cNO舌鳞癌颈淋巴结微转移检测及其临床意义

背景与目的:常规病理检查颈淋巴结阴性舌鳞状细胞癌(简称舌癌)术后出现颈部复发可能与微转移有关.本研究探讨I临床颈部阴性(cNO)舌癌患者淋巴结微转移情况及其临床意义.方法:49例患者523枚颈淋巴结同时行常规HE染色和CK19免疫组化(IHC)染色,所有病例随访9～83(平均56)月.结果:HE染色检出5例患者7枚(1.3%)淋巴结转移;IHC染色检出19例34枚(6.5%)淋巴结转移,两种检测方法差异有统计学意义(P<0.05).14例患者27枚(5.2%)淋巴结存在微转移.HE染色将3例cNO舌癌分期上升至pN1期,2例cNO上升至pN2b期;IHC染色将3例cNO舌癌分期上升至pN1期,16例cNO上升至pN2b期.淋巴结微转移与性别、年龄、T分期、分化程度和浸润深度无相关性(P>0.05).有、无微转移患者5年生存率分别为78.5%和86.7%,两者之间差异无统计学意义(P>0.05).结论:免疫组化染色可提高舌癌颈淋巴结转移的检出率和病理分期的准确性.本实验未能证明微转移与预后的关系,该问题仍有待进一步研究.     

淋巴结显示液联合CK19在乳腺癌腋窝淋巴结检测中的临床意义

目的探讨淋巴结显示液(LNRS)联合CK19在乳腺癌腋窝淋巴结检出及微转移灶检测中的临床意义。方法 58例经根治性手术乳腺癌标本分别应用传统法和LNRS法检出淋巴结,应用HE染色检测淋巴结转移状况,HE染色阴性淋巴结进一步行CK19免疫组织化学检测微转移病灶。结果传统法检出淋巴结774枚,HE染色pN0期患者37例(淋巴结463枚);应用LNRS处理后多检出淋巴结469枚,HE染色pN0期患者45例(淋巴结332枚);传统法和LNRS法HE染色均为pN0期的患者35例(传统法淋巴结441枚及LNRS法淋巴结244枚,共685枚)。685枚淋巴结进一步行CK19免疫组织化学检测,5例患者(淋巴结17枚)发现微转移病灶。传统法pN0期的患者中有13.5%(5/37)的患者分期移动为pN1mi;传统法pN0期的患者中有5.4%(2/37)的患者分期移动为pN1;传统法pN1期的患者中有16.7%(2/12)的患者分期移动为pN2;传统法pN2期的患者中有14.3%(1/7)的患者分期移动为pN3,总体上共有17.2%(10/58)的患者发生了N分期的移动。结论应用LNRS能够显著提高乳腺癌腋窝淋巴结检出数量,行CK19免疫组织化学检测微转移病灶,可更准确地反映乳腺癌腋窝淋巴结的转移状态,对于评估N分期及指导术后治疗有一定临床意义。     

舌体鳞癌颈淋巴结转移的规律和治疗策略

背景与目的:目前,对临床颈淋巴结阴性(cN0)的舌癌病例是否需行颈淋巴清扫术治疗仍存争议。本研究目的在于探讨舌体鳞癌的颈部淋巴结转移规律和分区性颈淋巴结清扫术应用于cN0舌癌病例的理论依据和应用原则。方法:回顾性分析1991年至1997年214例手术治疗的舌体鳞癌患者的临床资料;分析cN0pN+(病理检查淋巴结阳性)病例和cN+pN+病例的颈部转移淋巴结分布规律;比较不同分组的远期疗效;Cox回归分析法筛选影响舌体鳞癌患者预后的因素。结果:pN+病例69例,颈淋巴结转移率32.2%,其中同侧Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区各占22.3%、33.5%、22.3%、4.6%、1.0%;对侧Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区各占6.6%、3.6%、3.0%、2.0%、0.5%。pN+组和pN0组5年生存率各为47%、83%(P<0.001);Cox回归分析显示影响舌体鳞癌患者预后的独立因素为T分期、N分期。结论:舌体鳞癌淋巴结转移最常见于同侧颈部Ⅰ、Ⅱ、Ⅲ区;分区性颈淋巴结清扫术对cN0病例既可起治疗的作用,又可用于评价颈部淋巴结转移状况以决定是否行全颈淋巴结清扫术。     

