Comparison on the predictive values of four screening methods regarding cervical cancer / 中华流行病学杂志

To compare the predictive values of 5% acetic acid stain and visual inspection, human papillomavirus (HPV) Self test, ThinPrep Pap and HPV direct test in screening for cervical cancer with biopsy as gold standard. Positive predictive values and negative predictive values were compared simultaneously by joint hypothesis tests and then either positive predictive values or negative predictive values of the any two screening tests were compared by marginal regression based on both GEE and weighted least square methods. Hochberg method was used for multiplicity adjustment. It was showed that HPV direct test had the highest negative predictive value and ThinPrep Pap the highest positive predictive value. 5% acetic acid stain and visual inspection had both the lowest positive predictive value and negative predictive value. Both HPV direct test and ThinPrep Pap were efficient, but the latter required compatible infrastructure and skilled caregivers to go with. Both 5% acetic acid stain and visual inspection were inexpensive, and their positive predictive value and negative predictive value were lower than HPV self-test. They also had similar positive predictive value with HPV direct test and similar negative predictive value with ThinPrep Pap. HPV self-test appeared to be efficient, suggesting that it had significant potential for screening program to be implemented in the rural areas of China since the test could be performed without speculum examination in low-resource regions.

Detection of EGFR and K-ras mutations in non-small cell lung cancer using cytological specimens / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To validate the feasibility for detecting EGFR and k-ras mutations using cytological specimens.</p><p><b>METHODS</b>Cytological specimens including fine-needle aspiration (FNA), pleural effusion (PLE) and fiberoptic bronchoscopic (FOB) brushing were collected from patients with non-small cell lung cancer (NSCLC ) from January 2011 to July 2011 at the Department of Cytology, Cancer Hospital, Chinese Academy of Medical Sciences (CHCAMS). Polymerase chain reaction (PCR) was carried out to amplify EGFR exons 18-21 and k-ras codons 12-13, and then the PCR products sequencing and analysis were performed.</p><p><b>RESULTS</b>Fifty cytological specimens were collected including 19 cases of FOB, 9 cases of FNA, 22 cases of PLE. Of them DNA was successfully extracted in 43 cases, and specific PCR amplification products sequencing were performed in 42 cases. EGFR mutations were detected in 14 of 42 specimens (33.3%), the frequencies of EGFR mutations in exons 19, 20 and 21 were 16.7% (7/42), 4.8% (2/42) and 11.9% (5/42), respectively, and no mutation was found in exon 18. Higher frequencies of EGFR mutations were detected in exons 19 and 21 (85.7%). Mutations were identified in 38.7% (12/31) cases of adenocarcinoma. K-ras mutations were found in 2 of 42 specimens (4.8%). EGFR and K-ras mutations were not found in the same case.</p><p><b>CONCLUSIONS</b>Cytological specimens are feasible for detecting EGFR and K-ras mutation. This is especially beneficial in patients in whom histological materials can not be obtained.</p>

