中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2011年
3期
173-176
,共4页
陈晓端%石海燕%吕卫国%秦佳乐
陳曉耑%石海燕%呂衛國%秦佳樂
진효단%석해연%려위국%진가악
宫颈肿瘤%化学疗法,辅助%诊断%结果评价(卫生保健)
宮頸腫瘤%化學療法,輔助%診斷%結果評價(衛生保健)
궁경종류%화학요법,보조%진단%결과평개(위생보건)
Cervix neoplasms%Chemotherapy,adjuvant%Diagnosis%Outcome assessment ( health care)
目的 研究宫颈癌新辅助化疗(NACT)后病理形态改变及对病理诊断的影响,评价宫颈癌化疗组织学疗效评判标准.方法 对56例Ⅰb2/Ⅱa期局部晚期宫颈癌患者NACT手术前后病理切片进行形态观察和组织学疗效评价,并与影像学/妇科检查对化疗疗效评价结果进行比较.结果 56例局部晚期宫颈癌患者NACT后组织学3级/重度改变11例(19.6%),2级/中度改变24例(42.9%),1级/轻度改变13例(23.2%),0级/无变化8例(14.3%).组织学评价总有效率62.5%(35/56),影像学/妇科检查评价总有效率67.9%(38/56),组织学与影像学/妇科检查有效符合30例,无效符合14例,总符合率78.6%(44/56).组织学有效、影像学/妇科检查无效4例(7.1%,4/56),组织学无效、影像学/妇科检查有效8例(14.3%,8/56).化疗有效病例癌组织呈现从密集、拥挤、生长活跃到变性、坏死、稀疏,消融、结构逐渐恢复正常的特点.结论 宫颈癌患者NACT后大部分病例有明显的病理形态改变,影响术后病理诊断,组织学疗效评价与影像学/妇科检查评价存在一定差异,推荐采用宫颈癌组织学疗效评价标准.
目的 研究宮頸癌新輔助化療(NACT)後病理形態改變及對病理診斷的影響,評價宮頸癌化療組織學療效評判標準.方法 對56例Ⅰb2/Ⅱa期跼部晚期宮頸癌患者NACT手術前後病理切片進行形態觀察和組織學療效評價,併與影像學/婦科檢查對化療療效評價結果進行比較.結果 56例跼部晚期宮頸癌患者NACT後組織學3級/重度改變11例(19.6%),2級/中度改變24例(42.9%),1級/輕度改變13例(23.2%),0級/無變化8例(14.3%).組織學評價總有效率62.5%(35/56),影像學/婦科檢查評價總有效率67.9%(38/56),組織學與影像學/婦科檢查有效符閤30例,無效符閤14例,總符閤率78.6%(44/56).組織學有效、影像學/婦科檢查無效4例(7.1%,4/56),組織學無效、影像學/婦科檢查有效8例(14.3%,8/56).化療有效病例癌組織呈現從密集、擁擠、生長活躍到變性、壞死、稀疏,消融、結構逐漸恢複正常的特點.結論 宮頸癌患者NACT後大部分病例有明顯的病理形態改變,影響術後病理診斷,組織學療效評價與影像學/婦科檢查評價存在一定差異,推薦採用宮頸癌組織學療效評價標準.
목적 연구궁경암신보조화료(NACT)후병리형태개변급대병리진단적영향,평개궁경암화료조직학료효평판표준.방법 대56례Ⅰb2/Ⅱa기국부만기궁경암환자NACT수술전후병리절편진행형태관찰화조직학료효평개,병여영상학/부과검사대화료료효평개결과진행비교.결과 56례국부만기궁경암환자NACT후조직학3급/중도개변11례(19.6%),2급/중도개변24례(42.9%),1급/경도개변13례(23.2%),0급/무변화8례(14.3%).조직학평개총유효솔62.5%(35/56),영상학/부과검사평개총유효솔67.9%(38/56),조직학여영상학/부과검사유효부합30례,무효부합14례,총부합솔78.6%(44/56).조직학유효、영상학/부과검사무효4례(7.1%,4/56),조직학무효、영상학/부과검사유효8례(14.3%,8/56).화료유효병례암조직정현종밀집、옹제、생장활약도변성、배사、희소,소융、결구축점회복정상적특점.결론 궁경암환자NACT후대부분병례유명현적병리형태개변,영향술후병리진단,조직학료효평개여영상학/부과검사평개존재일정차이,추천채용궁경암조직학료효평개표준.
Objective To investigate the histological changes of cervical cancer after neoadjuvant chemotherapy (NACT) and to establish histological criteria for interpretation of chemotherapeutical effects.Methods Fifty-six patients with FIGO stage Ⅰb2-Ⅱa cervical cancers treated by NACT and subsequent radical surgery were retrospectively analyzed, in which the pre- and post-chemotherapeutic histopathological changes were assessed. Results The post-chemotherapeutic histopathological changes of 56 cases included grade 3 effects in 11 cases ( 19.6% ), grade 2 in 24 cases (42.9% ), grade 1 in 13 cases (23.2%) and no response in only 8 cases ( 14.3% ). The histologic response rate was 62.5% (35/56) and the overall clinical response rate was 67.9% (38/56). The overall coincidence by both criteria was 78.6% (44/56).Four cases (7.1%, 4/56) had only histological response and 8 cases ( 14.3%, 8/56) had response by imaging. In comparison with the pre-chemotherapy specimens, the chemotherapy-associated histologicalchanges included shrinkage and scattering of tumor nests, decrease of tumor cellularity, tumor cell degeneration and necrosis. Conclusions The histological changes in locally advanced cervical cancers induced by NACT are significant, which may challenge the diagnosis in the final specimens. There are some discreqancies between the histological criteria and imaging/gynecological ones for the therapeutic evaluation of cervical cancers,and it is thus recommended to use the pathological criteria for clinic practice.