临床N0期舌癌颈淋巴结转移相关因素及其外科处理

目的 探讨舌癌隐匿性颈淋巴结转移规律和相关影响因素,以及不同颈淋巴清扫术式对舌癌 的预后影响,为cN0期舌癌患者颈淋巴清扫术术式的选择提供理论依据。方法 收集2002年1月至2010 年8月在广西医科大学附属肿瘤医院头颈外科初治的cN0期舌癌住院患者87例。通过单因素分析隐匿性 颈淋巴结转移与年龄、性别、术前疾病持续时间、原发灶浸润深度、T分期、病理分级的相关性,多 因素分析cN0期舌癌患者的预后影响因素,探讨舌鳞癌颈部转移规律及外科处理方式。结果 单因素 统计分析显示：性别、年龄、术前疾病持续时间对cN0期舌癌患者隐匿性颈淋巴结转移的影响差异无 统计学意义（P＞0.05）,而原发灶浸润深度、T分期、病理分级等因素对颈淋巴结转移的影响差异有 统计学意义（P＜0.05）。多因素Cox风险比例模型分析显示：只有T分期是舌癌cN0期患者的独立预 后因素,不同颈淋巴清扫术对其预后的影响差异无统计学意义。颈择区性淋巴清扫术对肩部的影响更 小（P＜0.05）。结论 原发灶浸润 深度、T分期、病理分级与cN0期舌 癌隐匿性颈淋巴结转移有关,可以作 为预测cN0期舌癌隐匿性颈淋巴结转 移的指标;cN0期舌癌具有较高的隐 匿性颈部淋巴结转移率,以同侧颈部 Ⅰ、Ⅱ、Ⅲ区最为常见,主张行颈择 区淋巴清扫术。     

淋巴结标记及微转移检测对胃癌病理分期的影响

目的:本研究采用改良淋巴结显示液(MLNRS)与免疫组织化学染色(IHC)联合法对胃癌术后标本进行区域淋巴结检查,分析其对病理分期(pTNM)的影响.方法:以46例胃癌术后标本为研究对象.先行传统法检出淋巴结,再经MLNRS染色进一步检出淋巴结,所有淋巴结经HE染色诊断是否有转移,无转移者再经IHC法检测微转移.结果:传统法检出淋巴结共1 456枚,HE染色130枚有转移,无转移者再经IHC法检测出63枚存在微转移.标本再经MLNRS染色后又检出1 377枚淋巴结,其中HE染色106枚有转移,无转移者再经IHC法102枚存在微转移.联合检查法淋巴结平均检出数及淋巴结转移检出率均较传统检查法明显增加,差异有统计学意义.不同检查方法分组比较,pN分期以及pTNM分期结果差异明显,具有统计学意义.结论:MLNRS能够提高胃癌区域淋巴结平均检出数,IHC法有助于检测淋巴结微转移,两者联合应用能够提高胃癌区域淋巴结转移检出率,使术后病理分期更为准确.     