Value of CK20 immunocytochemistry as an adjuvant to urine liquid-based cytology in detection of urothelial carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the value of cytokeratin 20 (CK20) immunocytochemical (ICC) detection in the urine liquid-based cytological specimens in diagnosis of urothelial carcinoma (UC).</p><p><b>METHODS</b>The study consisted of prospective and retrospective groups. In the prospective group, voided urine samples were collected from patients with a variety of urological conditions and healthy individuals. Urine cytological diagnosis and CK20 ICC were performed on the collected specimens. In the retrospective group, archived urine slides with cytological diagnoses of atypical urothelial cells (AUC), suspicious carcinoma (SuCA) and carcinoma (CA) were selected. Then they were re-stained immunocytochemically with monoclonal antibody against CK20 after decolorization. Histological diagnosis and clinical follow-up result were used as the gold standard for analysis.</p><p><b>RESULTS</b>There were 136 cases in the prospective group, including 89 cases of UC, 19 cases of other urogenital malignancies, 12 cases of benign lesions and 16 cases of normal control. The sensitivity of CK20 ICC in detection of UC was 75.3%, significantly higher than that of LBC (48.3%, P < 0.001). The positive rate of CK20 was 64.7% (22/34) in G1 UC, 73.3% (22/30) in G2 UC, and 91.3% (21/23) in G3 UC (P < 0.001). The specificity of CK20 ICC was 91.5%, the same as that of LBC. There were 163 cases in retrospective group, including 119 cases of UC, 17 cases of other urogenital malignancies and 27 cases of benign lesions. The cytological diagnoses of them were 68 cases of CA, 47 cases of SuCA and 48 cases of AUC. The positive rates of CK20 ICC in UC and non-UC (other urogenital malignancies and benign lesions) cases were 90.8% and 15.9%, respectively, with a statistically very significant difference (P < 0.001). The LBC of all the 119 cases of UC included 62 (52.1%) cases of CA, 35 (29.4%) cases of SuCA and 22 (18.5%) cases of AUC. The positive rates of CK20 in the LBC-diagnosed CA, SuCA and AUC were 96.8%, 97.1% and 63.6%, respectively. The LBC of all the 44 non-UC cases included 6 (13.6%) cases of CA, 12 (27.3%) cases of SuCA and 26 (59.1%) cases of AUC, and the positive rates of CK20 in the LBC-diagnosed CA, SuCA and AUC were 33.3%, 33.3% and 3.8%, respectively. The differences of UC and non-UC cases between the corresponding categories of LBC were significant (P < 0.0001, respectively).</p><p><b>CONCLUSION</b>CK20 immunocytochemistry as an auxiliary method to urine liquid-based cytology can increase the sensitivity in detection of urothelial carcinomas.</p>

Expression of EGFR, survivn and hnRNPA2/B1 in bronchial brushing cytology specimens and their significance in diagnosis of lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the expression of EGFR, survivn and hnRNPA2/B1 proteins in ThinPrep bronchial brushing cytology specimens and their significance in diagnosis of lung cancer.</p><p><b>METHODS</b>The protein expression of EGFR, survivn and hnRNPA2/B1 was detected by immunocytochemistry (ICC) in the specimens from 110 cases of non-small cell lung cancer (NSCLC), 32 cases of small cell lung cancer (SCLC) and 37 cases of non-neoplastic lung lesions. The relationship between EGFR, survivn and hnRNPA2/B1 protein expression and clinical characteristics of the patients was analyzed using SPSS 16.0 software.</p><p><b>RESULTS</b>(1) Positive expression was observed in 81.1% of NSCLC for EGFR, 66.2% for survivn, 90.9% for hnRNPA2/B1, significantly higher in NSCLC than in the control specimens (P = 0.000, P = 0.000, P = 0.010). The positive expression rate of hnRNPA2/B1 in SCLC was 92.3%, significantly higher than that in the control specimens (P = 0.021). (2) The expression of EGFR was associated with differentiation (P = 0.003), clinical stage (P = 0.023) and lymph node metastasis (P = 0.038), but was not associated with gender, age and histological types. The survivn expression was not related with the above mentioned clinicopathological features (P>0.05). Expression of hnRNPA2/B1 was associated with clinical stage (P = 0.017), but not associated with gender, age, histological type, differentiation and lymph node metastasis. (3) There was a significant difference between the co-expression of EGFR and survivn in NSCLC (98.0%) and benign conditions (2.0%, P = 0.000), also a significant difference between the negative expression of both EGFR and survivn in NSCLC (38.2%) and nonneoplastic lesions (61.8%, P = 0.000).</p><p><b>CONCLUSIONS</b>Analysis of EGFR, survivn and hnRNPA2/B1 expression may be an useful adjunct method to stratify controversial cases. The positive expression of EGFR might be associated with invasion, progression and poor prognosis of NSCLC.</p>

