甲状腺结节微波消融治疗后6个月消融区细胞活性的酶组织化学检测
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摘要
目的探讨甲状腺结节微波消融治疗术后6个月消融区组织内细胞活性情况。方法选择2017年12月至2018年9月甲状腺结节微波消融治疗术后6个月进行消融区粗针穿刺活组织检查病理评估的患者20例24个消融区。使用切割式活检针分别对消融区中央域及边缘域进行粗针穿刺活组织检查,取得标本条置入液氮制成冰冻切片。采用酶组织化学染色法检测细胞内琥珀酸脱氢酶(SDH)和还原型烟酰胺腺嘌呤二核苷酸磷酸黄递酶(NADPH-d)的活性,并与常规病理切片H-E染色观察到的细胞形态及组织结构对比。结果微波消融术后6个月24个消融区的中央域及边缘域均成功取材。消融区中央域SDH及NADPH-d酶组织化学染色情况一致性好,阴性率均为95.83%(23/24)。消融区边缘域SDH及NADPH-d酶组织化学染色情况一致性好,阴性率均为91.67%(22/24)。23个中央域及22个边缘域的H-E染色切片均显示为红染无结构的大片坏死组织;1个中央域、2个边缘域H-E染色切片显示部分为坏死结构、部分为纤维组织增生,纤维组织增生处与酶组织化学染色阳性区域位置一致。结论微波消融术后6个月甲状腺结节消融区组织符合凝固性坏死改变,仍处于失活状态,酶组织化学染色结合H-E染色能够对陈旧消融区做出较为客观的评价。
Objective To explore the cell viability in the ablation area of thyroid nodules at 6 months after microwave ablation by enzyme histochemical staining. Methods Twenty-four ablation areas of thyroid nodules were selected from 20 patients who underwent histopathological assessment of the ablation area by core needle biopsy at 6 months after microwave ablation between Dec. 2017 and Sep. 2018. Core needle biopsy was performed at the central and marginal regions of the ablation area with a cutting biopsy needle. The specimens were obtained and placed in liquid nitrogen to make frozen sections. Enzyme histochemical staining was used to detect the activities of succinate dehydrogenase(SDH) and nicotinamide adenine dinucleotide phosphate diaphorase(NADPH-d), and the difference of cell morphology and histological structure was compared with H-E staining results. Results The specimens of the central and marginal regions of 24 ablation areas were successfully obtained. The histochemical staining of SDH and NADPH-d in the central region of ablation area had good consistency, and the negative rates were both 95.83%(23/24). The histochemical staining of SDH and NADPH-d in the marginal region of ablation area also had good consistency, and the negative rates were both 91.67%(22/24). H-E staining of 23 central regions and 22 marginal regions showed pink amorphous mass of necrosis. H-E staining of 1 central region and 2 marginal regions showed partly necrotic and fibrous tissue hyperplasia. The location of fibrous tissue hyperplasia was consistent with the location of the positive region of enzyme histochemical staining. Conclusion At 6 months after microwave ablation, the tissue in the ablation area of thyroid nodules is consistent with coagulative necrosis, and is still inactivated. SDH or NADPH-d enzyme histochemical staining combined with H-E staining can objectively evaluate the old ablation area.
Objective To explore the cell viability in the ablation area of thyroid nodules at 6 months after microwave ablation by enzyme histochemical staining. Methods Twenty-four ablation areas of thyroid nodules were selected from 20 patients who underwent histopathological assessment of the ablation area by core needle biopsy at 6 months after microwave ablation between Dec. 2017 and Sep. 2018. Core needle biopsy was performed at the central and marginal regions of the ablation area with a cutting biopsy needle. The specimens were obtained and placed in liquid nitrogen to make frozen sections. Enzyme histochemical staining was used to detect the activities of succinate dehydrogenase(SDH) and nicotinamide adenine dinucleotide phosphate diaphorase(NADPH-d), and the difference of cell morphology and histological structure was compared with H-E staining results. Results The specimens of the central and marginal regions of 24 ablation areas were successfully obtained. The histochemical staining of SDH and NADPH-d in the central region of ablation area had good consistency, and the negative rates were both 95.83%(23/24). The histochemical staining of SDH and NADPH-d in the marginal region of ablation area also had good consistency, and the negative rates were both 91.67%(22/24). H-E staining of 23 central regions and 22 marginal regions showed pink amorphous mass of necrosis. H-E staining of 1 central region and 2 marginal regions showed partly necrotic and fibrous tissue hyperplasia. The location of fibrous tissue hyperplasia was consistent with the location of the positive region of enzyme histochemical staining. Conclusion At 6 months after microwave ablation, the tissue in the ablation area of thyroid nodules is consistent with coagulative necrosis, and is still inactivated. SDH or NADPH-d enzyme histochemical staining combined with H-E staining can objectively evaluate the old ablation area.
引文
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[3]闫磊,章建全,曹昆昆,吴震中,盛建国,张航.微波消融改善甲状腺结节粗针穿刺活检的过程与结果[J].第二军医大学学报,2017,38:1250-1255.YAN L,ZHANG J Q,CAO K K,WU Z Z,SHENG J G,ZHANG H.Microwave ablation improves the process and outcome of core needle biopsy in thyroid nodules[J].Acad J Sec Mil Med Univ,2017,38:1250-1255.
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[6]CHAO Y J,SHAN Y S,ZUCHINI R,TSAI H W,LINP W,LEE G B,et al.Successfully seal pancreatic end after thermal distal pancreatectomy using needle arrays in alternating electromagnetic fields[J].Surg Innov,2013,20:150-157.
