Clinical efficacy and prognostic risk factors of endoscopic radiofrequency ablation for gastric low-grade intraepithelial neoplasia

BACKGROUND The use of radiofrequency ablation(RFA)has been reported in the treatment of gastric low-grade intraepithelial neoplasia(LGIN).However,its efficacy and prognostic risk factors have not been well analyzed.AIM To explore the efficacy and prognostic risk factors of RFA for gastric LGIN in a large,long-term follow-up clinical study.METHODS The clinical data of 271 consecutive cases from 198 patients who received RFA for treatment of gastric LGIN at the Chinese PLA General Hospital from October 2014 to October 2020 were reviewed in this retrospective study.Data on operative parameters,complications,and follow-up outcomes including curative rates were recorded and analyzed.RESULTS The curative rates of endoscopic RFA for gastric LGIN at 3 mo,6 mo,and 1-5 years after the operation were 93.3%,92.8%,91.5%,90.3%,88.5%,85.7%,and 83.3%,respectively.Multivariate analyses revealed that Helicobacter pylori(H.pylori)infection and disease duration>1 year had a significant effect on the curative rate(P<0.001 and P=0.013,respectively).None of patients had bleeding,perforation,infection,or other serious complications after RFA,and the main discomfort was postoperative abdominal pain.CONCLUSION RFA was safe and effective for gastric LGIN during long-term follow-up.H.pylori infection and disease course>1 year may be the main risk factors for relapse of LGIN after RFA.

Photodynamic Therapy for Low-grade Cervical Intraepithelial Neoplasia(CIN1):A Case Report

As a drug-mechanical combination technology,photodynamic(PDT)can achieve accurate and taurgeted therapy for maligmant tumors and benign diseases through the production of reactive oxygen species,oxygen free radicals or singlet oxygen by photosensitizers at specific wavelengths.Compared with traditional surgery,it has the advantages of selective killing.repeatable teatment,preserving target organ fiunction and so on.The purpose of this study was to explore the clinical value of photodynamic therapy in cervical precancerous lesions by taking the patients with low-grade cervical intaepithelial neoplasia(CIN1)with high-risk human papillomavinus(HR HPV)persistent infection diagnosed by"three-step diagnosis and teatment procedure"as an example.Using HiPorfn as a photosensitizer,photodynamic therapy was performed 48 hours after intavenous drip.Set laser wavelength 630nm,light dose density 137.58J/cm^2,ansmission efficiency 1.42,output power 2w.3cm columnar optical fber was placed around the 2cm in the cervical canal to cover all the lesions,and the inadiation time was 900s(600s in the cervical canal and 300s outside the cervical canal).The patients were given oxygen inhalation for 6 hours after operation,and the patients were observed for itching and other discomfort,and paid attention to avoid light.Photodynamic therapy was performed again in the same way on the second day.After two months of treatment,pathological biopsy showed chronic cervicitis,indicating that the disease had been effectively controlled.Theoretically,although the patient is not the absolhute indication of photodynamic therapy(hat is,meeting CIN Ⅱ or CIN Ⅲ,having fertility requirements and not undergoing surgery),this therapy can remove not only the superficial lesions inside and outside the cervix,but also the potential lesions not found under colposcopy.It can also block the persistent infection of HPV by.inhbting the expression of HPV18,E6 and E7mRNA in Hela cells.In combination with Baofukang suppository,it can block HPV infection.Increase the negative conversion rate of cervical HPV and reduce the probablity of recurence after CIN1 cure.For youmng female patients with persistent HR-HPV infection and fertility requirements,photodynamic therapy is an effective choice for clinical treatment of CIN1.

