胃癌前哨淋巴結體外檢測的臨床意義

Abstract

目的：探討胃癌前哨淋巴結(sentinel lymph node, SLN)體外測圖技術的可行性及其 對提高胃癌淋巴結病理分期準確性的臨床意義。方法：整塊切除的新鮮胃癌標本19例 病灶周圍漿膜或粘膜下注入10g/L專利藍，將標本內藍染淋巴結視為SLN，予以切除行 常規病理檢查，對陰性結果者進一步行細胞角蛋白免疫組化(immunohistochemistry, IHC)染色。結果：SLN檢測陽性率89.5% (17/19)，獲取SLN1-3個／例，平均14個／ 例。常規HE染色時，SLN診斷胃癌淋巴結轉移的準確性為70.5% (12/7)，假陰性率為 38.4% (5/3)；IHC染色後使25.0% (1/4 )胃癌病例的淋巴結病理分期得到上調，診斷 準確性提高至88.2% (15 /17)，假陰性率降低至14.2% (2/14)。結論：胃癌SLN體外 檢測可作為輔助手段使部分胃癌病例的病理分期得到上調。 AIM: To investigate the feasibility of ex vivo sentinel lymph node ( SLN) mapping and its clinical significance in improving the staging of gastric cancer. METHODS: Nineteen patients received curative resection of primary gastric cancer with extended lymph node dissection were included in this study. Gastric specimens were submucosally or subserosally injected with 10g/L Patent Blue. The blue-stained SLNs were excised for routine pathological examination (hematoxylin and eosin staining). The SLNs, which were negative after HE staining, were further examined by cytokeratin immunohistochemistry. RESULTS: The SLNs were identified in 89.5% (17/19) cases, with a mean number of 1.4 (1-3) for each case. After HE staining, the accuracy of the SLNs in diagnosis of the regional lymph node metastasis was 70.5% (12/17), and the false-negative rate was 38.4%. However, one case (25%) was upstaged by cytokeratin immunohistochemistry. Thus, the diagnostic accuracy increased to 88.2% and the false- negative rate decreased to 14.2%. CONCLUSION: Ex vivo SLN mapping in gastric cancer is technically feasible and may upstage some of the gastric cancer