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论著:结直肠癌前哨淋巴结活检及前哨淋巴结微转移检测方法研究
Priliminary Study of Sentinel Lymph Node Biopsy in Colorectal Cancer and Detection of Micrometastasis in Sentinel Lymph Node
童汉兴 张勇 张思 陆巍 江颖 朱隽 陆维祺
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作者单位:复旦大学附属中山医院普外科
中文关键字:结直肠肿瘤;前哨淋巴结;微转移;实时定量聚合酶链反应;免疫组织化学
英文关键字:Colorectal neoplasms; Sentined lymph node; Micrometastasis; Quantitative RT-PCR; Immunohistochemistry
中文摘要:目的:探讨纳米炭颗粒(carbon nanoparticles,CNP)和99m锝硫胶体(99mTc sulfur colloid,TSC)定位活检结直肠癌前哨淋巴结(sentinel lymph node,SLN)的可行性,评价免疫组织化学(immunohistochemistry,IHC)及实时定量聚合酶链反应(quantitative real time polymerase chain reaction,qRT-PCR)在分析SLN微转移中的价值。方法:对22例行根治术的结直肠癌患者,术中行CNP和TSC联合活检SLN。对常规病理学检查SLN及非SLN均阴性的SLN行细胞角蛋白20 (cytokratin 20,CK20) IHC检测。对所有SLN组织用qRT-PCR检测CK20-mRNA的水平。结果:22例患者中20例检出35个SLN,SLN活检(sentinel lymph node biopsy,SLNB)成功率为90.91%,每例平均(1.75±0.97)个。以HE染色病理检查结果作为金标准,SLNB判断区域淋巴结转移状态总的灵敏度、准确度、阴性预测值、假阴性率分别为70.00%、85.00%、76.92%和30.00%。对10例HE检查阴性SLN加行CK20-IHC检测,2例呈阳性,这使20%的病例分期上升。对20例SLN组织的CK20-mRNA水平进行qRT-PCR定量分析,在5例患者的SLN中发现高水平的CK20-mRNA,其中1例IHC检查结果阳性。结论:CNP联合TSC定位活检结直肠SLN对于预测其区域淋巴结的转移状态具有潜在价值。qRT-PCR联合IHC能够提高微转移的检出率。SLN中CK20-mRNA的水平差异可能和预后相关,但需要增加样本量作进一步评价。
英文摘要:Objective: To evaluate the feasibility of sentinel lymph node (SLN) biopsy with carbon nanoparticles (CNP) and 99mTc sulfur colloid (TSC) for colorectal cancer.To evaluate the value of immunohistochemistry (IHC) and quantitative Real Time PCR (QRT-PCR) for detection micrometastasis in SLN. Methods: Twenty-two patients who underwent radical resection of a primary colorectal cancer were enrolled. During operation, SLN mapping was performed . All lymph nodes were stained with hematoxylin eosin (HE) staining. SLNs, when negative by routione HE staining, were further analyzed with CK20 IHC staining. SLN tissue from 20 patients were analyzed with qRT-PCR. Results: SLNs were detected in 20 of 22 patients with a successful detection rate of 90.91%. The number of SLNs ranged from 1 to 4,with a mean value of 1.75±0.97 per case.Of 10 patients with SLNs being negative by HE staining, there were 2 patients detected micrometatastases by CK20 IHC.Five of twenty patients were found high level CK20-mRNA in SLN tissue by qRT-PCR. Conclusions: Combined-agent SLN mapping is a potential diagnostic method for predicting local lymph node metastasis in the patients with CRC. IHC and qRT-PCR can increase detection rate of micrometastasis in SLN. But the clinical value of difference of CK20-mRNA in SLN needs to be further studied.
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