常规苏木精-伊红染色诊断早期胃癌黏膜下淋巴管浸润状况的价值

Clinical value of routine haematoxylin-eosin stain in diagnosing submucosal lymphatic vessel infiltration in early gastric cancer

目的评价常规苏木精-伊红染色诊断早期胃癌黏膜下淋巴管浸润状况的价值。方法4420例接受剖腹胃癌D2根治术的早期胃癌．常规方法行苏木精-伊红染色检测黏膜下淋巴管浸润状况，并与病理诊断淋巴结转移状况作比较。结果全组早期胃癌患者中，常规苏木精-伊红染色诊断黏膜下淋巴管浸润的灵敏度、特异度、准确度、阳性预测值和阴性预测值分别为54．5％、82．0％、78．9％、27．4％和93．5％；其中2426例局限于黏膜内者分别为14．5％、98．0％、95．8％、15．8％和97．8％；而1994例侵及黏膜下层者则分别为60．3％、57．8％、58．3％、28．1％和84．2％。黏膜下淋巴管浸润阳性率与淋巴结转移阳性率显著相关（P〈0.01）；但与早期胃癌的预后无关（P〉0.05）。黏膜下淋巴管浸润阳性组和阴性组术后5年生存率分别为84．4％和87．3％．中位生存期分别为6998d和7237d，平均生存期分别为6163．9d和6042．6d（P=0．2495）。结论常规苏木精-伊红染色准确度过低．不适合于诊断早期胃癌黏膜下淋巴管浸润状况。

Objective To evaluate the value of routine haematoxylin-eosin （HE） stain for submucosal lymphatic vessel infiltration in early gastric cancer. Methods Four thousand four hundred and twenty early gastric cancer patients underwent D2 operation. Submucosal lymphatic vessel was detected by routine HE stain. The results were compared with pathological lymph node metastasis. Results In early gastric cancer, the sensitivity, specificity, accuracy, positive predicting value （PPV）, and negative predicting value （NPV） of routine HE stain for submucosal lymphatic vessel infiltration were 54.5%, 82.0%, 78.9%, 27.4%, and 93.5% respectively. In early gastric cancer limited in mucosa, these indexes were 14.5%, 98.0%, 95.8%, 15.8%, and 97.8% respectively. In early gastric cancer infiltrated to submucosa, they were 60.3%, 57.8%, 58.3%, 28.1%, and 84.2% respectively. There were significant differences of submucosal lymphatic vessel infiltration with lymph node metastasis （P〈0.001）, but no significant difference with survival rate. The 5-year survival rates of submucosal lymphatic vessel infiltration positive and negative group were 84.4% and 87.3%, median survival time was 6998 d and 7237 d, and mean survival time was 6163.9 d and 6042.6 d respectively （P=-0.2495）. Conclusion The accuracy of routine HE stain is too low, thus it is not suitable for diagnosing submucosal lymphatic vessel infiltration in early gastric cancer.