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자궁경부 세포진 검사에서 기존의 방법과 ThinPrep 법의 비교 연구
김대곤(Dae Gon Kim),이기헌(Gee Hun Lee),정환욱(Hwan Wook Jung),윤경호(Gyung Ho Yoon),문명진(Myung Jin Moon),김희숙(Hee Sook Kim),장희숙(Hee Sook Jang),박종숙(Jong Sook Park),박종택(Jong Taek Park),박인서(In Sur Park),심재욱(Jae Wook 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.8
Objectives : The purpose of this study was to evaluate the clinical usefulness of the automated fluid-based thin layer preparation (ThinPrep Pap test). Specimen adequacy and diagnostic detection rates for ThinPrep Pap Test(TP) were compared with conventional Pap smears(CP). Methods : A total of 504 women were included in this study. The cervical smears were performed by three different physicians. A plastic Ayre's spatula and a Cytobrush were used for the collection of ecto- and endo-cervical cells. Split-sampling study was done like that a CP slide was made first and then the sampling devices were immediately rinsed into a vial containing preservative fluid (PreservCyt; Cytyc corporation) to release the cells on sampling devices, from which a TP slide was made by ThinPrep 2000 Processor automated slide preparation system (Cytyc corporation). All TP slides and CP slides were screened and interpretated by two cytotechnologists and one pathologist, respectively. The Bethesda System (TBS) classification was applied. Results : The TP presented a cleaner background, uniform cellularity, and enhanced nuclear details than the CP. Although there was no statistical significance, the TP showed increased number of unsatisfactory and satisfactory but limited by (SBLB) specimens than CP, mostly due to hypocellularity and absence of transformation zone components. Despite the increased number of inadequate specimens, the diagnostic detection rates of the TP were slightly greater but not statistically significantly different than the CP, irrespective of the disease categories. Exact diagnostic agreement between TP and CP was 98.39%. The TP yielded a higher proportion of low and high grade squamous intraepithelial lesions (LSILs and HSILs), atypical squamous and glandular cells of undetermined significance (ASCUS and AGUS), and infectious benign cellular change(BCC) diagnoses when compared to the CP. The ASCUS:LSIL ratio was reduced by 43% in the TP. Conclusions : A comparative analysis of the results from this study indicates that at least the TP is comparable to the CP for the detection of cervical lesions while providing the advantage of improved quality of specimens and increased detection rates for cervical abnormalities without requiring changes in current cytologic screening practices. Possible explanations for the increased number of inadequate specimens with the TP in this study are increased frequency of scanty cellularity due to split-sampling method, inadequate transfer of the cells from the sampling devices into the preservative solution and/or inadequate technical ability to collect the sample.
김태진(Tae Jin Kim),임경택(Kyung Taek Lim),정환욱(Hwan Wook Jung),이기헌(Ki Heon Lee),박인서(In Sou Park),심재욱(Jae Uk Shim),박종택(Chong Taik Park) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.4
This paper reports our experiences in laparoscopically assisted surgical staging (LASS) to manage the patients with early-stage endometrial cancer. From March 1996 to March 1999, we performed LASS in 6 patients with clincal stage I adenocarcinoma of the endometrium. We performed laparoscopic-assisted vaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy (BSO) and intraoperative frozen-section (IFS) diagnosis. The depth of myometrial invasion, tumor differentiation, histologic types, cervical invasion, and adnexal involvement were determined by IFS diagnosis. Laparoscopic pelvic and/or para-aortic lymphadenectomies were performed based on the grade of the tumor and depth of myometrial invasion. One patient was discovered to have tumor metastases in pelvic peritoneum and uterosacral ligaments, and underwent only para-aortic lymphadenectomy for determining field of radiation therapy. 2 out of 5 patients only underwent LAVH with BSO and peroitoneal washing cytology. Three other patients underwent LAVH with BSO, peritoneal washing cytology and pelvic lymphadenectomy because they were identified by IFS diagnosis as intermediate risk group for nodal metastasis. The mean age of the patients was 46.4 years. Total length of the operation time ranged from 100 minutes to 305 minutes and the mean was 187.5 minutes. The mean hemoglobin decrement after the surgery was 0.9 gm/dl. No one recieved blood transfusion. The average number of pelvic and para-aortic lymph nodes removed were 16.7 and 18, respectively. After the surgery, the patients passed gas after an average of 2.0 days and urinated urine after an average of 3.8 days. No one had complication after LASS. Based on our experiences, LASS might be an alternative to the traditional surgical approach in patients with early-stage endometrial carcinoma.