Anal intraepithelial neoplasia: A review of diagnosis and management

Anal intraepithelial neoplasia(AIN) is a premalignant lesion of the anal mucosa that is a precursor to anal cancer. Although anal cancer is relatively uncommon, rates of this malignancy are steadily rising in the United States, and among certain high risk populations the incidence of anal cancer may exceed that of colon cancer. Risk factors for AIN and anal cancer consist of clinical factors and behaviors that are associated with the acquisition and persistence of human papilloma virus(HPV) infection. The strongest HPV-associated risk factors are HIV infection, receptive anal intercourse, and high risk sexual behavior. A history of HPVmediated genital cancer, which suggests infection with an oncogenic HPV strain, is another risk factor for AIN/anal cancer. Because progression of AIN to anal cancer is known to occur in some individuals over several years, screening for AIN and early anal cancer, as well as treatment of advanced AIN lesions, is reasonable in certain high-risk populations. Although randomized controlled trials evaluating screening and treatment outcomes are lacking, experts support routine screening for AIN in high risk populations. Screening is performed using anal cytological exams, similar to those performed in cervical cancer screening programs, along with direct tissue evaluation and biopsy via high resolution anoscopy. AIN can be treated using topical therapies such as imiquimod, 5-flurouracil, and trichloroacetic acid, as well as ablative therapies such as electrocautery and laser therapy. Reductions in AIN and anal cancer rates have been shown in studies where high-risk populations were vaccinated against the oncogenic strains of HPV. Currently, the CDC recommends both high-risk and average-risk populations be vaccinated against HPV infection using the quadrivalent or nonavalent vaccines. It is important for clinicians to be familiar with AIN and the role of HPV vaccination, particularly in high risk populations.

Optimal management of biopsy-proven low-grade gastric dysplasia

Gastric adenocarcinoma generally culminates via the inflammation-metaplasia-dysplasia-carcinoma sequence progression. The prevalence of gastric adenomas shows marked geographic variation. Recently, the rate of diagnosis of low-grade dysplasia(LGD) has increased due to increased use of upper endoscopy. Many investigators have reported that gastric highgrade dysplasia has high potential for malignancy and should be removed; however, the treatment for gastric LGD remains controversial. Although the risk of LGD progression to invasive carcinoma has been reported to be inconsistent, progression has been observed during follow-up. Additionally, the rate of upgraded diagnosis in biopsy-proven LGD is high. Therefore, endoscopic resection(ER) may be useful in the treatment and diagnosis of LGD, especially if lesions are found to have risk factors for upgraded histology after ER, such as large size, surface erythema or depressed morphology. Fatal complications in endoscopic submucosal dissection(ESD) are extremely low and its therapeutic and diagnostic outcomes are excellent. Therefore, ESD should be applied preferentially instead of endoscopic mucosal resection.

Clinical Value of Human Papillomavirus E6/E7 mRNA Testing in Patients with Atypical Squamous Cells of Undetermined Significance and Low-Grade Squamous Intraepithelial Lesion

Objective: To explore the clinical significance of the quantitative detection of human papillomavirus(HPV) E6/E7 mRN A in triage of patients with atypical squamous cells of undetermined significance(ASC-US) and low-grade squamous intraepithelial lesion(LSIL).Methods: A cross-sectional screening study was conducted among women who underwent outpatient gynecological screening at the Obstetrics and Gynecology Hospital of Fudan University from September 2015 to July 2016. A total of 500 patients from our hospital with ASC-US or LSIL based on cytology testing were subjected to HPV DNA and HPV E6/E7 mRNA quantitative analysis.Results: The specificity of the HPV E6/E7 mRNA test for detecting ≥high-grade squamous intraepithelial lesion(HSIL+) was statistically higher than that of the HPV DNA test(61.3% vs. 40.0%, P< 0.05), whereas there was no significant difference in the sensitivity of HPV E6/E7 mRNA test and HPV DNA test(90.0% vs. 95.0%, P > 0.05). The positive rates of HPV in the participants tested by HPV E6/E7 mRNA and HPV DNA were, respectively, 42.8%(214/500) and 62.8%(314/500), with statistical significance(P < 0.05).Conclusions: The HPV E6/E7 mRNA test was slightly less sensitivity than that of the HPV DNA test for diagnosing HSIL+ in patients with ASC-US and LSIL, but the difference was not significant, although the specificity of the former was significantly higher. HPV E6/E7 mRNA detection can effectively reduce overdiagnosis and overtreatment of patients with ASC-US and LSIL and has important clinical value in triage of patients with ASC-US and LSIL.

