Department of Otolaryngology - Head and Neck Surgery, Ohio State University, Columbus, OH, USA.
Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Am J Otolaryngol. 2021 May-Jun;42(3):102876. doi: 10.1016/j.amjoto.2020.102876. Epub 2021 Jan 6.
To investigate the potential for cancer cells to be transferred between anatomic sites via instruments and other materials.
Pilot prospective study from April 2018-January 2019 at Rush University Medical Center. Glove and instrument washings were collected from 18 high-risk head and neck cancer resection cases (36 samples total). Each case maintained at least one of the following features in addition to a diagnosis of squamous cell carcinoma or sarcoma: palliative/salvage surgery, positive margins, extensive tumor burden, and/or extra capsular extension (ECE). Surgical gloves and four main instruments were placed through washings for blind cytological assessment (2 samples/case).
18 patients undergoing surgical tumor resection for biopsy-proven squamous cell carcinoma with at least one of the aforementioned characteristics were included. 26.7% of cases had ECE, 40.0% had positive final margins and 46.7% had close final margins. Tumor locations included: oral cavity (10), neck (4), parotid gland (2), and skin (2). Malignant cells were isolated on glove washings in 1 case (5.5%). No malignant cells were isolated from instrument washings. The single case of malignant cells on glove washings occurred in a recurrent, invasive squamous cell carcinoma of the scalp with intracranial extension. Anucleated squamous cells likely from surgeon skin were isolated from 94.4% of washings. Squamous cells were differentiated from mature cells by the absence of nuclei.
Malignant squamous cells can be isolated from surgical glove washings, supporting the practice of changing of gloves after gross tumor resection during major head and neck cancer resections.
研究癌细胞是否可能通过器械和其他材料在解剖部位之间转移。
2018 年 4 月至 2019 年 1 月在 Rush 大学医学中心进行的前瞻性初步研究。从 18 例高风险头颈部癌症切除术（共 36 个样本）中收集手套和器械清洗液。除鳞状细胞癌或肉瘤诊断外，每个病例至少具有以下特征之一：姑息/挽救性手术、阳性切缘、广泛的肿瘤负担和/或包膜外扩展（ECE）。将手术手套和四种主要器械置于清洗液中进行盲法细胞学评估（每个病例 2 个样本）。
共纳入 18 例经手术肿瘤切除活检证实为鳞状细胞癌且具有上述特征之一的患者。26.7%的病例有 ECE，40.0%的病例有阳性的最终切缘，46.7%的病例有接近的最终切缘。肿瘤部位包括口腔（10 例）、颈部（4 例）、腮腺（2 例）和皮肤（2 例）。在 1 例（5.5%）手套清洗液中分离出恶性细胞。器械清洗液中未分离出恶性细胞。手套清洗液中仅 1 例恶性细胞来自头皮复发性侵袭性鳞状细胞癌伴颅内延伸。94.4%的清洗液中分离出无核鳞状细胞，可能来自外科医生的皮肤。通过缺乏核来区分成熟细胞与鳞状细胞。
可以从手术手套清洗液中分离出恶性鳞状细胞，这支持在大型头颈部癌症切除术中，在大体肿瘤切除后更换手套的做法。