Comparison of touch imprint cytology of core needle biopsy and section histopathology in breast cancer diagnosis / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the sensitivity, specificity of touch imprint cytology (TIC), and to compare its conformity rate with histopathology, to observe the consistence of immunocytochemistry (ICC) with immunohistochemistry (IHC), and to assess the diagnostic value of TIC prior to neoadjuvant chemotherapy for breast cancer.</p><p><b>METHODS</b>289 cases of TIC and 287 cases with core needle biopsy (CNB) histopathology accumulated from October 2005 to October 2008 in our hospital were included in this study. One hundred ninety cases TIC results were compared with that of final histopathology. 64 cases were tested for ER, PR, HER-2 by immunocytochemistry.</p><p><b>RESULTS</b>Twenty-four benign cases and 263 malignant cases were diagnosed. 4 specimens were unsatisfactory. False negative rate and unsatisfactory rate were 1.4%, both, and false positive rate was 0.35%. The accuracy rate of TIC and CNB was 95.8% and 95.3%, respectively (P = 0.804). The sensitivity of TIC and CNB was 96.2% and 95.0% (P = 0.601), specificity 87.5% and 100% (P = 0.471) were found, when compared with the results of routine histopathology. 52 cases had a control with IHC of CNB in 64 ICC, and 43 cases had a final histopathology IHC. The ICC conformity rate of ER, PR, HER-2 with IHC of CNB was 86.5%, 75.0%, 78.8%, and that with IHC of final histopathology was 88.4%, 74.4%, 75.6%, respectively. The conformity rate of IHC between CNB and final histopathology was 83.7%, 74.4%, 76.5%, respectively. There was no significant statistical difference between them.</p><p><b>CONCLUSION</b>Compared with routine CNB histopathology, TIC has a high accuracy and sensitivity, and can provide a rapid and reliable cytological diagnosis to complement CNB for breast lesions. The conformity rates are high in ER, PR, HER-2 expression between ICC and IHC. ICC of TIC can be used to determine the estrogen and progesterone receptor levels in breast cancer before neoadjuvant chemotherapy.</p>

A study of cervical cancer screening algorithms / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To assess the feasibility and accuracy of different cervical cancer screening algorithms suitable for different regions, and promote the prevention and control of cervical cancer in China.</p><p><b>METHODS</b>Using the data of a cross-sectional comparative trial of multiple techniques to detect cervical intraepithelial neoplasia in Xiangyuan County, Shanxi Province, conducted in 1999, to evaluate the feasibility and accuracy of different cervical cancer screening algorithms. All the women were screened by six screening tests, including liquid based cytology (LBC), fluorescence spectroscopy, visual inspection with 5% acetic acid staining (VIA), colposcopy, self-sampled HPV DNA and clinician-sampled HPV DNA test, and each woman had histopathological diagnosis. Different screening algorithms were developed by combining the screening tests in parallel or in serial, and the performance indexes of the algorithms such as sensitivity, specificity, colposcopy referral rate and receiver operating characteristic (ROC) curve for detecting the high grade lesions (>or= CIN 2) were compared.</p><p><b>RESULTS</b>Among the algorithms combined by LBC and HPV DNA testing, for the combination in parallel (either cytology was greater than ASC-US or HPV positives), its sensitivity was 100%, specificity was 68.6%, and colposcopy referral rate was 34.4%; for the algorithm of LBC as primary screening test, with ASC-US women triage by HPV DNA testing, its sensitivity was 93.0%, specificity was 89.9%, and colposcopy referral rate was 13.7%; for the algorithm of HPV DNA testing as the primary screening test, with HPV positive women triage by LBC, its sensitivity was 91.7%, specificity was 93.0%, and colposcopy referral rate was 10.6%. ROC analysis showed that LBC primary testing followed by HPV triage and HPV primary testing followed by LBC triage were much better than the combination in parallel (P = 0.0003, P = 0.0002). Among the algorithms with LBC or HPV DNA testing solely as primary screening test, the sensitivity, specificity and colposcopy referral rate of LBC were 94.2%, 77.3%, 25.7% and 87.2%, 93.5%, 10.0%, respectively, for cutoff by ASC-US or by LSIL; the sensitivity, specificity and colposcopy referral rate of HPV DNA testing were 97.6%, 84.8%, 18.8% and 83.5%, 85.9%, 17.1%, respectively, for clinician-sampled and self-sampled. Clinician-sampled HPV DNA testing was better than LBC cutoff by ASC-US or self-sampled HPV DNA testing (P = 0.005, P = 0.002). Among the algorithms combined by VIA and HPV DNA testing, the sensitivity, specificity and colposcopy referral rate were 70.9%, 74.3% and 27.6% for VIA alone as primary screening test; the sensitivity, specificity and colposcopy referral rate were 65.9%, 95.2% and 7.4% for HPV as primary screening test with HPV positive women triage by VIA. HPV primary testing followed by VIA triage was better than VIA alone (P = 0.004).</p><p><b>CONCLUSION</b>Considering the health-resource settings and women's preference, both HPV primary testing followed by LBC triage and LBC primary testing followed by HPV triage are suitable for developed regions, moderately developed regions may choose either LBC or HPV as the screening approach, VIA is a suitable primary screening test in less developed regions, and HPV primary testing followed by VIA triage will be more effective if low cost HPV test is available in the future.</p>