Anal squamous cell carcinoma: An evolution in disease and management

Anal cancer represents less than 1% of all new cancers diagnosed annually in the United States. Yet, despite the relative paucity of cases, the incidence of anal cancer has seen a steady about 2% rise each year over the last decade. As such, all healthcare providers need to be cognizant of the evaluation and treatment of anal squamous cell carcinoma. While chemoradiation remains the mainstay of therapy for most patients with anal cancer, surgery may still be required in recurrent, recalcitrant and palliative disease. In this manuscript, we will explore the diagnosis and management of squamous cell carcinoma of the anus.

食管鳞状上皮内瘤变的研究进展

我国是食管癌高发国家,病理类型以鳞状细胞癌为主。鳞状上皮内瘤变是当前最为公认的食管鳞癌前病变,对其进行监测和干预是降低食管鳞癌发生率以及提高患者生活质量的有效方法。认识食管鳞状上皮内瘤变的病因、临床特征、诊断及治疗,对于食管鳞癌的预防和早期诊治发挥着至关重要的作用。目前食管鳞状上皮内瘤变相关临床研究仍不充分,临床处置也存在一定分歧。本综述在近年相关领域文献的基础上,从鳞状上皮内瘤变的危险因素、临床特征、诊断、转归及治疗方面进行总结综述,希望为食管鳞状上皮内瘤变临床管理提供思路。

Transcriptome sequencing reveals novel biomarkers and immune cell infiltration in esophageal tumorigenesis

BACKGROUND Esophageal squamous cell carcinoma(ESCC)is one of the most common malignancies worldwide,and its development comprises a multistep process from intraepithelial neoplasia(IN)to carcinoma(CA).However,the critical regulators and underlying molecular mechanisms remain largely unknown.AIM To explore the genes and infiltrating immune cells in the microenvironment that are associated with the multistage progression of ESCC to facilitate diagnosis and early intervention.METHODS A mouse model mimicking the multistage development of ESCC was established by providing warter containing 4-nitroquinoline 1-oxide(4NQO)to C57BL/6 mice.Moreover,we established a control group without 4NQO treatment of mice.Then,transcriptome sequencing was performed for esophageal tissues from patients with different pathological statuses,including low-grade IN(LGIN),high-grade IN(HGIN),and CA,and controlled normal tissue(NOR)samples.Differentially expressed genes(DEGs)were identified in the LGIN,HGIN,and CA groups,and the biological functions of the DEGs were analyzed via Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses.The CIBERSORT algorithm was used to detect the pattern of immune cell infilt-ration.Immunohistochemistry(IHC)was also conducted to validate our results.Finally,the Luminex multiplex cytokine analysis was utilized to measure the serum cytokine levels in the mice.RESULTS Compared with those in the NOR group,a total of 681541,and 840 DEGs were obtained in the LGIN,HGIN,and CA groups,respectively.Using the intersection of the three sets of DEGs,we identified 86 genes as key genes involved in the development of ESCC.Enrichment analysis revealed that these genes were enriched mainly in the keratinization,epidermal cell differentiation,and interleukin(IL)-17 signaling pathways.CIBERSORT analysis revealed that,compared with those in the NOR group,M0 and M1 macrophages in the 4NQO group showed stronger infiltration,which was validated by IHC.Serum cytokine analysis revealed that,compared with those in the NOR group,IL-1βand IL-6 were upregulated,while IL-10 was downregulated in the LGIN,HGIN,and CA groups.Moreover,the expression of the representative key genes,such as S100a8 and Krt6b,was verified in external human samples,and the results of immunohistochemical staining were consistent with the findings in mice.CONCLUSION We identified a set of key genes represented by S100a8 and Krt6b and investigated their potential biological functions.In addition,we found that macrophage infiltration and abnormal alterations in the levels of inflam-mation-associated cytokines,such as IL-1β,IL-6,and IL-10,in the peripheral blood may be closely associated with the development of ESCC.

