CK19 mRNA测定在乳腺癌腋淋巴结微转移诊断中的应用

The Use of CK19 mRNA in Diagnosing Micrometastases of Breast Carcinoma in Axillary Lymph Nodes

研究敏感的方法检测乳腺癌腋窝淋巴结微转移。方法:对15例乳腺癌者的61个腋淋巴结和5个正常对照淋巴结同时进行HE染色组织学检查和CKl9逆转录-聚合酶链式反应(CK19RT-PCR)检测。结果:15例乳腺癌组织均有CK19mRNA表达,而5个正常淋巴结中均末见表达。61个腋窝淋巴结中7个组织学检查证实转移,其CK19mRNA亦表达阳性。组织学检测无转移的54个淋巴结中有12个CK19RT-PCR表达阳性,42个阴性;提示该12个淋巴结存在微转移只能用CK19RT-PCR方法检测出。经统计学分析,CK19RT-PCR与组织学检查二者有显著差异(X^2检验,P<0.01)。结论:CK19表达于恶性乳腺细胞,正常淋巴细胞无表达,CK19能作为组织特异基因进行RT-PCR扩增以检测乳腺癌腋淋巴结微转移。CK19 RT-PCR方法比组织学方法更敏感,特别对在筛选组织学检查淋巴结阴性而具有高度复发危险性的病人将有实用价值。

Objective: To develop a sensitive method to detect breast carcinoma micrometastases in axillary lymph nodes(LNs). Methods: Sixty-one axillary LNs from 15 patients of breast carcinoma and 5 control LNs were submitted to pathological examination by using HE staining as well as to reverse transcriptase-polymerase chain reaction (RT-PCR). Results: CK19 mRNA expression was detected in all 15 primary breast carcinomas but not in 5 control LNs. Of 61 axillary LNs, 7 LNs were found to bear metastasis by means of histological staining and CK19 PT-PCR. Of the remaining 54 diagnosed to be exempted from metastases by HE staining, 12 were found to have metastases by the CK19 RT-PCR method, 42 were found negative by using both HE staining and CK19 RT-PCR. The 12 lymph nodes detected only by the CK19 RT-PCE indicated that there is a significant difference between the results obtained by the RT-PCR method and HE staining(X2,P<0.01). Con-clusions: CK19 is expressed in malignant breast cell and not in lymphocytes. CK19 mRNA can be targeted as a tissue specific marker for micrometastases detection in breast cancer. It is a more sensitive method than the histologic study especially in discovering recurrence in patients at high risk who have negative lymph node histologically.