Association between high-risk human papillomavirus DNA load and different histological grades of cervical neoplasia / 中华预防医学杂志

<p><b>OBJECTIVE</b>To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN).</p><p><b>METHODS</b>Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00), low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load > or = 100.00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression.</p><p><b>RESULTS</b>The HR-HPV infection rate of the population was 14.51% (2515/17334). 100.00% (29/29) of SCC, 97.63% (206/211) of CIN 3, 93.43% (199/213) of CIN 2, 75.04% (421/561) of CIN 1 and 10.17% (1660/16320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC, CIN 3, CIN 2, CIN 1 and normal were 320.85, 158.05, 143.70, 125.34 and 9.64, respectively. There were significant differences among the distributions of viral loads in each lesion (chi2 = 6190.40, P < 0.01). The severity of CIN increased with the viral load (chi2 = 5493.35, P <0.01). Compared with the risks of CINs in HR-HPV negative population, the risks of CINs in low, moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9.01(6.31 - 12.87), 24.96(18.23 - 34.17) and 68.42(51.40 - 91.08); CIN 2 : 26.44(12.07 - 57.95), 98.53(49.54 - 195.98) and 322.88(168.62 - 618.27); CIN 3+ : 72.89(24.02-221.18); 343.58(121.81-969.09) and >999.99(473.38 - >999.99)], and there were obvious dose-response relationships (chi2trend was 3115.05, 2413.95 and 3098.57, respectively. P< 0.01). In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95% CI): <35 : 4.71(1.23 - 18.09) and 15.06(4.40 - 51.49); 35 -: 4.01 (1.62 -9.90) and 14.09(6.15 -32.28); 40 - : 3.06(1.52 -6.16) and 7.78(4.05 -14.95); > or =45: 3.50(1.36 -9. 01) and 7.57(3.13 - 18. 30)], and there was a positive correlation between the risk of CIN 2+ and the viral load (chi2trend was 51.33, 66.28, 53.64 and 51.00, respectively. P <0.01). The risk of CIN 2 + was highest among the women aged 40 - with high viral load [OR (95% CI) : 2.02 (1.15 - 3.52)].</p><p><b>CONCLUSION</b>There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3, and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.</p>

