病检阴性胃癌淋巴结转移的检测:免疫组化和RT-PCR的比较

Detection of micrometastases in the lymph nodes of patients with pN0 gastric cancer:a comparative study between immunohistochemistry and RT-PCR

目的:比较免疫组化和RT-PCR方法对常规病检阴性(pN0)胃癌淋巴结微转移的检测价值。方法:研究pN0胃癌14例249枚淋巴结,分别用癌胚抗原和CK19作为标记物,用免疫组化和RT-PCR方法检测淋巴结微转移。结果:在6例患者的淋巴结中发现微转移,免疫组化和RT-PCR法分别发现11枚和19枚微转移淋巴结,2种方法发现的微转移阳性率分别为4.4%和7.6%。在免疫组化检测阳性的11枚淋巴结中,8枚用CK19和癌胚抗原的抗体染色均为阳性,另3枚仅在CK19抗体染色时阳性而癌胚抗原的抗体染色阴性。在19枚RT-CPR检测阳性的淋巴结中,15枚用CK19和癌胚抗原作为标记物检测均为阳性,另4枚仅在用CK19检测阳性而用癌胚抗原作为标记物检测为阴性。所有用免疫组化检测为阳性的淋巴结用RT-PCR检测均为阳性,但19枚RT-PCR检测阳性的淋巴结中枚有10枚被免疫组化证实为阳性。结论:RT-PCR是比免疫组化更为敏感的检测胃癌淋巴结微转移的方法,而CK19作为检测标记物比癌胚抗原更敏感。

Objective:To compare diagnostic power for the detection of micrometastases in the lymph nodes of pN0 gastric carcinomas between immunohistochemistry and RT-PCR.Methods:249 lymph nodes from 14 pN0 gastric cancer patients were studied,and micrometastases in lymph nodes were investigated by immunohistochemistry and RT-PCR in all the lymph nodes with CEA and CK19 as the markers.Results:Micrometastases were found in 6 different patients, and fiybd in 11 and 19 lymph nodes by immunohistochemistry and RT-PCR, respectively.The positive rates for micrometastases by immunohistochemistry and RT-PCR were 4.4% and 7.6%, respectively.Eight lymph nodes were positive with both CK19 and CEA immunostaining in the 11 lymph nodes positive with immunostaining, the other 3 lymph nodes were only positive with CK19 immunostaining but negative with CEA immunostaining.In the 19 lymph nodes positive with RT-PCR, 15 lymph nodes were positive with both CK19 and CEA expression, the other 4 lymph nodes were positive with CK19 expression but negative with CEA expression. All of those with positive immunostaining were positive with RT-PCR for the same marker, but only 10 of 19 lymph nodes positive with RT-PCR were confirmed with immunohistochemistry.Conclusion:RT-PCR is more sensitive than immunohistochemistry for detection of micrometastases in lymph nodes of gastric cancer patients,and CK19 is more sensitive than CEA when used as a marker in both methods.