Pe'er J, Rummelt V, Mawn L, Hwang T, Woolson R F, Folberg R
Department of Ophthalmology, University of Iowa, Iowa City 52242.
Ophthalmology. 1994 Jul;101(7):1227-35. doi: 10.1016/s0161-6420(94)31184-5.
Cytomorphometric measurements and the architecture of the microcirculation in tissue sections of eyes removed for ciliary body or choroidal melanomas have been identified independently as prognostically significant factors for survival. The relative significance of these two histologic features is addressed in this study.
The same 234 cases used to assess the prognostic significance of the microcirculatory patterns of choroidal and ciliary body melanomas were examined by two independent observers who measured the largest diameter of melanoma cell nucleoli from digitized images at a high magnification (x 3000) using the laser scanning confocal microscope. The mean of the ten largest nucleoli was calculated for each tumor according to previously published methods. Intraobserver and interobserver reproducibility was assessed for these measurements. Several Cox multiple regression models were constructed which included this cytomorphometric variable with and without the inclusion of the microcirculatory patterns.
There is a high degree of intraobserver reproducibility but only a weak degree of interobserver reproducibility in measuring the mean of the ten largest nucleoli. Using multiple Cox regression models, the mean of the ten largest nucleoli from each observer failed to exert any effect on outcome after enucleation, regardless of whether the presence of networks of closed vascular loops was considered in the statistical formulation. The presence of networks of closed vascular loops was found to be the most statistically dominant histologic prognostic characteristic.
The authors have not been able to confirm the use of the mean of the ten largest nucleoli as a significant prognostic factor in the outcome of patients whose eyes have been removed for ciliary body or choroidal melanomas. Further investigation of this cytomorphometric technique by other laboratories is warranted.
对于因睫状体或脉络膜黑色素瘤而摘除眼球的组织切片，细胞形态计量学测量以及微循环结构已被独立确定为具有预后意义的生存因素。本研究探讨了这两种组织学特征的相对重要性。
由两名独立观察者对用于评估脉络膜和睫状体黑色素瘤微循环模式预后意义的234例相同病例进行检查，他们使用激光扫描共聚焦显微镜在高倍放大（×3000）下从数字化图像测量黑色素瘤细胞核仁的最大直径。根据先前发表的方法计算每个肿瘤十个最大核仁的平均值。评估这些测量的观察者内和观察者间的可重复性。构建了几个Cox多元回归模型，其中包括这个细胞形态计量学变量，同时考虑了有无微循环模式。
在测量十个最大核仁的平均值时，观察者内具有高度可重复性，但观察者间的可重复性较弱。使用多个Cox回归模型，每个观察者测量的十个最大核仁的平均值在眼球摘除后的预后中均未产生任何影响，无论在统计公式中是否考虑了闭合血管环网络的存在。发现闭合血管环网络的存在是统计学上最主要的组织学预后特征因素。
作者未能证实将十个最大核仁的平均值作为因睫状体或脉络膜黑色素瘤而摘除眼球患者预后的一个重要预后因素。其他实验室有必要对这种细胞形态计量学技术进行进一步研究。
