| Part 1.Diagnostic value of MR-DWI scan in lymph node metastasis of bladder cancerObjective:Bladder cancer is the most common urologic malignancy in China,and the incidence is increasing in recent years.The prognostic factors of bladder cancer include lymph node metastasis besides pathological grading.It is of great significance to discover lymphatic metastasis as soon as possible for the treatment of bladder cancer.The accurate clinical staging of bladder cancer is the basis for making the treatment plan and judging the prognosis,and it is particularly vital to estimate the lymph node metastasis accurately.MR-DWI can be used as a new imaging diagnostic tool for detecting lymph node metastasis of bladder cancer,and its application value in lymph node metastasis of bladder cancer is evaluated by comparing its detection rate with the positive rate of lymph node metastasis confirmed by postoperative pathology.Methods:The MR-DWI images and pathological data of the patients,with total radical cystectomy and lymph node dissection in our hospital from January 2013 to December 2017,were analyzed retrospectively.The size parameter,anatomic position,shape and apparent diffusion coefficient(ADC value)of the lymph nodes were recorded,and we evaluate the value of MR-DWI in the evaluation of lymph node metastasis in bladder cancer with the gold standard,of which were confirmed by postoperative pathology after surgry.Results:1.The accuracy rate of MR-DWI in preoperative evaluation of lymph node metastasis in bladder cancer patients reached 81%,the accuracy rate of lymph node infiltration by cancer cell was 77.4%,the false positive rate(FPR)was 29.2%,and the false negative rate(FNR)22.2%.2.The diameter line of the short axis of the lymph nodes infiltranted by cancer cell and false positive lymph nodes were 6.84 + 2.37mm and 4.80 + 1.44mm in turn,which is a statistical difference(P=0.01),and they are the same in long diameter(7.89+ 3.07mm vs 8.74 + 2.57mm),P>0.05.3.The lymph nodes infiltranted by cancer cell were more prevalent around the common iliac vessels(44.22%),followed by iliac vessels(around 31.29%)and external iliac vessels(14.29%);the lymph nodes infiltranited located on the left and right side of the pelvis was 35.37%and 54.42%in turn,and 10.20%aroud the bladder.4.The appearance of metastatic lymph nodes:the oval accoumted for 55.38%,and the circular accounted for 44.62%;inflammatory hyperplasia and other false positive lymph nodes appearance:oval accounted for 52.63%,and circular accounted for 47.37%,they are the same in appearance figure statistics(p>0.05).5.The ADC values of the metastases and false positive lymph nodes were 0.728±0.108 × 10-3mm2.S-1 and 0.999±0.167 ×10-3 mm2.S-1 in turn,which is a statistical difference(P=0.00).6.The standard deviation of ADC value of metastatic lymph nodes were 52.85±24.91 vs 118.25±39.76 in turn,which is a statistical difference(P=0.001).Conclusion:MR-DWI,as a mature and relative frontier nuclear magnetic technique,has a certain value in the preoperative evaluation of lymphadenocarcinoma infiltration of carcinoma of urinary bladder.The short diameter of the lymph node can improve the sensitivity and specificity of lymph node detection to a certain extent combined with its ADC value and the standard,so as to provides a reference for clinicians in radical cystectomy and lymph node dissection.Part 2.Diagnostic value of VEGF-C expression in human peripheral blood in staging and lymph node metastasis of bladder cancerObjective:VEGF-C is a vascular endothelial factor more reported and associated with many human malignant tumor and lymph node metastasis.Through the expression of mRNA and protein level of VEGF-C in patients’ peripheral blood,We open up a new approach to the diagnosis of preoperative staging of bladder cancer and lymph node metastasis in order to serve as a useful supplement to existing diagnostic methods,and to further demonstrate the reported results from the macro level of gene expression.Methods:Three milliliter blood was extracted from the venous blood of the 126 patients diagnosed with bladder cancer,15 patients of benign prostatic hyperplasia,and 15 patients diagnosed with renal cyst before and 2 weeks or 3 months after the operation.The patients who met the requirements were divided into 5 groups:group pTis～pT1,pT2,pT3,pT4 and lymph node metastasis,with 15～30 in each group.Then we used rt-qPCR and Elisa to detect the expression of VEGF-C and mRNA in peripheral blood,and to analyze the relationship between the expression level of VEGF-C and related clinical indicators of patients,such as clinical staging and lymph node metastasis.Results:1.The relative expression of VEGF-C mRNA and VEGF-C protein in peri pheral blood of pT4 stage and lymph node metastasis group was significantly higher than that of control group,pTis-pTl,pT2 and pT3 phase group(P<0.05).2.There was no significant difference in VEGF-C mRNA between the con trol group,pTis-pTl,pT2 and pT3 group,pT4 phase and lymph node infiltrate d group,and there is no significant difference between them(P>0.05).3.The expression amount of VEGF-C mRNA and protein in pT4 and lymp h node metastasis group was statistically significant(P<0.05)before and after th e surgery.4.There was no significant difference in the expression of VEGF-C mRN A and protein between the control group,pTa-pTis,pTl,pT2 and pT3 group b efore and after the surgery(P>0.05).5.There was no significant difference in the expression of VEGF-C mRN A and protein in peripheral blood of patients with bladder cancer between diffe rent cytological classification and different types of cancer cells(P>0.05).Conclusion:VEGF-C plays an important role not only in the occurrence and invasion of bladder cancer,but also in lymph node metastasis of bladder cancer,and its expression level of mRNA and protein can be used as a potential indicator for preoperative diagnosis of staging and invasive lymph node in patients with carcinoma of urinary bladder. |
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