Thedual pathogenesisofpenileneoplasia: The heterogeneous morphology of human papillomavirus-relatedtumors

Objective:Penile neoplasia,usually of squamous histogenesis,is currently classfied into human papillomavirus(HPV)-related or-dependent and non-HPV-related or-indepen dent.There are distinct morphological differences among the two groups.New research studies on penile cancer from Northern countries showed that the presence of HPV is corre lated with a better prognosis than virus negative people,while studies in Southern countries had not confirmed,perhaps due to differences in staging or treatment.Methods:We focused on the description of the HPV.related carcinomas of the penis.The approach was to describe common clinical features followed by the pathological features of each entity or subtype stressing the characteristics for differential diagnosis,HPV genotypes,and prognostic features of the invasive carcinomas.Similar structure was followed for penile intraepithelial neoplasia,except for prognosis because of the scant evidence available.Results:Most of HPV-related lesions can be straightforwardly recognized by routine hematoxylin and eosin stains,but in some cases surrogate p16 immunohistochemical staining or molecular methods such as in situ hybridization or polymerase chain reaction can be utilized.Currently,there are eight tumor invasive variants associated with HPV,as follows:basaloid,warty,warty-basaloid,papillary basaloid,clear cell,medullary,lymphoepithelioma-like,and giant condylomas with malignant transformation.Conclusion:This review presents and describes the heterogeneous clinical,morphological,and genatypic features of the HPV-related subtypes of invasive and non-invasive penile neoplasia.

阴道镜下宫颈环切术治疗宫颈鳞状上皮内瘤变的临床效果

目的分析阴道镜下宫颈环切术治疗宫颈鳞状上皮内瘤变(CIN)的临床效果。方法选择本院门诊收治的460例CIN患者,按照随机数字表法分两组。研究组(236例)行阴道镜下宫颈环切术治疗,对照组(224例)行冷刀锥切术治疗。比较两组患者的疗效。结果研究组各项手术情况指标均优于对照组(P<0.05)。研究组并发症发生率低于对照组(P<0.05)。两组术后复发率比较,差异无统计学意义(P>0.05)。结论阴道镜下宫颈环切术治疗CIN的效果显著优于冷刀锥切术,能有效降低手术时间、减少手术损伤,降低并发症的发生率,减少疾病复发,值得临床推广。

基于血液炎症指标的食管鳞状上皮内瘤变风险预测模型的构建与应用

目的探究食管鳞状上皮内瘤变发生风险的预测因素,构建列线图预测模型。方法回顾性收集2016年01月至2021年12月在扬州大学附属医院诊断为食管鳞状上皮内瘤变患者126例,以及同期于健康管理中心进行体检者344例,收集患者一般临床资料、血常规检测、肿瘤标志物、病变资料。确定食管鳞状上皮内瘤变的独立预测因子,构建列线图预测模型、绘制受试者操作特征(receiver operating characteristic,ROC)曲线,计算得出Harrell一致性指数(C-index)并采用Bootstrap自抽样法,对模型进行内部验证并绘制校准曲线及决策曲线。结果为构建食管上皮内瘤变的风险预测模型,经PSM法匹配后,本研究共纳入96例食管鳞状上皮内瘤变患者及96例健康对照。多因素Logistic回归分析显示,血红蛋白(HGB)计数、血小板(PLT)计数、血小板分布宽度(PDW)、NLR水平是食管鳞状上皮内瘤变的独立预测因子。根据以上四项指标构建的列线图模型曲线下面积(area under curve,AUC)为0.787。Bootstrap内部验证的C-index值为0.771,提示该食管鳞状上皮内瘤变风险预测模型的识别能力、一致性和临床净获益良好。结论基于HGB、PLT、PDW及NLR建立的列线图预测模型可有效鉴别有无食管鳞状上皮内瘤变病变人群,对诊断食管癌前病变有辅助价值。

