Stereological And Quantitative Diagnosis Pathological Study On The Carcinomatons Nucleus Of Esophagus Carcinoma

OBJECTIVE:Using the method of stereology to reveal quantitatively the characteristics and changing rules of the three-dimensional structure of the carcinomatous cell nucleus in the esophagus.To explore the value of the stereologic parameters of the esophagus carcinomatous nucleus on the diagnosing, sub-typing and grading of esophagus carcinoma. To explore the relation of the stereologic parameters of the esophagus carcinomatous nucleus and lymph node ransfer.METHODS:The forty-eight esophagus carcinomatous specimens and forty-eight normal esophagus mucosas were obtained from the esophagus surgical resections, which were grouped into squamous cell carcinoma (a) ,adenosquamous carcinoma(b) and normal group(c). The squamous cell carcinoma group consisted of the highly-differentiated group(a₁),moderately-differentiated group(a₂) and poorly-differentiated group(a₃). The normal group consisted of the surface layer group(c₁),intermediate layer group(c₂) and basal layer group(c₃). Ten views were selected stochastically from each stain cut from five esophagus carcinomatous tissue and five esophagus incisal edge normal mucosas selected randomly and stained by Hematoxylin-Eosin. We measured the nucleus of carcinomatous cell and the normal esophagus mucous membrane epithelium and reference space using the Image- Pro analytical software. Using the carcinomatous cells as the reference space, the following parameters were acquired according to the stereologic formulas. The parameters consisted of the nuclear volume density (V_vn) ,surface density (S_vn) , numerical density (N_vn) , mean nuclear volume (v_n) , mean nuclear surface (s_n) , ratio of nuclear to plasm (R_np) , ratio of surface to volum (R_svn), mean free distance of components (λ_n), ratio of major diameter to minimal diameter (R_ab). The parameters were compared to analyse the differences among different groups. The parameters were compared to analyse the differences among whether or not lymph node transfer in esophagus carcinomatous primary focus by independent-samples T test. The following groups were separately submited to discriminant analysis and stepwise discriminant analysis.They were the different esophagus carcinoma group and the normal group, the different subtypes of the esophagus carcinoma and the normal group, the different graded squamous cell carcinoma and the normal group, the different graded squamous cell carcinoma.RESULTS:1 .The basal measuring results of the nuclear stereologic parameters in the esophaguscarcinoma, subtype of it and the normal groupThe parameters of S_vn, V_vn, N_vn, V_n, S_n, R_np,R_svn andλ_n showed significantly diferent between the esophagus carcinoma group and the normal group. The carcinomatous nuclear parameters of S_vn, V_vn, N_vn, V_n, S_n and R_np in the esophagus carcinoma are bigger than in normal group. The carcinomatous nuclear parameters of R_svn andλ_n in the esophagus carcinoma are less than in normal group.The parameters of S_vn,V_vn, N_vn,V_n, S_n, R_np, R_svn andλ_n showed significant difference between the squamous cell carcinoma, adenosquamous carcinoma and normal group.The result of interclass multiple comparison showed that above-mentioned parameters were significantly different between the squamous cell carcinoma and normal group. The carcinomatous nuclear parameters of S_vn, V_vn, N_vn, V_n, S_n and R_np in the esophagus squamous cell carcinoma are bigger than in normal group. The carcinomatous nuclear parameters of R_svn andλ_n in the esophagus squamous cell carcinoma are less than in normal group. The parameters of S_vn,V_vn, N_vn,R_np andλ_n of the adenosquamous carcinoma are significantly different from those of the normal group. The carcinomatous nuclear parameters of S_vn,V_vn,N_vn and R_np in the adenosquamous carcinoma are bigger than in normal group. The carcinomatous nuclear parameter ofλ_n in the adenosquamous carcinoma are less than in normal group.2.The discriminant analysis results of the nuclear in the esophagus carcinoma, subtype of it and the normal groupThe forty-eight esophagus carcinomatous specimens and forty-eight normal esophagus mucosas were discriminated accurately by the discriminative equations(1), which were made up of the parameters of S_vn, V_vn, N_vn, V_n, S_n, R_np,R_svn,R_ab andλ_n. To discriminate the forty-eight esophagus carcinomatous specimens and the forty-eight normal esophagus mucosas using the stepwise discriminative equations(2), the discriminative veracity were respectively 95.8% and 97.9%, which were made up of the parameters V_vn and R_np.To discriminate the forty-one squamous cell carcinoma , the seven adenosquamous carcinoma and the forty-eight normal esophagus mucosas using the