The value of thin-layer cytology in intraoperative fine-needle aspiration biopsy of pancreatic cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The purpose of this study was to explore the value of thin-layer cytology (TLC) in intraoperative fine needle aspiration cytology diagnosis of pancreatic cancer.</p><p><b>METHODS</b>Results of cytological examination with thin-layer smears were compared with that with conventional smears in intraoperative fine-needle aspiration (FNA) biopsy.</p><p><b>RESULTS</b>Totally 271 fine needle aspiration biopsies were performed, among them, 70 were examined with thin-layer smears, showing unsatisfactory smear in 5 cases (7.1%); 201 were examined with conventional smears (CS), showing unsatisfactory smear in 9 cases (4.5%). No significant difference in the unsatisfactory smears was observed between those two groups. The positive rate of diagnosis with CS smears was 60.0% (42/70) and that of TLC was 81.6% (164/201), with a significant difference (P < 0.01). The sensitivity of CS and TLC was 68.9% and 87.7%, respectively (P < 0.01). The sensitivity of both FNA and frozen section diagnosis in 20 cases was 90.0%, respectively, but that of FNA combined with frozen section diagnosis was 95.0%. 9 cancer cases diagnosed by pathology were initially negative by cytology, but adenocarcinoma cells were found in 7 cases of them by the second time cytology examination.</p><p><b>CONCLUSION</b>The positive rate is high in TLC smears, and unsatisfactory rate is low. TLC smears are one of the best methods in intraoperative confirmation of pancreatic cancer. The use of FNA smears combined with frozen section biopsy can further improve the sensitivity of diagnosis.</p>

Application of protein markers in combination with ThinPrep bronchial brush cytology in classification of lung cancer subtypes / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the value of application of cellular protein markers stained by immunocytochemistry in combination with ThinPrep bronchial brush cytology in classification of lung cancer subtypes.</p><p><b>METHODS</b>Remaining bronchial brush cytology samples from 206 lung cancer patients with positive cytological diagnosis and 45 fine needle aspiration samples of resected lung carcinomas were collected. The expressions of CK10/13, CK7, CK18, CD56 and SYN in those samples were detected by immunocytochemistry (ICC) using corresponding antibodies.</p><p><b>RESULTS</b>The sensitivity and specificity of CK10/13 were 94.7% and 72.0%, respectively, in diagnosis of squamous cell carcinoma. The sensitivity and specificity of CK7 were 98.6% and 61.5%, and those of CK18 were 98.6% and 37.5%, respectively, in diagnosis of adenocarcinoma. The sensitivity and specificity of CD56 were 86.3% and 82.9%, and those of SYN were 81.6% and 93.5%, respectively, in diagnosis of small cell lung cancer. No significant difference was found in the expressions of CK10/13, CK7 and CK18 protein markers among differently differentiated lung squamous cell carcinomas and adenocarcinomas (P > 0.05). The classification rate of cytology in combination with ICC in differential diagnosis for 44 cases of unclassified lung cancer reached 90.0% for squamous cell carcinoma, 96.3% for adenocarcinoma, and 100.0% for small cell lung carcinoma.</p><p><b>CONCLUSION</b>Application of cellular protein markers in combination with ThinPrep bronchial brush cytology is helpful to improve the differential diagnosis of lung cancer subtypes, and may become a supplementary diagnostic method in subclassification of lung cancer.</p>