合成MRI联合IVIM模型对宫颈鳞癌及CINⅢ的诊断价值

目的探讨合成MRI中的相关定量参数联合体素内不相干运动(Intravoxel Incoherent Motion,IVIM)成像相关参数对宫颈鳞癌及宫颈上皮内瘤变(Cervical Intraepithelial Neoplasia,CIN)Ⅲ的鉴别诊断价值。方法前瞻性选取2021年5—12月于我院接受MRI及IVIM检查的35例女性宫颈鳞癌患者(宫颈鳞癌组)以及35例CINⅢ患者(CINⅢ组)。通过后处理技术得到合成MRI序列中的纵向弛豫时间(T1)、横向弛豫时间(T_(2))、质子密度(Proton Density,PD)以及IVIM成像中的慢扩散系数(D)、快扩散系数(D*)和灌注分数(f)。比较宫颈鳞癌组与CINⅢ组的影像特征差异,绘制受试者工作特征曲线,计算各参数的曲线下面积(Area Under Curve,AUC),评估各参数值在鉴别诊断宫颈鳞癌及CINⅢ中的效能,并比较其效能差异。结果宫颈鳞癌组的T2值以及PD值均高于CINⅢ组,其差异具有统计学意义(P<0.05)。宫颈鳞癌组的D值、f值低于CINⅢ组,差异具有统计学意义(P<0.05)。合成MRI中T_(2)值诊断效能最高(AUC=0.812)、IVIM成像中f值诊断效能最高(AUC=0.889),合成MRI参数与D值、f值联合,其诊断效能均提高,其中T2与f值联合诊断效能达最高(AUC=0.956)。结论合成MRI序列中的T2值和IVIM成像中f值诊断敏感度和特异性较高,两者联合诊断效能更高,有助于提高对宫颈鳞癌及CINⅢ的鉴别诊断效能。

高强度聚焦超声和宫颈锥切术治疗宫颈高级别鳞状上皮内病变患者的临床疗效及其对T细胞亚群、炎症因子影响

目的比较高强度聚焦超声(HIFU)和宫颈锥切术(CKC)治疗宫颈高级别鳞状上皮内病变患者的临床疗效及对T细胞亚群、炎症因子影响。方法回顾性选取2018年6月至2020年6月沧州市人民医院妇科收治的110例宫颈高级别鳞状上皮内病变患者为研究对象,按照手术方式不同分为HIFU组(n=60)和CKC组(n=50)。HIFU组接受HIFU手术治疗,CKC组接受CKC手术治疗。比较两组手术相关指标(手术时间、术中出血量)、高危型人乳头瘤病毒(HR-HPV)转阴率、手术前后阴道T细胞亚群水平、血清炎症因子[白细胞介素(IL)-10、IL-6、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平、疗效及并发症发生、复发率情况。结果HIFU组手术时间为(8.13±1.75)min,明显短于CKC组[(23.61±3.89)min],术中出血量为(3.06±0.82)mL,明显少于CKC组[(3.06±0.82)mL],差异均有统计学意义(P<0.05)。术后6个月,两组HR-HPV转阴率比较,差异无统计学意义(P>0.05)。术后1个月,两组CD4^(+)、CD4^(+)/CD8^(+)水平较术前明显升高,CD8^(+)水平较术前明显降低,且HIFU组CD4^(+)、CD4^(+)/CD8^(+)水平分别为(42.21±6.33)%、2.10±0.05,均明显高于CKC组[(2.10±0.05)%、1.63±0.07],CD8^(+)水平为(42.21±6.33)%,明显低于CKC组[(42.21±6.33)%],差异均有统计学意义(P<0.05)。术后1个月,两组血清IL-10水平较术前明显升高,IL-6、CRP、TNF-α水平较术前明显降低,差异均有统计学意义(P<0.05),但两组术后各炎症因子水平比较,差异均无统计学意义(P>0.05)。两组疗效比较,差异无统计学意义(P>0.05)。HIFU组术后并发症发生率为0,明显低于CKC组(10.00%),差异有统计学意义(P<0.05)。两组术后1年复发率比较,差异无统计学意义(P>0.05)。结论HIFU和CKC治疗宫颈高级别鳞状上皮内病变均有较好的疗效,但HIFU手术时间更短,术中出血量和术后并发症发生率更少,术后T细胞亚群改善程度优于CKC,但是两种术式对炎症因子的影响差异不明显。

