结直肠癌前哨淋巴结体外标本定位及其微转移免疫组化研究

Mapping the sentinel lymph node ex vivo and finding the micrometastasis by CK-immunostaining in carcinoma of the colon and rectum

目的探讨结直肠癌前哨淋巴结(SLN)体外定位技术方法及其可行性、准确性和临床价值.方法选择2003年3月至2003年10月间中山大学肿瘤防治中心腹科住院行根治手术的结直肠癌患者60例,62个肿瘤(2例患者为多原发),进行体外SLN定位.标本离体后尽早进行异硫蓝SLN定位,传统病理检查阴性的SLN进行细胞角蛋白免疫组化检查.结果 62例肿瘤成功检出SLN的59例,检出率95.2%.59例患者总共获得并检测1114枚淋巴结,平均每人18.9(4～46)枚.其中SLN 157枚(14.9%),平均每人2.7(1～9)枚.SLN敏感性39.1%(9/23),假阴性率23.7%(14/59),准确率76.3%(45/59).50例SLN阴性的中有12例(24%)细胞角蛋白免疫组化检测阳性.36例HE和细胞角蛋白免疫组化检查全阴性者中4例(11.1%)SLN发现微转移灶.14例仅非SLN阳性中8例SLN发现微转移灶.结论结直肠癌异硫蓝SLN体外定位活检技术是可行的,结合免疫组化检测微转移可以提高术后分期,可以提高送检淋巴结个数,结合免疫组化技术,可以减少淋巴结转移漏诊发生率.但该方法假阴性率较高,不能完全取代常规淋巴结病理检查.

Objective To evaluate the feasibility and utility of an ex vivo sentinel lymph node （SLN） identification and uhrastaging for colorectal cancer （CRC）. Methods CRC patients undergoing resection of a primary colorectal cancer were considered for inclusion. Following resection, SLN identification was performed. The SLN was dissected from the mesentery and submitted separately for pathologic analysis. All lymph nodes were stained with HE. Blue lymph nodes, when negative by routine HE staining, were further analyzed. Results A total of 62 tumors from 60 patients with colorectal cancer were studied. 95. 2% （59/62） specimens was successfully identified. In these 59 specimens, a total of 1114 （ 18. 9 per specimens） lymph nodes were examined; of these, 157 （ 14. 9% ） were designated as SLNs. The number of blue-stalnod lymph nodes removed ranged from 1 to 9, with a mean of 2. 7 blue nodes identified. The sensitivity of a blue-stained lymph node identifying metastatic disease was 39. 1%. The false-negative was 23.7%. In 4 specimens micrometastases were detected only by immunohistochemistry with cytokeratin. Conclusions Ex vivo sentinel lymph nodes mapping in colorectal cancer is feasible and can identify the SLNs with a very high success rate. Ex vivo SLN mapping improves pathologic staging of patients with CRC. The SLN evaluation should not replace attempts to harvest large number of nodes for standard processing. SLN mapping can help improving the number of nodes for pathological examination.