活检会不会引起癌肿扩散?

曾女士在洗澡时发现自己的左侧乳房上有一个肿块，去医院的乳腺专科检查后，医生怀疑是乳房肿瘤，建议她手术切除，可在手术前要先穿刺取一小块组织做病理活检。曾女士有些担心：穿刺会引起肿瘤的种植和扩散，还会引起出血。让她想不通的是。既然要做手术切除．为何还要做穿刺活检？

The altered DNA methylation pattern and its implications in liver cancer

DNA methylation is the most intensively studied epigenetic phenomenon, disturbances of which result in changes ingene transcription, thus exerting drastic imparts onto biological behaviors of cancer. Both the global demethylation andthe local hypermethylation have been widely reported in all types of tumors, providing both challenges and opportunitiesfor a better understanding and eventually controlling of the malignance. However, we are still in the very early stage ofinformation accumulation concerning the tumor associated changes in DNA methylation pattern. A number of excellentrecent reviews have covered this issue in depth. Therefore, this review will summarize our recent data on DNA methy-lation profiling in cancers. Perspectives for the future direction in this dynamic and exciting field will also be given.

Transrectal ultrasound and magnetic resonance imaging measurement of extramural tumor spread in rectal cancer

AIM： To evaluate the agreement between transrectal ultrasound （TRUS） and magnetic resonance imaging （MRI） in classification of ≥ T3 rectal tumors. METHODS： From January 2010 to January 2012, 86 consecutive patients with ≥ T3 tumors were included in this study. The mean age of the patients was 66.4 years （range： 26-91 years）. The tumors were all ≥ T3 on TRUS. The sub-classification was defined by the penetration of the rectal wall： a： 0 to 1 mm; b： 1-5 mm, c： 6-15; d： 〉 15 mm. Early tumors as ab （≤ 5 ram） and advanced tumors as cd （〉 5 mm）. All patients underwent TRUS using a 6.5 MHz transrectal transducer. The MRI was performed with a 1.5 T Phil- ips unit. The TRUS findings were blinded to the radiol- ogist performing the interpretation of the MRI images and measuring the depth of extramural tumor spread RESULTS： TRUS found 51 patients to have an early ≥ T3 tumors and 35 to have an advanced tumor, where- as MRI categorized 48 as early ≥ T3 tumors and 38 as advanced tumors. No patients with tumors classified as advanced by TRUS were found to be early on MRI. The kappa value in classifying early versus advanced T3 rectal tumors was 0.93 （95% CI： 0.85-1.00）. We found a kappa value of 0.74 （95% CI： 0.63-0.86） for the total sub-classification between the two methods. The mean maximal tumor outgrowth measured by TRUS, 5.5 mm ± 5.63 mm and on MRI, 6.3 mm ±6.18 mm, P = 0.004. In 19 of the 86 patients the following CT scan or surgery revealed distant metastases; of the 51 patients in the ultrasound ab group three （5.9%） had metastases, whereas 16 （45.7%） of 35 in the cd group harbored distant metastases, P = 0.00002. The odds ratio of having distant metastases in the ultra- sound cd group compared to the ab group was 13.5 （95% CI： 3.5-51.6）, P = 0.00002. The mean maximal ultrasound measured outgrowth was 4.3 mm （95% CI： 3.2-5.5 mm） in patients without distant metastases, while the mean maximal outgrowth was 9.5 mm （95% CI： 6.2-12.8 ram） in the patients with metastases, P = 0.00004. Using the MRI classification three （6.3%） of 48 in the MRI ab group had distant metastases, while 16 （42.1%） of the 38 in the MRI cd group, P = 0.00004. The MRI odds ratio was 10.9 （95% CI： 2.9-41.4）, P = 0.00008. The mean maximal MRI measured out- growth was 4.9 mm （95% CI： 3.7-6.1 turn） in patients without distant metastases, while the mean maximal outgrowth was 11.5 mm （95% CI： 7.8-15.2 mm） in the patients with metastases, P = 0.000006. CONCLUSION： There is good agreement between TRUS and MRI in the pretreatment sub-classification of ≥ T3 tumors. Distant metastases are more frequent in the advanced group.

STUDY ON SMALL HEPATOCELLULAR CARCINOMAAND ITS EXTENSION

This paper summarizes the 'study On small hepatocellular carcinoma and its extensionII in Liver CancerInstitute, Zhongshan Hospital Of Shanghai MedicaI University during the past 25 years. The results 1ndl-cated that it was an impOrtant approach to obtain long-term HCC survivOrs, of the 239 patients with 5-yearsurvival, small HCC resection accounted for 51. 4 %. It was an effective apprOach to lmprove the prognosisof HCC in the entire series, the 5-year survlval of lnpatients treated ln authorsI institution was 4. 8% in1958~1970, l2. 2 % in 197l ~ 1983, and 46. 7 % in l984~ 1995; which were correlated to the increaseProportion of small HCC resection in the series; it was more effective as compared to large HCC resection,the 5 year survival was 6l. 3 % (n= 645 ) versus 33. 6 % (n= 950). ExtensiOns of small HCC study includ-ed early detection and treatment of small recurrent HCC, Of the l47 patients wlth re-resection, the 5-yearsurvival was 48. 9% caIculated frOm the time Of first resectiOn. Another extenslon was conversiOn Of largeHCC intO small HCC, using multimodality combination treatment, 72 out of the 663 patients wlth surgical-ly verified unresectable HCCs have been converted to resectable, 5-year survival being 62' l %, wh1ch wascomparable tO that of small HCC resection. Studies on related basic aspect of small HCC such as cell originof recurrence, and mOlecular aspect of small HCC, indicated that biOlOgical characterlstics, particularly thetumor invasiveness, remalned the key link for further prolong survival after small HCC resection. Recent-ly, a'patient-like' human HCC metastatic medel in nude mice has been established. Experimental inter-ventions have also been tried. Clinical trials fOr preventiOn of recurrence after small HCC resection haveshown preliminary encouraging results. However, the IIcOst-effectivenessn Of screening, the invasiveness ofHCC, the multicentric origin, the coexisted Child C cirrhosis, etc., remained great chal1enge.