二氧化碳激光联合干扰素治疗宫颈低级别上皮内病变伴HR-HPV感染患者的临床效果

目的 探究二氧化碳(CO_(2))激光联合干扰素治疗对宫颈低级别上皮内病变(LSIL)伴高危型人乳头瘤病毒(HR-HPV)感染患者的效果。方法 纳入2020年9月至2021年7月就诊于安徽医科大学附属妇幼保健院的LSIL伴HR-HPV感染的患者183例。采用随机数表法分为三组,分别为CO_(2)激光治疗组(61例)、干扰素治疗组(61例)、联合治疗组(61例)。比较三组患者一个疗程结束后第3、6、12个月宫颈HR-HPV的转阴率及LSIL的治愈率。结果 联合治疗组治疗结束后第3、6、12个月宫颈HR-HPV转阴率(77.05%、88.52%、91.80%)均高于CO_(2)激光治疗组(37.70%、65.57%、73.77%)及干扰素治疗组(21.31%、45.90%、54.10%)(P <0.05)。联合治疗组治疗结束后第3、6、12个月宫颈LSIL治愈率(78.69%、90.16%、93.44%)均高于CO_(2)激光治疗组(52.46%、65.57%、78.69%)及干扰素治疗组(29.51%、45.90%、57.38%)(P <0.05)。结论 在LSIL治愈率及HR-HPV转阴率效果方面,CO_(2)激光比干扰素效果好,但两者联合效果更佳。

KIF20A在宫颈炎、宫颈鳞状上皮内瘤变、宫颈鳞状细胞癌中的表达及临床意义

目的分析驱动蛋白家族成员20A(KIF20A)在宫颈炎、宫颈鳞状上皮内瘤变(CIN)、宫颈鳞状细胞癌(CSCC)中的表达及临床意义。方法回顾性收集2015年1月至2018年2月于徐州医科大学附属宿迁医院就诊的CSCC患者40例、CIN患者40例、宫颈炎患者20例的临床资料,均保存良好的石蜡标本。KIF20A蛋白采用免疫组织化学法进行检测,比较3组KIF20A蛋白阳性表达率;Kaplan-Meier法分析KIF20A表达与CSCC生存预后的关系。结果宫颈炎、CIN、CSCC组织中KIF20A的阳性率分别为10.00%、42.50%、70.00%,逐步提高,差异有统计学意义(P<0.05)。浸润深度≥1/3层、发生盆腔淋巴结转移、FIGO分期为ⅡB+Ⅲ期的CSCC患者KIF20A阳性表达率高于浸润深度<1/3层、未发生盆腔淋巴结转移、FIGO分期为Ⅰ+ⅡA期的CSCC患者,差异均有统计学意义(P<0.05)。Kaplan-Meier法分析显示,KIF20A阴性表达的CSCC患者5年生存率为67.86%(19/28),高于KIF20A阳性表达患者[58.33%(7/12)],差异有统计学意义(χ^(2)=5.559,P<0.05)。结论KIF20A蛋白在宫颈炎、CIN组织、CSCC组织中的阳性率逐步提高,可能参与CSCC的发生与发展,其表达与CSCC患者预后有关。

