Guidozzi F, Szumel R C, Ball J H, Johnston D A, Katz R L, Kidd L
Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston, 77030, USA.
Gynecol Oncol. 1996 May;61(2):204-9. doi: 10.1006/gyno.1996.0125.
Image analysis has rarely been used to quantitate the DNA content of intact cells derived from peritoneal fluid in patients with ovarian malignancy. An average of 118 (range 100-208) of the most atypical, visually selected Feulgen-stained cells in peritoneal fluid obtained from 46 patients undergoing primary cytoreductive surgery for histologically proven ovarian tumors of low malignant potential and truly invasive ovarian cancer were evaluated retrospectively using the SAMBA-4000 Image analysis system. The patients were stratified into 3 groups: 16 with ovarian tumors of low malignant potential (LMP), 14 with low-stage disease (LSD) (FIGO I and II), and 16 with advanced-stage (ASD) (FIGO III and IV). A pattern of high-degree aneuploidy with negative balance (means: LMP, 3.3; LSD, 20.5; ASD, 32.0), increased proliferative index (LMP, 11.2; LSD, 16.1; ASD, 13.9), and percentage of cells with DNA content greater than 5C (LMP, 6.7; LSD, 6.5; ASD, 9.5) was demonstrated in the peritoneal fluid of 8 of 16 patients with LMP (50%), 8 of 14 patients with LSD (57%), and 13 of 16 with ASD (81%). The median disease-free interval for patients with invasive epithelial ovarian cancer with peritoneal DNA diploid tumor cells was 57 months and for those with DNA aneuploid tumor cells 28 months, while in patients with LMP it was 65 and 54 months, respectively. In total, 19 patients developed a recurrence (LMP, 2; LSD, 5; ASD, 12) of which 17 were shown to have DNA aneuploid cells in the peritoneal fluid. Multivariate analysis, however, did not identify aneuploid population in the fluid, ploidy balance, proliferation indices, or degree of hyperploidy as an independently significant variable for predicting recurrence. It did appear, however, that tumor cells in peritoneal fluid with a degree of hyperploidy greater than 8 had a strong correlation for development of recurrence, although not statistically significant. Interactive image analysis of tumor cells in peritoneal fluid proved to be a valuable adjunct to cytodiagnosis. Seven of 28 patients (25%) who were underdiagnosed by cytology alone (LMP, 2; LSD, 3; ASD, 2) were shown to have malignant cells in their peritoneal fluid, while 2 of 18 patients (11%) who were called positive by cytology (LMP, 1; LSD, 1) showed diploid pattern histograms and upon review were interpreted as reactive mesothelial cells.
图像分析很少用于定量卵巢恶性肿瘤患者腹水中完整细胞的DNA含量。对46例经组织学证实为低恶性潜能卵巢肿瘤和真正浸润性卵巢癌并接受初次肿瘤细胞减灭术患者腹水中通过视觉选择的118个（范围100 - 208）最不典型的福尔根染色细胞，使用SAMBA - 4000图像分析系统进行回顾性评估。患者被分为3组：16例低恶性潜能（LMP）卵巢肿瘤患者，14例低分期疾病（LSD）（国际妇产科联盟I期和II期）患者，以及16例晚期（ASD）（国际妇产科联盟III期和IV期）患者。结果显示，16例LMP患者中有8例（50%）、14例LSD患者中有8例（57%）以及16例ASD患者中有13例（81%）的腹水中存在高度非整倍体且平衡为负的模式（平均值：LMP为3.3；LSD为20.5；ASD为32.0）、增殖指数增加（LMP为11.2；LSD为16.1；ASD为13.9）以及DNA含量大于5C的细胞百分比（LMP为6.7；LSD为6.5；ASD为9.5）。浸润性上皮性卵巢癌患者腹水中DNA二倍体肿瘤细胞患者的无病生存期中位数为57个月，DNA非整倍体肿瘤细胞患者为28个月，而LMP患者分别为65个月和54个月。总共有19例患者复发（LMP为2例；LSD为5例；ASD为12例），其中17例腹水中显示有DNA非整倍体细胞。然而，多变量分析未将腹水中的非整倍体细胞群体、倍体平衡、增殖指数或超倍体程度确定为预测复发的独立显著变量。不过，腹水中超倍体程度大于8的肿瘤细胞似乎与复发的发生有很强的相关性，尽管无统计学意义。腹水中肿瘤细胞的交互式图像分析被证明是细胞诊断的有价值辅助手段。仅通过细胞学检查被漏诊的28例患者中有7例（25%）（LMP为2例；LSD为3例；ASD为2例）腹水中显示有恶性细胞，而通过细胞学检查被判为阳性的18例患者中有2例（11%）（LMP为1例；LSD为1例）显示二倍体模式直方图，经复查被解释为反应性间皮细胞。
