CK19在非小细胞肺癌淋巴结微转移中的检测价值(附90例分析)

Detection value of CK19 in lymph node micrometastasis of NSCLC:analysis of 90 cases

目的分析pT1a^bN0M0 Ia1~2期非小细胞肺癌(NSCLC)患者术后淋巴结微转移情况、危险因素,以及淋巴结清扫术的方式。方法应用免疫组化法检测90例经手术治疗的孤立单发直径≤2 cm的NSCLC患者CK19表达水平,以评估淋巴结微转移情况,并结合临床资料进行分析。结果 90例患者术后常规HE染色阴性淋巴结6例(6.6%)检出CK19阳性表达。微乳头或实性为主的病理类型、CEA水平≥5 ng/mL的患者,术后淋巴结CK19表达显著(P<0.05)。其中微乳头或实性为主的病理类型是发生淋巴结微转移的危险因素。纯磨玻璃结节术后淋巴结未发现微转移灶;部分实性磨玻璃结节术后检出2例淋巴结微转移。结论 Ia期NSCLC患者可发生淋巴结微转移,微乳头或实性为主的病理类型是发生淋巴结微转移的危险因素;CT影像表现为纯磨玻璃的肺癌结节术中可避免行系统性淋巴结清扫;部分实性磨玻璃结节,若术中冰冻病理提示有微乳头或实性为主或术前CEA水平≥5 ng/mL应行系统性淋巴结清扫。

Objective To analyze lymph node micrometastasis in the patients with non-small cell lung cancer(NSCLC)(pT1 a-bN0 M0 Ia1-2 stage,IASLC eighth edition of the TNM classification for lung cancer) after surgery,explore the risk factors of lymph node micrometastasis, and further analyze the choice of surgical procedures for stage Ia1-2 NSCLC lymph node dissection.Methods A total of 569 lymph nodes from 90 surgically treated isolated pulmonary nodules(diameter≤2 cm) were selected, the expression of CK19 was detected by immunohistochemistry and analyzed together with the clinical data.Results CK19 expression was detected in 6 cases(6.6%) of 90 patients with conventional H&E-staining negative lymph nodes after surgery.In patients with micropapillary or solid pathology type and CEA level ≥5 ng/mL, the expression of CK19 in lymph nodes was statistically different(P<0.05).Among them, micropapillary or solid pathology was a risk factor for lymph node micrometastasis.No micrometastasis were found in lymph nodes after pure Ground-Glass Opacity(pGGO) surgery;two cases of lymph node micrometastasis were detected after Part-solid GGO surgery.Conclusion Lymph node micrometastasis can occur in patients with stage Ia1-2 NSCLC.Micropapillary or solid pathology is a risk factor for lymph node micrometastasis.CT images show pure ground glass lung cancer nodules,which can be avoided during surgery.For some solid ground glass nodules, if intraoperative frozen pathology indicates micropapillary or solid components or preoperative CEA level ≥ 5 ng/mL,systemic lymph node dissection should be performed.