discriminative equations(3), the discriminative veracity were respectively 92.7%, 28.6% and 100.0%, which were made up of the parameters of S_vn, V_vn, N_vn, V_n, S_n,R_np, R_svn, R_ab andλ_n.To discriminate the forty-one squamous cell carcinoma, the seven adenosquamous carcinoma and the forty-eight normal esophagus mucosas using the stepwise discriminative equations(4), the discriminative veracity were respectively 95.1%, 0% and 97.9%, which were made up of the parameters V_vn andR_np. The Y(d) and Y (c) in the discriminative equations(1) represent the esophagus carcinoma and normal group.The Y(a), Y(b) and Y (c) in the discriminative equations(3) represent the esophagus squamous cell carcinoma, adenosquamous carcinoma and normal group.3. The measuring results of the nuclear in the different graded esophagus squamous cell carcinoma and normal group1).The compared results of the nuclear in the different graded esophagus squamous cell carcinoma and normal groupThe parameters of S_vn, V_vn, N_vn, V_n, S_n, R_np andλ_n showed significant differences between the highly-differentiated esophagus squamous cell carcinoma , the adenosquamous carcinoma esophagus squamous cell carcinoma, the poorly-differentiated esophagus squamous cell carcinoma and the normal group.The nuclear parameters of S_vn, V_vn, S_n and R_np in the different graded esophagus squamous cell carcinoma are bigger than in normal group.But nuclear parameter ofλ_n in the different graded esophagus squamous cell carcinoma is less than those in normal group. The parameter of Nv in the the moderately-differentiated esophagus squamous cell carcinoma, the poorly-differentiated esophagus squamous cell carcinoma is bigger than it in normal group. The parameter of Nv in the highly-differentiated esophagus squamous cell carcinoma, the the moderately-differentiated esophagus squamous cell carcinoma is bigger than it in normal group.In addition,the nuclear parameters of S_vn,V_vn and R_np in the highly-differentiated esophagus squamous cell carcinoma are less than in the moderately-differentiated esophagus squamous cell carcinoma and the poorly-differentiated esophagus squamous cell carcinoma. the nuclear parameter ofλ_n in the highly-differentiated esophagus squamous cell carcinoma is bigger than in the moderately-differentiated esophagus squamous cell carcinoma and the poorly-differentiated esophagus squamous cell carcinoma.2)The discriminant analysis results of the nuclear in the different graded esophagus squamous cell carcinoma and the normal groupTo discriminate the twelve highly-differentiated esophagus squamous cell carcinoma, the seventeen anmoderately-differentiated esophagus squamous cell carcinoma, the twelve poorly-differentiated esophagus squamou cell carcinoma and the forty-eight normal esophagus mucosas using the discriminative equations(5), the discriminative veracity were respectively 66.7%, 70.6%, 16.7% and 100%, which were made up of the parameters of S_vn,V_vn, N_vn, V_n, S_n, R_np, R_svn, R_ab andλ_n. To discriminate the twelve highly-differentiated esophagus squamous cell carcinoma, the seventeen anmoderately -differentiated esophagus squamous cell carcinoma, the twelve poorly-differentiated esophagus squamou cell carcinoma and the forty-eight normal esophagus mucosas using the stepwise discriminative equations(6), the discriminative veracity were respectively 75.0%, 70.6%, 8.3%, and 100%, which were made up of the parameters of S_vn,S_n and R_np.To discriminate the twelve highly-differentiated esophagus squamous cell carcinoma , the seventeen anmoderately-differentiated esophagus squamous cell carcinoma and the twelve poorly-differentiated esophagus squamou cell carcinoma using the discriminative equations(7), the discriminative veracity were respectively 66.7%, 82.4% and 58.3%, which were made up of the parameters of S_vn, V_vn, N_vn, V_n, S_n, R_np, R_svn andλ_n. To discriminate the twelve highly-differentiated esophagus squamous cell carcinoma, the seventeen anmoderately-differentiated esophagus squamous cell carcinoma and the twelve poorly-differentiated esophagus squamou cell carcinoma using the stepwise discriminative equations(8), the discriminative veracity were respectively 58.3%, 82.4% and 0%, which was made up of the parameters of S_vn, S_n and R_np.The Y(a₁), Y(a₂) and Y (a₃) in the discriminative equations(7) represent the highly-differentiated esophagus squamous cell carcinoma , the moderately-differentiated esophagus squamous cell carcinoma and the poorly-differentiated esophagus squamous cell carcinoma.4.The results of the nuclear in the lymph node transferred esophagus carcinomatous primary focus and the lymph node untransferred esophagus carcinomatous primary focus . The parameter of R_ab showed significant differences between the lymph node transferred esophagus