临床Ⅰ和Ⅱ期肺癌纵隔淋巴结微小转移灶的研究

目的 研究早期肺癌患者纵隔淋巴结内癌细胞微小转移的发生发展规律及其临床意义。方法 收集32例临床分期为Ⅰ期或Ⅱ期且未经任何术前治疗的肺癌患者的181枚纵隔淋巴结,每枚淋巴结于两个不同层面切取冰冻切片,用抗上皮细胞抗原的Ber-Ep4抗体进行免疫组化染色,同时行HE染色进行对照,观察早期肺癌纵隔淋巴结内微小转移的情况。结果 15例患者(46．9％)的2l枚(11．6％)常规病理石蜡切片HE染色阴性的纵隔淋巴结,经Ber-Ep4免疫组化染色发现有微小癌细胞转移灶,其中6例患者冰冻切片HE染色也发现有微小转移灶。术后常规病理检查确定为N0、N1、N2的患者分别为19,6,7例,Ber-Ep4免疫组化染色后微小转移灶阳性的患者分别为7,2,6例,即7例Ⅰb期(N0)和2例Ⅱb期(N1)患者上升为Ⅲa期(N2)。32例早期肺癌患者术前临床分期、术后常规病理分期和免疫组化分期中,N2患者分别占0、18．8％和46．9％。结论病期愈晚,纵隔淋巴结微小转移愈多见,Ber-Ep4免疫组化染色较两平面HE染色更易于发现淋巴结中微小转移灶。临床诊断为早期肺癌患者的临床分期和常规病理分期存在分期偏早现象。     

甲状腺滤泡状癌淋巴结N0期与淋巴结微转移的相关性研究

目的 探讨甲状腺滤泡状癌淋巴结N0期与淋巴结微转移的相关因素.方法 83例432枚常规病理检查阴性的颈淋巴结(pN0),其中N115例,颈淋巴结(pN0)76枚;N0 68例,颈淋巴结(pN0)356枚.选择细胞角蛋白(CK-19)单克隆抗体,应用免疫组化SP法进行检测,确定其微转移情况并与随访资料进行对比分析.结果 83例中16例(19.3%)58枚淋巴结有微转移.在微转移患者中9例(9/16)出现局部复发或远处转移,而67例无微转移患者中仅6例(6/67),P＜0.001.同时,N1、N0其微转移分别是7例(7/15)和9例(9/68),P＜0.01.结论 甲状腺滤泡状癌淋巴结微转移与肿瘤复发及转移密切相关.微转移的检测对术后辅助治疗和预后评估具有一定的指导意义.     

舌癌前哨淋巴结微转移检测的初步研究

目的 探索舌癌前哨淋巴结(Sentinel node, SN)微转移检测的适当方法及其预测颈部转移状况的功效.方法 使用γ探头法、术前核素扫描+γ探头法、γ探头法+术中亚甲蓝示踪法进行SN检测,以颈清扫标本的常规病理结果为金标准,评价各方法的功效.石蜡切片病理检查阴性的SN进一步行多层切片+免疫组化检查.结果 全组23例患者(其中初诊的cN0 20例、有手术史的cN0 1例、cN+2例)单用γ探头法,SN检出率为95.6%(22/23),假阴性率为10.5%(2/19),准确率为91%(20/22).5例cN0患者使用术前核素扫描+γ探头法,SN检出率为100%,均为cN0pN0,无假阴性.11例cN0患者使用γ探头探测+染料示踪法检测,全部定位到SN,无假阴性;多层切片+免疫组化检查微转移发现率为6.7%(3/45).结论 舌癌SN活检的初步研究显示出良好的应用前景,但还需进一步研究.术前核素扫描与术中γ探头法、生物染料法相结合是舌癌SN检测的适当方法.连续切片+免疫组化可提高微转移灶的检出率.     

