The aim of the presentation is to introduce a dramatic accomplishments of high technology and the current applications of medicine, particularly in the field of Gynecology and Obstetrics. An author's demonstration includes both of a brief basic concept of window and fraction sorting and some clinical applications. Cell sorting based on genotypic (neoplastic) and phenotypic markers of a benign and malignant lesions of female genital tract seems to be expressed at the cellular and molecular level in terms of degree of cell growth, differentiation and functions, which are not readily appreciated by descriptive morphology. DNA aneuploidy is a conclusive marker of malignant characteristics and a monoclonal antibodies of Bromodeoxyuridine (BrdU), an analog of thymidine, is an available identification of DNA synthetic cells. Among phenotypic cell markers, surface membrane antigens have been extensively studied on the immunological state in pregnancy, peripheral lymphocyte subsets from pregnant women by the use of monoclonal antibodies. From gynecological and obstetrical patients management perspective, a role of cell sorting technology in flow cytometry is emerging as a tool for diagnosis of cancer (DNA abnormalities and cell cycle analysis) multiparameter analysis in quantitation (DNA base pairs, RNA and protein), surface markers for immunological state in pregnancy (membrane antigen and monoclonal antibodies), prognosis (adverse impact of aneuploidy and high S percentage using BrdU with monoclonal antibody) and targeting cytotoxicity to steroid responding tumor cells (estrogen receptor and site-directed chemotherapy).

The chromosome changes in early cancer had been thought to be difficult to analyse because of the technical reasons and of the complex nature of the chromosomal abnormalities as compared with hematological diseases having simple diploid karyotype. Recent advances allowed to analyse the chromosomes of solid tumors by the improved technics for cell disaggregation, short term culture, and chromosome banding. Although some advanced solid cancers kept the simple near by diploid chromosomal features, many tumors such as cervical cancers reveal complex chromosomal changes already in the pre-invasive stage. Much more data must be collected to evaluate the role of chromosomal changes in benign and early malignant tumors.

Analysis of DNA ploidy patterns was performed on 129 primary gastric cancers and the results correlated with histologic findings and in vivo bromodeoxyuridine (BrdU) labeling. Forty-nine cases were diploid (38%) and 80 cases were aneuploid. There was no correlation between DNA ploidy and histologic type. In aneuploid cancers, incidence of lymphatic invasion, lymph node metastasis and rate of advanced cases were significantly higher than those in diploid tumors. During the follow-up period of 5-10 years, 23 of the 40 patients (55%) with aneuploid tumors died of disease within 3-120 months. Only 13 of the 36 patients (36%) with diploid tumors died of disease. The BrdU labeling indices (BrdU LI) were from 2.8% to 26.7%, with a mean of 10.4%. There was no correlation between BrdU LI and histologic type or stage. The mean BrdU LI of early cancers was 8.1%, of advanced cancers, 11.9%. BrdU LI of cancers with lymphatic invasion or lymph node metastasis was higher than those without them. The mean BrdU LI of diploid cancer was 6.0%, of aneuploid cancers, 11.9%. There was a good correlation between BrdU labeling indices and DNA ploidy patterns. These results indicate that determination of DNA ploidy patterns and growth fractions by BrdU labeling may be useful in the conjecture of prognosis of the patient and in the selection of patients from various modalities.

Reviewing recent publications, especially on ras and myc expression in GI tract tumors, the usefulness of detecting oncogene changes for differential diagnosis among non-neoplastic changes, precancerous lesions, early and advanced cancers were discussed. While quantitative change of oncogene expression per se appears to have only limited value, qualitative alteration in oncogenes or in regulatory mechanisms of oncogene expression seems to offer more promising perspective for judging the biological character of individual lesions. The definition of precancerous lesion and early carcinoma is also carefully discussed.

It is difficult to identify early ovarian cancer at present. However, some tumor markers (CA125, CA19-9, CEA) and soon imaging system (MRI, CT, UT) and some oncogenes are available for diagnosis of ovarian cancer recently. Multivariate analysis of tumor markers has a possibility of stage I cancer. MRI is very useful to identify some cystic and hemorrhagic lesions. Amplifiers of N-myc and K-ras may be applied to diagnose ovarian cancer. In future, these new technologies may identify early ovarian cancer.

We have investigated the effects of preoperative Lipiodol-Transcatheter arterial embolization (Lp-TAE) on both the nuclear DNA content of noncancerous liver cells by DNA-cytofluorometry (using NIKON SPM-RF1-D), and the histopathological findings of liver lesions. Lp-TAE through the hepatic artery was performed on ten primary hepatocellular carcinoma patients using Gelfoam in combination with adriamycin (40 mg) or mitomycin C (20 mg), emulsified in Lipiodol (10 ml) and 60% Urografin (2 ml). And hepatic resection was carried out after one or two months later in each case. Histologically, primary hepatocellular carcinoma lesions showed various patterns of necrosis, while the non-cancerous liver cells did not show hepatocellular infarction in the liver cirrhosis. The results of the nuclear DNA content showed an increase in the fractions of poliploid cells in the non-cancerous lesions treated with Lp-TAE compared with that in the normal age-matched controls. But we found no remarkable differences in the ploidy patterns between Lp-TAE treated patients and untreated patients with liver cirrhosis. In conclusion, preoperative Lp-TAE does not induce any remarkable histological hepatocellular damage of non-cancerous lesion and does not affect nuclear DNA content of non-cancerous liver cells.