carcinomatous primary focus and the lymph node untransferred esophagus carcinomatous primary focus. The parameters of V_vn, S_vn, N_vn, V_n, S_n, R_np, R_svn andλ_n did not showed significant difference between the lymph node transferred esophagus carcinomatous primary focus and the lymph node untransferred esophagus carcinomatous primary focus.5.The value of the nuclear stereologic parameters in the different layer of the normal esophagus mucous membrane epithelium are different. CONCLUSIONS:1. The carcinomatous nuclear stereological parameters of the esophagus carcinoma are evident changed.The carcinomatous nuclear parameters of S_vn, V_vn, N_vn, V_n, S_n and R_np in the esophagus carcinoma are bigger than in normal group. The carcinomatous nuclear parameters of R_svn andλ_n in the esophagus carcinoma are less than in normal group. The carcinomatous nuclear parameters of S_vn, V_vn, N_vn,V_n, S_n and R_np in the esophagus squamous cell carcinoma are bigger than in normal group. The carcinomatous nuclear parameters of R_svn andλ_n in the esophagus squamous cell carcinoma are less than in normal group. The carcinomatous nuclear parameters of S_vn, V_vn, N_vn and R_np in the adenosquamous carcinoma are bigger than in normal group. The carcinomatous nuclear parameter ofλ_n in the adenosquamous carcinoma are less than in normal group.2.The significance of the carcinomatous nuclear stereologic parameters to pathological diagnosis and type the esophagus carcinomaThe parameters of V_vn,S_vn,N_vn,V_n, S_n, R_np, R_svn andλ_n can be used to discriminate the squamous cell carcinoma and the normal esophagus mucosas. And the parameters of V_vn, S_vn,N_vn, R_np andλ_n can be used to discriminate the adenosquamous carcinoma and the normal esophagus mucosas. The forty-eight esophagus carcinomatous specimens and forty-eight normal esophagus mucosas were discriminated accurately by the discriminative equations(1), which were made up of the parameters of S_vn,V_vn,N_vn,V_n, S_n, R_np, R_svn, R_ab andλ_n.To discriminate the forty-one squamous cell carcinoma , the seven adenosquamous carcinoma and the forty-eight normal esophagus mucosas using the stepwise discriminative equations(3), the discriminative veracity were respectively 92.7%, 28.6% and 100.0%, which were made up of the parameters of S_vn, V_vn,N_vn, V_n, S_n, R_np, R_svn, R_ab andλ_n.3. The significance of the carcinomatous nuclear stereologic parameters to grade the esophagus squamous cell carcinoma 1)The parameters of V_vn, S_vn,N_vn,R_np andλ_n are all able to differentiate effectively the highly-differentiated squamous cell carcinoma from the moderately-differentiated squamous cell carcinoma and the poorly-differentiated squamous cell carcinoma.2) To discriminate the twelve highly-differentiated esophagus squamous cell carcinoma, the seventeen anmoderately -differentiated esophagus squamous cell carcinoma, the twelve poorly-differentiated esophagus squamou cell carcinoma and the forty-eight normal esophagus mucosas using the stepwise discriminative equations(6), the discriminative veracity were respectively 75.0%, 70.6%, 8.3%, and 100%, which were made up of the parameters of S_vn,S_n and R_np.To discriminate the twelve highly-differentiated esophagus squamous cell carcinoma, the seventeen anmoderately-differentiated esophagus squamous cell carcinoma and the twelve poorly-differentiated esophagus squamou cell carcinoma using the discriminative equations(7),the discriminative veracity were respectively 66.7%, 82.4% and 58.3%,which were made up of the parameters of S_vn, V_vn, N_vn, V_n, S_n, R_np, R_svn andλ_n.4. The quantitative pathologic diagnosis strategy on account of the stereologic parameters of the esophagus carcinomatous nucleus.The following groups were separately submited to discriminant analysis.They were the esophagus carcinoma and the normal esophagus epithelium, the different esophagus carcinoma and the normal group, the different graded squamous cell carcinoma.We analysis according to the backswing discrimination effect.We can use the following quantitative pathologic diagnosis strategy to distinguish the esophagus carcinoma. Firstly,to discriminate the esophagus carcinoma and normal esophagus epithelium.using the discriminative equations(1). Secondly,to discriminate the squamous cell carcinoma and the adenosquamous carcinoma using the discriminative equations(3).Thirdly, to discriminate the highly-differentiated esophagus squamous cell carcinoma, moderately-differentiated esophagus squamous cell carcinoma and poorly-differentiated esophagus squamous cell carcinoma using the discriminative equations(7).5.The parameter of R_ab is able to differentiate efectively the lymph node transferred esophagus carcinomatous primary focus from the lymph node untransferred esophagus carcinomatous primary focus.