Study on the value assessment of various screening programs regarding cervical cancer screening strategy in the rural areas of China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the application value and feasibility of various cervical screening methods and to explore a rapid and efficient cervical cancer screening program for the women in the rural areas of China.</p><p><b>METHODS</b>We sequentially conducted human papillomavirus (HPV) DNA test by hybrid capture-2 (hc2) with cervical cells, liquid-based thinprep cytology test (TCT), visual inspection with acetic acid (VIA), visual inspection with iodine (VILI), colposcopy respectively for the 2499 married women between 30 and 49 years from Xiushui county of Jiangxi province. All the detection methods were performed independently under double-blind design. Women who were diagnosed positive for having any VIA,VILI and colposcopy inspection or for those women who were diagnosed negative for VIA, VILI and colposcopy but with positive result of HPV or TCT test underwent cervical biopsy directly and endocervical curettage (ECC)when necessary. We performed cervical biopsy endocervical curettage within two weeks to observe the sensitive (SE), specificity (SP), negative predict value (NPV) and positive predict value (PPV) of these detection methods when used alone or combined each other, including HPV test, TCT inspection, VIA, VILI, and colposcopy, the pathological diagnosises of cervical tissue were confirmed by IARC (International Agency for Research on Cancer) while the cytological findings were underegone through the updated program of TBS (The Bethesda System) in 2001.</p><p><b>RESULTS</b>A total of 2499 women underwent the screening and found 443 women who were diagnosed as HPV positive, 337 women with abnormal cervical cytology and 27 women with ASC-H, 157 cases with ASCUS; 103 cases with HSIL, 49 cases with LSIL and 1 cervical cancer. According to the pathological findings. There were 181 women diagnosed as cervical intraepithelial neoplasia (CIN) or cervical cancer, including 81 cases with CIN1 37 cases with CIN2,60 case cervical cancer. The sensitivity rates of HPV, TCT, HPV+ TCT, VIA, VILI, VIA+VILI and colposcopy were 96.67%, 89.47%, 97.98%, 56.57%, 36.36%, 63.64% and 39.39%, and the specificity rates were 85.00%, 96.91%, 86.97%, 94.60%, 96.23%, 92.97% and 98.14% respectively.</p><p><b>CONCLUSION</b>HPV + TCT seemed to be more sensitive than other screening methods in the cervical cancer screening program.</p>

The usefulness of p16INK4a in cytological screening of cervical carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the value of p16INK4a immuncytochemical examination in cytological screening of cervical carcinoma and precancerous lesions.</p><p><b>METHODS</b>p16JNK4a immuncytochemical detection was performed on 220 specimens remaining from liquid-based cytology, followed up by biopsy histology , and compared with the results of high-risk human papillomavirus ( HR - HPV ) DNA tests . Results In patients with cytological diagnosis of squamous cell carcinoma( SCC) , high-grade squamous intraepithelial lesion (HSIL) , low-grade squamous intraepithelial lesion (LSIL) , atypical squamous cells-cannot exclude HSIL (ASC-H) , and atypical squamous cells of undetermined significance (ASC-US) , the positive rates of p16INK4a were 100.0% (7/7), 92. 2% (107/116) , 24. 3% (17/70) , 100. 0% (14/14) and 36.4% (4/ 11) , respectively. In 111 of the 150 p6INK4a positive cases, we found 97 (87.4% ) cases which had biopsy diagnosises of > or =CIN2, but none in 18 of 70 p16INK4a negative cases was. The difference in the positive rates for p16INK4a between cervical intraepithelial neoplasia (CIN) 1 and > or =CIN2 lesions had statistical significance (P < 0. 01) , whereas for HR-HPV DNA test it was not.</p><p><b>CONCLUSION</b>p16LNK4a is over-expressed in a HSIL, and it may be useful in cytological screening of high risk patients.</p>

Value of ThinPrep bronchial brushing cytology in the diagnosis of lung cancers / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the ThinPrep bronchial brushing cytology in the diagnosis of lung cancers.</p><p><b>METHODS</b>The smear slides of ThinPrep bronchial brushing cytology in 1000 patients collected from April 2001 to April 2002 were reviewed.</p><p><b>RESULTS</b>Of 389 patients diagnosed as having lung cancer clinically or histopathologically, 273 (70.2%) were revealed by ThinPrep bronchial brushing cytology. Among the 74 patients with benign lung diseases comfirmed by pathology, 3 had been suspected as having lung cancer by ThinPrep bronchial brushing cytology. Actually, they were two patients suffering from tuberculosis and one hamartoma proven by histopathology later. The sensitivity and specificity of ThinPrep bronchial brushing cytology were 70.2% and 95.9%, respectively. Of the 179 patients who had both cytological and histopathological results, the cytology and pathology concordance rate was 95.4% in squamous carcinoma, 87.0% in adenocarcinoma and 95.7% in small cell carcinoma.</p><p><b>CONCLUSION</b>Although ThinPrep bronchial brushing cytology has a high specificity, it is not good in diagnosing lung cancer. Poor smearing technique may be responsible for most of the false negative. Type diagnosis of poorly differentiated carcinomas can be difficult when based on the ThinPrep bronchial brushing cytology alone.</p>

