Dieterich M, Goodman S N, Rojas-Corona R R, Emralino A B, Jimenez-Joseph D, Sherman M E
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Acta Cytol. 1994 Nov-Dec;38(6):945-52.
To identify prognostic indicators in breast cancer patients with malignant pleural effusions, we analyzed the cytopathologic features of 57 fluids representing the first pathologic diagnosis of a distant metastasis in these women. The specimens were analyzed prior to reviewing the clinical records. The median survival of 55 patients who died of the disease was five months following the effusion diagnosis (range, 1-114). Univariate analysis identified three cytopathologic features that correlated with relatively prolonged survival: arrangement of tumor cells in spheroids, slight nuclear atypia and low mitotic rate. Women whose tumor cells formed spheroids survived a median of 24.5 months as compared to 4 months for women with all other architectural patterns (P = .004). Multivariate analysis revealed that slight nuclear atypia and low mitotic rate strongly correlated with spheroid formation. Since breast cancers that form spheroids in effusions portend a relatively favorable prognosis, we recommend that cytopathologists comment on this pattern when reporting on metastatic breast carcinoma in pleural fluids.
为了确定伴有恶性胸腔积液的乳腺癌患者的预后指标，我们分析了57份液体的细胞病理学特征，这些液体代表了这些女性首次被病理诊断为远处转移。在查阅临床记录之前，先对标本进行分析。55例死于该病的患者在胸腔积液诊断后的中位生存期为5个月（范围为1-114个月）。单因素分析确定了与生存期相对延长相关的三个细胞病理学特征：肿瘤细胞呈球样排列、轻度核异型性和低有丝分裂率。肿瘤细胞形成球样的女性中位生存期为24.5个月，而具有所有其他结构模式的女性为4个月（P = 0.004）。多因素分析显示，轻度核异型性和低有丝分裂率与球样形成密切相关。由于在胸腔积液中形成球样的乳腺癌预示着相对较好的预后，我们建议细胞病理学家在报告胸腔积液转移性乳腺癌时对这种模式进行描述。
