结肠癌前哨淋巴结微转移的检测

Micrometastasis examination of sentinel lymph node in colon cancer

目的:探讨监测结肠癌淋巴结转移的简便而准确的方法。方法:对5 6例结肠癌患者应用术中染料定位的方法对其前哨淋巴结(sentinellymphnode ,SLN)进行了定位,绿染的第一个淋巴结为SLN ,术后从根治性切除的标本中寻找SLN。常规HE染色检查从标本中找到的SLN ;对常规检查为阴性的SLN进行抗CEA免疫组化染色(SP法) ,寻找阳性染色的淋巴结。结果:共检出SLN130枚,每例患者的SLN为1～4枚,平均2 .5枚。HE染色共发现有转移者15例,2 4枚,患者淋巴结转移率为2 7%(15 /5 6 ) ;淋巴结阳性率为18% (2 4 /130 )。免疫组化法在4 1例HE染色阴性的患者中又发现有30例存在微转移,微转移的发生率为73% (30 /4 1) ;在HE染色阴性的10 6枚SLN中共有80枚免疫组化阳性,SLN微转移发生率为75 .5 % (80 /10 6 )。结果显示免疫组化检测SLN的转移率明显高于常规HE染色(P <0 .0 1)。结论:通过对结肠癌SLN进行术中定位,术后深入细致的病理学检测,可以在不增加病理科医生工作量的情况下明显提高对结肠癌淋巴结转移的检出率。

Objective:To investigate a convenient an d accurate method to detect the metastasis of lymph node in colon cancer. Methods:Sentinel lymph node(SLN) of 56 cases with colon c ancer was mapped by staining method.The SLN were searched in the samples after radical excision ,and examined metastasis of lymph nodes by routine hematoxylin and eosin(HE) stain.Whe n the lymph nodes were negative by HE stain,the immunohistochemistry stain was u sed to detect the micrometastasis of SLN.Results:A total of 130 SLNs were found in the 56 cases ,ranged from 1 to 4 in each patient , averagely 2.5 pills. Metastasis was diagnosed in 15 cases and 24 SLNs by HE s tain.The metastasis rate of SLN was 27%(15/56) in cases and 18%(24/130)in SLNs.A nother 30 were found with metastasis in the 41 patients who was diagnosed negative by HE stain. Eighty SLNs were found with mi crome tastasis in the 106 SLN which were detected negative by HE stain. Micrometastasi s rate was 73%(30/41)in patients and 75.5%(80/106)in SLNs.The metastasis rat e was higher by immunohistochemistry than by HE stain(P<0.01). Conclusion:Mapping the SLN of patients with colon cancer in operation and then focussing the examination is a good method to diagnose the me tastasis rate of lymph node.