Differential diagnostic value of B72.3, Ber-EP4 and calretinin in serous effusions / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To determine the diagnostic value of B72.3, BerEP4 and calretinin in differentiating metastatic carcinoma cells from reactive mesothelial cells (RMC) in serous effusions by using immunocytochemical method (ICC), and to investigate the feasibility of ThinPrep (TP) preparation for ICC.</p><p><b>METHODS</b>One hundred fifty eight serous effusion specimens were examined by ICC on cell block (CB) sections (CB-ICC) using antibodies against of B72.3, BerEP4 and calretinin. Fourty-nine of the samples, ICC on ThinPrep slides (TP-ICC) and CB-ICC were performed concurrently.</p><p><b>RESULTS</b>The sensitivities of B72.3 and Ber-EP4 for detecting carcimoma cells were 76.9% and 69.2% respectively, and when combined the sensitivity was increased to 89.7%. The sensitivity and specificity of Calretinin for detecting mesothelial cells were 90.9% and 87.2% respectively. The sensitivity of B72.3 in differentiating cancer cells from reactive mesothelial cells by CB-ICC and TP-ICC was 78.9% and 68.4%. It was 78.9% and 68.4% of BerEP4 respectively. No statistical significance was observed between CB-ICC and TP-ICC in differentiating metastatic carcinoma cells from reactive mesothelial cells.</p><p><b>CONCLUSION</b>The combination of antibodies of B72.3, Ber-EP4 and calretinin is quite helpful as an auxiliary in differentiating metastatic carcinoma cells from reactive mesothelial cells. ThinPrep preparation slides may effectively replace the cell block sections for ICC in differential diagnosis of serous effusions.</p>

Endocervical curretage: an analysis of results in 1997 women / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the value of endocervical curettage (ECC) in the detection of cervical intraepithelial neoplasia (CIN) and cervical cancer, and the necessity of ECC during colposcopic examination.</p><p><b>METHODS</b>In the high prevalent area of cervical cancer in Shanxi Province, China, a total of 1997 women aged 35 approximately 45 years old were enrolled. Cervical cytology, colposcopy and targeted multiple biopsies, as well as ECC were performed for all women.</p><p><b>RESULTS</b>Among the 1997 women received ECC, 31 was positive for abnormal histologic changes with a frequency of 1.6%. Of the 31 cases, 9 had low grade squamous intraepithelial lesions (LSIL, 0.5%), 20 had high grade squamous intraepithelial lesions (HSIL, 1.0%), and 2 had squamous-cell carcinoma. No pathologic diagnosis could be made in 131 women because the tissue curretaged was insufficient. The women with positive cytologic findings had higher frequency (5.3%) of abnormal ECC than those with negative cytologic findings (0.3%). There was positive correlation between the frequency of abnormal ECC and the grade of cytolologic findings. Abnormal ECC was present in 9.1% of those with unsatisfactory colposcopy while 1.3% of those with satisfactory colposcopy (P < 0.01). The frequency of abnormal ECC was 0.6% in patients with negative colpocopy, 0.9% in LSIL and 24.1% in HSIL. Frequency of abnormal ECC in women with a negative colposcopy or LSIL was significantly lower than that with HSIL. The positive rate of ECC pathologically verified was 3.3% in LSIL, 22.2% in HSIL and 50.0% in squamous carcinoma, respectively (P < 0.01). Of the 316 patients with positive cytology but negative colposcopy, ECC was abnormal in 8 (2.5%), of which HSIL cytologically verified was in 3.</p><p><b>CONCLUSION</b>If cytology or colposcopy shows HSIL or more severe changes, and cytology is positive while colposcopy is unsatisfactory, ECC should be done routinely.</p>

