早期胃癌前哨淋巴结微转移临床分析

Clinical analysis on micrometastasis of sentinel lymph nodes in early gastric cancer

目的探讨亚甲蓝示踪法前哨淋巴结(SLN)活检术在早期胃癌外科诊疗中的临床意义。方法 39例早期胃癌患者,术中用亚甲蓝示踪SLN,对SLN及所有术后胃周淋巴结进行HE染色,对SLN进一步行细胞角蛋白20(CK20)的免疫组化染色(IHC)及逆转录聚合酶链反应(RT-PCR)检测。比较3种检测方法对SLN转移灶检出的差异。结果 39例患者中,亚甲蓝示踪成功检出37例,检出成功率达94.5%。IHC与RT-PCR微转移检出率均为18.9%。由SLN状态预测胃周淋巴结转移情况:HE切片病检组前哨淋巴结检测准确率97.3%(36/37),假阴性率为16.7%(1/6);CK-20行IHC及RT-PCR组检测准确率97.3%(36/37),假阴性率为14.3%(1/7)。结论亚甲蓝示踪法能有效检出早期胃癌SLN。HE染色结合IHC及RT-PCR检测能提高SLN中微转移的检出率。

Objective To investigate the clinical significance of methylene blue tracer in sentinel lymph node（SLN） biopsy in the diagnosis and treatment of early gastric cancer.Methods With methylene blue tracer,micrometastasis of early gastric cancer in SLN was detected by HE stain in 39 cases,which was compared to the results reported by the examinations of cytokeratin 20（CK20） immunohistochemistry（IHC） and RT-PCR technique.Results With methylene blue tracer,micrometastasis of early gastric cancer in SLN was detected by HE stain in 37 cases（94.5%）.The detection rate of micrometastasis of early gastric cancer in SLN was 18.9% by IHC and RT-PCR.In predicting the micrometastasis,the accuracy rate was 97.3%（36/37） and false negative rate was 16.7%（1/6） reported by HE stain,which were 97.3%（36/37） and 14.3%（1/7） by IHC and RT-PCR of CK-20 protein,respectively.Conclusion Methylene blue tracer method,especially combined examination with IHC and RT-PCR,can effectively increase the detection rate of the micrometastasis in early gastric cancer SLN.