김태진,김정욱,심재욱,백두진,정환욱,박인서,임경택,이기헌,전이경,박종택,김혜선 대한부인종양 콜포스코피학회 1999 Journal of Gynecologic Oncology Vol.10 No.2
Apoptosis, including the programmed cell death, is important event in normal cell turnover and maintenance of adult tissues. Apoptosis exerts a homeostatic function in relation to tissues dynamics, as the steady state of continuously renewing tissues achieved by a balance between cell replication and cell death. This study was undertaken to investigate the association between apoptosis and development of the cervical neoplasia. Archival cervical samples from normal epithelium (n = 10), low-grade squamous intraepithelial lesions (LSIL, n = 10), high-grade squamous intraepithelial lesions (HSIL, n = 10), microinvasive squamous cell carcinomas (n = 10), and invasive squamous cell carcinomas (n = 10) were evaluated for apoptosis. We used in situ end-labeling of DNA strand breaks by terminal deoxynucleotidyltransferase incorporation of biotinylated deoxyuridine to 3-OH ends of DNA, identified by nickel-avidine-peroxidase. The apoptotic index (sum of apoptotic bodies divided by the total nuclei times 100) significantly decreased (P $lt; 0.05) as the degree of neoplasia increased: 3.1 ± 0.9 % in normal epithelium, 5.5 ± 1.4 % in LSIL, 1.6 ± 0.4 % in HSIL, 1.9 ± 0.5 % in microinvasive carcinomas, and 0.6 ± 0.3 % in invasive carcinomas. Compared to normal epithelium, the total cell number per 200x field increased significantly (P $lt; 0,05): 379 ± 47 in normal epithelium, 462 ± 228 in LSIL, 670 293 in HSIL, 1035 ± 254 in microinvasive carcinomas, and 1389 ± 247 in invasive carcinomas. Consequently, these results suggest that progression of cervical carcinogenesis is associated with a decrease in apoptotic index and an increase in the number of the total cell.
난소가 적출된 임신성 융모성 질환에서 고원정체를 보인 p-hCG의 완전관해에 관한 증례
김태진,현우영,심재욱,이기헌,정환욱,강옥림,함경렬,이문섭,임경택,박종택,박인서 대한부인종양 콜포스코피학회 1998 Journal of Gynecologic Oncology Vol.9 No.2
Although chemotherapy remains to be the mainstay of treatment of trophoblastic disease, hysterectomy has been performed as the primary management of nonmetastatic trophoblastic disease who desire sterilization and for uterine disease resistant to chemotherapy. Clinically, the documentation of disease regression is provided by serial quantitative serum β-hCG assays and the persistent disease may be indicated when the serum β-hCG values rise for 2 weeks or plateau for 3 weeks or more. Because of similarity in molecular structure, the confounding effect of an elevated LH on β-hCG assessment in castrated women after treatment for trophoblastic disease has been documented. This LH cross-reactivity may be suspected in women with bilateral oophorectomy demonstrating persistent low levels of β-hCG. It is particularly true when the assay is perfo-rmed by conventional polyclonal radioimmunoassay. We have experienced two cases of nonmetastatic trophoblastic disease whose serum β-hCG assay plateaued at a low level atotal abdominal hysterectomy with bilateral salpingo-oophorectomy and chemotherapy. Clinical and radiologic work-ups were done for metastatic lesion in dose patients, but the results were negative. The quantitative LH assays (Serono LH MAIAclone kit, Roma, Italy) were performed with the sera obtained from the patients; the results were 37 and 31 mIU/ml (1st IRP) with β-hCG of 14 and 13 mIU/ml (1st IRP), respec-tively. With the initiation of oral estrogen replacement thrapy to those patients, the quantitative β-hCG values fell below 5 mIU/ml (1st IRP) and they remained in complete chemical remission without any additional chemotherapy for one year. The persistant low titers of β-hCG in those patients were considered to be result of LH cross-reactivity on β-hCG assessment. It is concluded that whenever the assay of β-hCG shows persistent low titers in the oophorectomized patient for treatment of trophoblastic disease, LH cross-reactivity should be suspected.