Hypermethylation of p16 gene in clinical specimens of patients with lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate aberrant methylation of the p16 promoter as a useful biomarker of lung cancer.</p><p><b>METHODS</b>A modified methylation-specific semi-nested PCR was performed to detect p16 hypermethylation in the matched samples of tumor tissue, blood plasma and sputum derived from 51 cases of lung cancer patients.</p><p><b>RESULTS</b>Hypermethylation of p16 promoter was demonstrated in 84.3% of the tumor tissues, 70.6% of the blood plasma and 76.5% of the sputum specimens, respectively. Only the patients whose tumor tissues had p16 hypermethylation exhibited aberrant methylation in their plasma and/or sputum specimens. Combining with cytological examination, 92.2% of the patients with lung cancer could be detected by p16 hypermethylation assay in both sputum and plasma samples.</p><p><b>CONCLUSION</b>The results indicate that p16 hypermethylation in plasma and sputum identified by semi-nested PCR is a biomarker of lung cancer which can be useful as an auxillary diagnostic parameter.</p>

A comparison of Thinprep and conventional smears / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze ThinPrep (TP) application by comparing TP slides with conventional smear (CS) slides in fine needle aspiration cytology.</p><p><b>METHODS</b>A total of 522 samples from the breast, metastatic cancer, lymph node, thyroid and salivary gland were used in parallel preparations of one TP slide and one CS slide. The paired slides were compared according to cell quality, overall cellularity, cell preservation, nuclear architecture and background.</p><p><b>RESULTS</b>Cell quality of TP was superior to CS in the breast group (36.2%, 28.0%, P > 0.05) and metastatic cancer group (51.0%, 14.9%, P < 0.05), but inferior to CS in lymph node group (16.5%, 58.2%, P > 0.05). Cellularities of TP and CS were similar in breast groups (25.1%), while TP had greater cellularity than CS in metastatic cancer group (32.2%, 21.8%, P > 0.05). Cell preservation and abnormal architecture of TP were superior to CS in breast group (36.7%, 12.1%, P < 0.05) and metastasis cancer group (60.9%, 9.4%, P < 0.05). Cell quality of TP slide was inferior to CS in lymph node group (16.5%, 58.2%, P < 0.05) with 27 of the 46 cases showing tuberculosis. Cell quality of TP and CS slide was similar in the thyroid and salivary gland group (35.3%). Myoepithelial cells of fibroadenoma on the TP slide were decreased in number and, due to the increased papillary and flattened cells, it was easy to diagnose benign lesion.</p><p><b>CONCLUSION</b>In the breast group and metastatic cancer group, cell quality of the TP slides is superior to CS, but they are similar in thyroid and salivary gland group. The difference of diagnosis criteria between TP and CS slides exists only in tuberculosis, partly the reactive hyperplasia cases.</p>

A methodology study on assessment of cancer screening test / 中国医学科学院学报

<p><b>OBJECTIVE</b>To analyze the effect of gold standard, blind comparison and different cut-points choosing on screening techniques assessment, and to promote the application of evidence-based medicine theory in screening study.</p><p><b>METHODS</b>A screening study for cervical cancer in rural China in 1999, where 1997 women had been tested for pathology as gold standard and simulating situations without gold standard, blind comparison and under different cut-points. Indices such as detectable rate, sensitivity and specificity were calculated for each technique. Receiver operating characteristics (ROC) curves were drawn and areas under ROC curves between screening techniques were tested.</p><p><b>RESULTS</b>Without gold standard, diagnostic techniques could not be evaluated correctly, and without the blind comparison, the sensitivity and specificity of the tests would be subjectively increased. Furthermore, use of different cut-points led to different sensitivities and specificities of test.</p><p><b>CONCLUSIONS</b>Gold standard, blind comparison and perfect cut-points can improve the quality of screening test and drawing ROC curves is an effective way to confirm cut-points and evaluate diagnostic techniques. It is necessary to enforce the application of evidence-based medicine theory in scientific research.</p>