Clinicopathologic diagnosis of dVIN related vulvar squamous cell carcinoma:An extended appraisal from a tertiary women's hospital

Background:Differentiated vulvar intraepithelial neoplasia(dVIN)is a non-human papilloma virus(HPV)-related high-grade precursor lesion to vulvar squamous cell carcinoma(vSCCa).Although TP53 gene mutations have been identified in 80%of dVIN,its role in dVIN pathogenesis as well as malignant transformation is still being poorly understood.Poor reproducible diagnostic criteria and ambiguous p53 immunostaining patterns,along with morphologic discordance still pose a diagnostic challenge.Methods:A series of 60 cases of dVIN-related vSCCa along with adjacent dVIN were evaluated.Clinicopathological features as well as immunohistochemical results were recorded on the resection-confirmed dVIN-related vSCCa.Results:The average age of the patients was 71 years.Thirty-five cases(58.4%)of dVIN-related vSCCa were moderately differentiated,fourteen cases(23.3%)were poorly differentiated,and the remaining eleven cases(18.3%)were well-differentiated.Twenty-nine cases(48.3%)were found to have lichen sclerosus adjacent to dVIN.In terms of p53 and p16 expression in dVIN-related vSCCa and the adjacent dVIN,fifty-five(91.7%)dVIN showed mutant p53 immunostaining pattern with strong positive expression in 80%cases(basal/para-basal expression)and null pattern expression in 11.7%cases.Five(8.3%)dVIN showed p53 wild-type staining pattern.The wild-type pattern were seen in 5%of vSCCa and p53 null pattern were seen in 13.3%vSCCa.Six cases demonstrated atypical staining patterns:two cases showed p53 null expression in dVIN but p53 overexpression in invasive carcinoma;three cases exhibited p53 null expression in invasive carcinoma,with the adjacent dVIN showing basal and para-basal mutant(2 cases)and wild-type(1 case)p53 expression patterns.A single case demonstrated p53 wild-type pattern in dVIN and overexpression in invasive carcinoma.In addition,65%dVIN were p16 negative and 31.7%dVIN had patchy p16 staining.Conclusion:Clinical and prognostic value of the ambiguous/inconsistent patterns are uncertain and molecular studies are needed for further characterization.

不同年龄早期食管癌及鳞状上皮内瘤变的临床特点分析

背景近年来随着内镜技术的发展,内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)因其较低的并发症风险、较快的恢复速度等优点广泛应用于早期食管癌(early esophageal cancer,EEC)及鳞状上皮内瘤变(squamous intraepithelial neoplasia,SIN)的治疗.本研究重点评估了老年患者EEC及SIN的临床特点及行ESD治疗的安全性.目的分析不同年龄早期食管癌及鳞状上皮内瘤变的临床特点.方法收集自2019-01/2022-10在郑州大学第一附属医院行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗的349例早期食管癌及鳞状上皮内瘤变(包括高级别上皮内瘤变及低级别上皮内瘤变)病例,按照手术时年龄分为老年组(≥65岁)与中青年组(<65岁),采用t检验或Mann-Whitney U检验,以及卡方检验或Fisher精确概率法,比较2组之间的一般临床资料(性别、吸烟情况、饮酒情况、高血压、糖尿病、冠心病、其他肿瘤史、腹部手术史及家族消化道肿瘤疾病史等)和病理资料(病变位置、病理类型、浸润深度、内镜分型、病变长径、是否同时存在多个病灶、是否合并慢性食管炎、胃息肉、萎缩性胃炎等),同时比较两组病例的术后相关指标(术后住院时间、术后出血、是否合并食管狭窄及切缘).结果老年组患者中患有高血压的人数较多(P=0.034),中青年组患者中吸烟比例更高(P=0.017),差异有统计学意义.从病变位置上来说,中青年组病变多位于胸下段,而老年组病变多位于胸中段(P=0.005),且老年组发现时病变较中青年组更严重(P=0.005),也更高比例的合并有胃息肉(P=0.026).而ESD术后并发症及住院时间等方面,老年组与中青年组无明显差异.结论老年早期食管癌及鳞状上皮内瘤变患者合并疾病更多、病变相对严重,好发于胸中段,可结合病变位置等方面的不同予以进行更为细致的内镜下观察和密切的随访,改善患者的预后.

