输卵管的管状细胞学作为卵巢癌早期检测的有前景的工具
Summary
我们探索了输卵管细胞学方法，采用输卵管直接手术切除术作为卵巢癌早期检测的工具。在这里，我们提出一个收集新鲜手术标本的输卵管细胞的方案。
Abstract
目前，广泛接受的是绝大多数卵巢高级浆液性癌（HGSC）来源于输卵管。然而，由于缺乏用于卵巢癌鉴定的标记物或工具，HGSC的早期检测仍然具有挑战性。当肿瘤不可见时，输卵管的直接取样可增强检测肿瘤细胞的敏感性。我们开发了一种从新鲜手术标本直接收集输卵管细胞的方法，与组织学检查结果具有良好的相关性。这种方法为高风险患者群体中微创腹腔镜筛查的未来应用奠定了基础。
Introduction
卵巢高级浆液性癌（HGSC）是最常见和致命的卵巢癌，仍然是对公众健康的主要威胁。在过去十年中，研究人员已经表明，绝大多数的HGSC情况下从该输卵管而不是卵巢本身1，2，3，4，5，6出现。浆液性输卵管上皮内癌（STIC）作为HGSC 1，7，8，9，10，11的前体已被广泛接受。到目前为止，卵巢癌的早期发现仍然很困难。目前的筛选方案与联合癌抗原125（CA-125）和经阴道超声显示对病人的死亡率12，13几乎没有影响。卵巢癌检测的子宫内膜取样显示极低的灵敏度14 。两个先驱研究15,16探索良性输卵管腹腔镜直接采样的使用，并且其特征在于良性输卵管上皮的细胞学特征。我们认为，输卵管的直接取样也可以成为在肿瘤未被成像可视化的早期阶段检测STIC或HGSC的实用且直接的方法。
尽管最终目标是在高风险因素患者中进行微创腹腔镜筛查的实用性，但目前研究的直接目标是：1）建立良性输卵管上皮细胞基线细胞学特征;和2）检测输卵管细胞学检测卵巢癌的敏感性和特异性和癌症前体。因此，我们开发了以下基线输卵管细胞学方法来检测该方案检测HGSC及其前体STIC 17的有效性。在这项研究中，我们利用了大量定期接受的手术标本，除了常规手术程序之外，还对手术切除的输卵管进行了直接取样。
我们最近的研究17显示，恶性肿瘤的恶性或怀疑的细胞学诊断与HGSC的组织学诊断（100％）高度相关。此外，输卵管细胞学评估确定了在本研究中涉及的仅有两个组织学证实的STIC病例的颅内瘤变。我们认为输卵管细胞学在早期检测中具有很大的潜力，将为患者管理提供有价值的信息。
Protocol
Representative Results
Discussion
已经显示预防性双侧输卵管切除术或输卵管卵巢切除术可降低高危人群发生HGSC的风险，如BRCA基因突变妇女和家族性癌症史。然而，由手术导致的不育和外科绝经是严重后果，造成困难的决定，特别是对于育龄妇女。以前的研究显示输卵管细胞学和组织学之间有很好的相关性17 。我们认为腹腔镜收集的输卵管细胞的输卵管细胞学具有很大的潜力成为早期癌症检测的实用的，微创?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
作者要感谢亚利桑那大学病理学系的财政支持。该项目得到了WZ的Mark和Jane Gibson捐赠基金的部分支持。
Materials
| Cytobrush plus GT gentle touch of Medscand sample collection kit | CooperSurgical | C0112 | |
| ThinPrep preservCyt solution | HOLOGIC | 234005 | |
| ThinPrep 2000 Processor | HOLOGIC | 70031-001 | |
| Papanicolaou Stain, EA 65 | sigma aldrich | HT40432 | |
| 95% Ethanol | sigma aldrich | 652261 | |
| 100% Ethanol | sigma aldrich | 493538 | |
| Xylene | sigma aldrich | 214736 | |
| Hematoxylin | sigma aldrich | H9627 | |
| Sakura Tissue Tek 2000 tissue processor | SAKURA | TISSUE-TEK VIP 2000 | |
| Mayo Dissecting Scissors,5.5 straight | Pilgrim medical equiment | FA710-45 | |
| Chemware Forceps | United state plastic corp | 76122 | |
| Tissue-Tek Accu-Edge Trimming blades,short | SAKURA | 4785 | |
| Tissue-Tek Accu-Edge Trimming blades handle,short | SAKURA | 4786 |
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