AutoPap 300 Qc system을 이용한 자궁경부세포진검사의 위음상률에 관한 보고
이동진,박종택,심재욱,김창헌,정환욱,허걸,이기헌,박인서,홍성란 대한부인종양 콜포스코피학회 2000 Journal of Gynecologic Oncology Vol.11 No.3
Objectives: To estimate false-negative rate of cervical smears using Autopap 300 QC system in rescreening modality. Methods: From September 1997 to December 1997, Total 26,983 cervical smears were obtained and 18,592 cervical smears were rescreened by Autopap 300 QC system with 10% review rate. The 274 cases of total 26,983 cervical smears were confirmed histologically by colposcopic biopsy, cone biopsy and hysterectomy. The 274 cases of cervical smears, which obtained prior to pathologic diagnosis made, were evaluated based on cyto-histologic correlation and then the false negative rate were estimated. The cervical smears were reviewed, researching for the cause of false negative. Results: ① Histologic diagnosis of 274 cases include 65 cases of Low SIL, 173 cases of High SIL, 29 cases of SCC, 2 cases of adenocarcinoma in situ, and 5 cases of invasive adenocarcinoma. ② The false negative rate were 3% (9/274). Those were 6.2%(4/65) of LSIL, 2.3% (4/173) Of HSIL, none of SCC and AIS, and 20%(5/1) of invasive enocarcinoma. ③ The false negative cases were reviewed. The 6 cases were sampling error and 3 cases were screening error. Conclusion: Using AutoPap 300 QC system in rescreening modality, The false negative rate of cervical smears were decreased, compared with our previous study.
김태진,정영철,심재욱,정환욱,이홍복,임경택,이기헌,김동욱,박종택 대한부인종양 콜포스코피학회 1999 Journal of Gynecologic Oncology Vol.10 No.2
Three cases of synchronous carcinomas of endometrium-fallopian tube, endometrium-cervix and endometrium-ovary are reported. Case 1 is endometrial endometrioid adenocarcinoma with FIGO stageIb, Grade 2 and tubal serous adenocarcinoma with FIGO stage Ib, Grade 2. Case 2 is endometrial serous carcinoma with FIGO stage Ilb and squamous cell carcinoma with FIGO stage Ial. Case 3 is endometrial endometrioid adenocarcinoma with FIGO stage Ia, Grade 1 and ovarian mucinous adenocarcinoma with FIGO stage IIIa, Grade 2. There is much controversy with respect to staging and management of such cases since these tumors may represent either two synchronously occurring primaries or single primary with metastases. It is suggested that when each tumor is different histological subtype the tumors may be considered as two separate primaries and treatment may be less aggressive. It may be a favorable prognosis. The authors present three cases of synchronous carcinomas with a review of literature.
난소와 부난소에서 발생한 원발성 이행상피암종 4예에 대한 임상 및 병리학적 분석
김태진,한인수,심재욱,정환욱,박인서,임경택,이기헌,김희숙,최용관,전이경,박종택,고명인,김의정,홍성란 대한부인종양 콜포스코피학회 1999 Journal of Gynecologic Oncology Vol.10 No.3
Four cases of primary transitional cell carcinoma (TCC) arising in the ovary (3 cases) and the parovarium (1 case) were collected for clinicopathologic analysis. The mean age was 46.2 years (range, 39-57 years). Two patients complained abdominal discomfort and vaginal discharge, respectively. Other 2 cases were incidentally found from routine check. Grossly, the tumors were solid and cystic (2 cases), solid (1 case) and surface papillary growth on capsule (1 case). Microscopically, the tumor showed almostly same to the histologic features of TCC of urinary bladder. Three cases were pure TCC, and one was mixed TCC and serous carcinoma. FIGO stage were 1 IIa, 2 IIc, and 1 IIIc. Treatment was surgery with adjuvant chemotherapy. Two patients are alive with no evidence of disease, and two have lung or brain metastasis.