阴道上皮内瘤变治疗的研究进展

阴道上皮内瘤变(VaIN)是一组发病率较低的疾病,是阴道浸润性癌的癌前病变,其发生与人乳头瘤病毒感染密切相关。VaIN患者通常无特征性的临床症状,仅有少数患者有阴道出血或阴道分泌物异常的表现。目前临床治疗VaIN的方法主要有保守治疗、药物治疗、物理治疗、手术治疗和放疗,不同的治疗方法各有其优缺点。在临床上,VaIN的治疗常根据患者的实际情况进行个体化治疗。但目前有关这方面的研究较少、样本量较小,且国际上尚无公认的治疗指南,仍需要进行深入研究,以期为VaIN的治疗提供新思路。

病变鳞状上皮细胞DNA倍体分析对宫颈上皮内瘤变的诊断和预后分析

目的 探讨病变鳞状上皮细胞DNA倍体分析对宫颈上皮内瘤变(CIN)的诊断和预后的价值分析。方法 选取2019年1月至2022年1月西安市第三医院就诊的115例CIN患者作为研究对象,其中低级别鳞状上皮内病变患者32例,高级别鳞状上皮内病变患者83例。采用Blue Feulgen检测试剂盒检测患者DNA倍体,并使用DNA图像细胞术分析DNA倍体。结果 低级别鳞状上皮内病变患者中有17例(53.1%)出现异倍体,而高级别鳞状上皮内病变患者中有68例(81.9%)为异倍体;高级别鳞状上皮内病变患者中DNA异倍体的出现率更高(P<0.05)。DNA倍体与CIN分级关系分析发现,CINⅠ级DNA异倍体阳性率为54.5%,CINⅡ级DNA异倍体阳性率为69.2%,CINⅢ级DNA异倍体阳性率高达95.6%。DNA倍体细胞数预测CIN的受试者工作特征(ROC)曲线显示,曲线下面积为0.913。随访2年发现,CINⅡ级和CINⅢ级患者治疗后有17例复发,其中16例(94.1%)是异倍体阳性。结论 随着CIN分级的增加,DNA倍体异常情况发病率越高,DNA倍体细胞数变化可很好地预测CIN,且DNA倍体异常与CIN患者预后也具有一定的相关性。

RNAscope技术检测hTERC RNA组分在宫颈鳞状上皮内瘤变中的表达及其应用价值

目的:探讨RNAscope技术检测hTERC RNA组分表达对宫颈鳞状上皮内瘤变分级诊断价值。方法:筛选2021年9月至2022年2月华北理工大学附属医院病理科已确诊为HR-HPV感染的宫颈活检标本80例,分3组:炎症组14例、低级别组34例、高级别组32例。分别采用荧光原位杂交技术及RNAscope技术检测石蜡包埋组织中hTERC基因的扩增状况及其RNA组分的表达。结果:FISH检测hTERC基因扩增三组间具有差异性(P<0.05)。RNAscope检测三组间检出率具有统计学差异(P<0.05)。组织学诊断分组中,炎症组14例中hTERC RNA组分阳性表达程度均为(-/++),低级别组中以hTERC RNA组分(++)为主(19/34),高级别组中以hTERC RNA组分(+++/++++)为主(27/32),上述染色模式表达情况在组织学分级诊断中具有统计学差异(P<0.05)。结论:RNAscope技术检测宫颈上皮内瘤变组织中hTERC RNA组分的表达有助于宫颈病变组织学诊断及进展预测。