乳腺癌前哨淋巴结中细胞角蛋白19的表达及临床意义

Expression of CK19 in sentinel lymph node for breast cancer and its clinical significance

目的 检测乳腺癌前哨淋巴结（SIN）组织中细胞角蛋白19（CK19）在mRNA和蛋白水平的表达情况,以探讨检测淋巴结CK19的表达对预测乳腺癌前哨淋巴结微转移的临床价值.方法 本组30例可手术的原发性乳腺癌患者,手术中均行肿块周围或乳晕周围注射亚甲蓝进行SLN定位成功,同时常规行腋窝淋巴结清扫,术后对SLN和非SLN均行常规病理学检测,对SLN同时采用RT-PCR和Western Blot方法检测CK19的表达.结果 30例SLN常规病理检测发现8例阳性SLN,阳性率为26.67%（8/30）,1例假阴性.应用RT-PCR方法和Western Blot方法检测30例SLN中CK19的表达,结果HE染色阳性的8例SLN及1例假阴性SLN均呈阳性表达,共有12例SLN CK19mRNA表达阳性,阳性率为40.0%（12/30） Western Blot检测发现1I例SLN CK19呈阳性,阳性率为36.67%（11/30）.RT-PCR、Western Blot检测结果分别与HE染色结果比较,差异均有统计学意义（P〈0.05）,假阴性率为0.结论 CK19mRNA可作为标志物来检测乳腺癌SLN中的微转移情况 RT-PCR方法可检测到SLN微转移灶,通过SLN定位后检测其中CK19mRNA的阳性表达,可明显提高乳腺癌SLN的阳性率,降低SLN单纯病理检测的假阴性率.

Objective To detect the expression of CK19 in sentinel lymph node for breast cancer and to evaluate its clinical significance.Methods SLNs of 30 patients with breast cancer were successfully detected with methylene blue,both SLN and ALN were examined by hematoxylin and eosin staining （ HK staining）. The expression level of CK19 in SLNs were assessed by RT-PCR and Western Blot for mRNA and Protein respectively. Results Detection positive rate of SLN melastases was 26. 67% （8/30） by HE staining,and 1 case of false negative. Through RT-PCR,12 cases,including all the positive cases detected by routine pathological examination,were detected to be positive in the expression of CK19mRNA, with a positive rate of 40. 0% （ 12/30） , and a positive rate of 36. 67% （11/30） for CK19 was observed by Western Blot There was a significant difference between RT-PCR or Western Blot methods and routine pathological examination （ P 〈 0.05 ） for the detection efficiency of SI.Ns melastases. Conclusions CK19rnRNA may be a potential tumor marker for detecting micrometastasis in SLNs of breast cancer. The combined utilization of locating SLNs and detecting CK19 mRNA expression by RT-PCR instead of histopathological examination can greatly enhance the detection efficiency of SLN micrometastasis of breast cancer.