[7]OLUTOYE O O,GAY A N,SHEIKH F,AKINKUOTUA C,SUNDARARAJAN M,LAZAR D A,et al.Inutero radiofrequency ablation in fetal piglets:lessons learned[J].J Pediatr Surg,2016,51:554-558.
[8]张弘,方廖琼,龚晓波,田耘博,丁晓燕,王智彪,等.酶组织化学法检测高强度聚焦超声消融后牛肝细胞活性[J].中国超声医学杂志,2011,27:12-14.
[9]冯炼强,刘大全,朱兆玲,吕明德,谭进富,王竹,等.微波凝固肝癌细胞活性的酶组织化学检测[J].热带医学杂志,2006,6:679-681,封二.
[10]谭进富,吕明德,刘大全,王竹,周忠信,黄洁夫.微波消融对小鼠肝癌细胞活性和HSP70表达的影响[J].中山大学学报(医学科学版),2006,27:378-382.
[11]LUO W,ZHOU X,YU M,HE G,ZHENG X,LI Q,et al.Ablation of high-intensity focused ultrasound assisted with SonoVue on rabbit VX2 liver tumors:sequential findings with histopathology,immunohistochemistry,and enzyme histochemistry[J].Ann Surg Oncol,2009,16:2359-2368.
[12]RITZ J P,LEHMANN K S,SCHUMANN T,KNAPPEV,ZURBUCHEN U,BUHR H J,et al.Effectiveness of various thermal ablation techniques for the treatment of nodular thyroid disease―comparison of laser-induced thermotherapy and bipolar radiofrequency ablation[J].Lasers Med Sci,2011,26:545-552.
[13]章建全,闫磊,陈红琼,吴震中.微波消融致甲状腺结节细胞活性的快速变化分析[J].中华医学杂志,2018,98:3524-3527.
[14]陈杰,李甘地.病理学[M].北京:人民卫生出版社,2015:27.
[15]马奔,王宇,嵇庆海,赵志泓,陈彤箴,常彬,等.原发性甲状腺癌热消融治疗后再手术2例分析[J].中国实用外科杂志,2016,36:875-879.
[16]董文武,张浩,张平,邵亮,张挺,吕承洲,等.甲状腺乳头状癌射频消融治疗后再手术5例临床分析[J].中国实用外科杂志,2015,35:653-655.
[2]章建全.经皮热消融治疗在甲状腺乳头状癌及其区域淋巴结转移中的应用前景[J].中华医学超声杂志(电子版),2014,11:1-4.
[3]闫磊,章建全,曹昆昆,吴震中,盛建国,张航.微波消融改善甲状腺结节粗针穿刺活检的过程与结果[J].第二军医大学学报,2017,38:1250-1255.YAN L,ZHANG J Q,CAO K K,WU Z Z,SHENG J G,ZHANG H.Microwave ablation improves the process and outcome of core needle biopsy in thyroid nodules[J].Acad J Sec Mil Med Univ,2017,38:1250-1255.
[4]范卫君,叶欣.肿瘤微波消融治疗学[M].北京:人民卫生出版社,2012:25-27.
[5]吴震中,章建全.甲状腺结节微波热消融治疗的临床进展[J].中国介入影像与治疗学,2016,13:772-774.
[6]CHAO Y J,SHAN Y S,ZUCHINI R,TSAI H W,LINP W,LEE G B,et al.Successfully seal pancreatic end after thermal distal pancreatectomy using needle arrays in alternating electromagnetic fields[J].Surg Innov,2013,20:150-157.
[7]OLUTOYE O O,GAY A N,SHEIKH F,AKINKUOTUA C,SUNDARARAJAN M,LAZAR D A,et al.Inutero radiofrequency ablation in fetal piglets:lessons learned[J].J Pediatr Surg,2016,51:554-558.
[8]张弘,方廖琼,龚晓波,田耘博,丁晓燕,王智彪,等.酶组织化学法检测高强度聚焦超声消融后牛肝细胞活性[J].中国超声医学杂志,2011,27:12-14.
[9]冯炼强,刘大全,朱兆玲,吕明德,谭进富,王竹,等.微波凝固肝癌细胞活性的酶组织化学检测[J].热带医学杂志,2006,6:679-681,封二.
[10]谭进富,吕明德,刘大全,王竹,周忠信,黄洁夫.微波消融对小鼠肝癌细胞活性和HSP70表达的影响[J].中山大学学报(医学科学版),2006,27:378-382.
[11]LUO W,ZHOU X,YU M,HE G,ZHENG X,LI Q,et al.Ablation of high-intensity focused ultrasound assisted with SonoVue on rabbit VX2 liver tumors:sequential findings with histopathology,immunohistochemistry,and enzyme histochemistry[J].Ann Surg Oncol,2009,16:2359-2368.
[12]RITZ J P,LEHMANN K S,SCHUMANN T,KNAPPEV,ZURBUCHEN U,BUHR H J,et al.Effectiveness of various thermal ablation techniques for the treatment of nodular thyroid disease―comparison of laser-induced thermotherapy and bipolar radiofrequency ablation[J].Lasers Med Sci,2011,26:545-552.
[13]章建全,闫磊,陈红琼,吴震中.微波消融致甲状腺结节细胞活性的快速变化分析[J].中华医学杂志,2018,98:3524-3527.
[14]陈杰,李甘地.病理学[M].北京:人民卫生出版社,2015:27.
[15]马奔,王宇,嵇庆海,赵志泓,陈彤箴,常彬,等.原发性甲状腺癌热消融治疗后再手术2例分析[J].中国实用外科杂志,2016,36:875-879.
[16]董文武,张浩,张平,邵亮,张挺,吕承洲,等.甲状腺乳头状癌射频消融治疗后再手术5例临床分析[J].中国实用外科杂志,2015,35:653-655.
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