况。