结直肠癌前哨淋巴结体外定位检测的临床研究

Clinical study of colorectal cancer sentinel lymph node in vitro positioning detection

目的:探讨用体外亚甲蓝作为染色剂寻找前哨淋巴结(sentinellymph node,SLN)的方法在结直肠癌SLN定位中的可行性及临床价值。方法:将行标准根治性切除的结直肠癌标本离体后,在肿块四周黏膜下注射亚甲蓝后追踪辨认。蓝染的淋巴结视为SLN,未蓝染的淋巴结被视为NSLN。SLN中无癌细胞转移者常规行细胞角蛋白(CK、AE1/AE3)免疫组化检查,CK阳性者视为有微转移病例。结果:82例患者成功标记SLN(96.47%),准确度为90.24%。通过CK检测,16例SLN阴性患者发现微转移,总转移率提升了18.30%,TNM分期得以提升的患者达18.82%。HE染色下SLN的假阴性率为23.17%,结直肠癌的假阴性率分别为6.38%和45.71%,有统计学意义(P=0.001)。结论:前哨淋巴结活检(SLNB)对结肠癌区域淋巴结转移情况的判断更有临床价值,但在直肠癌方面的应用值得进一步探讨。

Objective：To evaluate the feasibility and utility of an ex vivo sentinel lymph node（SLN） identification and ultrastaging for eolorectal cancer（CRC）. Methods：The radically resected specimens of colorectal cancer were in- jected with Methylene blue into subserosa of the large bowel around the tumor. The specimens were fixed routinely and subjected to subsequent pathologic examination. The blue stained lymph nodes were considered as SLNs. No blue - stained lymph node was regarded as NSLN,without metastasis routine cytokeratin cancer cell SLN（ CK, AE1/AE3 ） immunohistoehemieal examination, CK positive as micro metastasis. Results：82 patients were successfully labeled with SLN（96.47% ） ,the accuracy was 90.24%. Testing by CK, 16 cases of SLN negative patients find mierometastasis. The total transfer rate was 18.30%. TNM stage of the promotion of the patients was 18.82% , no statistical signifi- cance with colorectal cancer. HE staining of SLN under the false negative rate 23.17% ,false negative colorectal canc- er rates were 6.38% and 45.71% （P 〈0.05）. Conclusion：SLNB is of clinical value for metastasis of colon cancer with regional lymph node, but the application in colorectal cancer need further research.