T3-T4期声门型喉癌颈淋巴结转移情况及其与预后的关系

背景与目的:声门型喉癌颈淋巴结转移率低,有关报道不多,本研究旨在探讨T3-T4期声门型喉癌颈淋巴结转移的相关因素及其对预后的影响。方法:回顾性分析我院1992～2000年收治T3-T4期声门型喉癌83例的临床资料,对颈淋巴结转移率、转移淋巴结的分布、影响cN0颈部复发的因素(颈部预防性放疗、病理分级及T分期)、淋巴结转移与预后的关系。结果:T3-T4期声门型喉癌,总的颈淋巴结转移率为20.5%,cN0颈部复发率为14.3%。绝大多数转移淋巴结位于同侧Ⅱ、Ⅲ、Ⅳ区,仅1例位于对侧Ⅱ区。cN0者中,颈部预防性放疗与颈部观察在颈部复发率上无差异(P=0.772);病理分级影响cN0颈部复发率(P=0.028);不同T分期颈部复发率无差异(P=0.217)。cN 患者预后明显差于cN0患者(P<0.001);cN0颈部复发不影响预后(P=0.460)。对T3-T4期声门型喉癌cN 患者采用治疗性颈清扫;对cN0患者颈部可密切观察,待出现淋巴结复发再积极治疗。结论:T3-T4期声门型喉癌主要转移至同侧Ⅱ、Ⅲ、Ⅳ区;病理组织分化级别越差,cN0颈部复发的风险越大;cN0颈部复发与预后无关;对cN0患者颈部可进行密切观察;对出现淋巴结复发者应积极治疗。     

淋巴结微转移检测对结直肠癌病理分期的影响

目的:探讨淋巴结微转移对结直肠癌患者病理分期的影响。方法:对2003年3月至2008年10月间手术切除的60例结直肠癌患者的990枚淋巴结进行常规HE染色和CK20免疫组化检查,检测结直肠癌的淋巴结转移,并对结果进行统计学分析。结果:应用HE染色法淋巴结转移检出率27.2%(269/990),CK20免疫组化淋巴转移检测率为37.2%(368/990),两者差异有统计学意义(P<0.05)。99枚淋巴结检出有微转移,11例TNM分期提高,HE染色重新分期率为18.3%(11/60)。结论:CK20免疫组化的检测可以显著提高淋巴结转移的检出率,有助于更准确地进行结直肠癌的临床病理分期。     

MMP-2及CK19在早期宫颈癌淋巴结微转移中的表达及其意义

检测MMP-2和CK19在早期宫颈癌盆腔淋巴结中的表达,探讨淋巴结微转移的表达及意义。方法:采用免疫组化法对64例早期宫颈癌患者常规病理光镜检查证实无转移淋巴结902枚进行MMP-2及CK19的检测。结果:1）复发组477枚淋巴结中11枚CK19阳性（2.3%）,来自32例患者中的8例（25.0%）;8枚MMP-2阳性（1.7%）,来自32例患者中的6例（18.8%）,两种检测指标的结果有较好的一致性。未复发组425枚淋巴结中均无CK19及MMP-2阳性表达（0/425）,该组32例患者中CK19及MMP-2的阳性表达率均为0。二者之间比较差异有统计学意义。2）CK19及MMP-2表达与病理类型及组织的分化程度均有相关性（P<0.05）。3）复发组32例患者中带瘤生存25例,死亡7例,且均死于癌症,其中6例患者盆腔淋巴结中的CK-19及MMP-2检测均表达阳性,微转移与术后复发转移有相关性（P<0.05）。结论:采用免疫组化技术检测淋巴结中CK19及MMP-2表达可检测出早期宫颈癌淋巴结中的微转移,显著提高微转移的检出率。通过本研究证实MMP-2及CK19的高表达与宫颈癌的侵袭转移有关,可作为检测早期宫颈癌淋巴转移的生物学指标之一,指导临床治疗。      

Ⅰa-Ⅱa期宫颈癌患者盆腔淋巴结中高危型HPVDNA及CK19的检测及其意义

目的：分别采用原位杂交法和免疫组化法检测早期宫颈癌盆腔淋巴结中高危型HPVDNA和CK19的表达,探讨早期宫颈癌微小转移的检测率及检测方法。方法：选取28例早期宫颈癌患者常规病理光镜检查证实转移和未转移淋巴结共104个,分别采用原位杂交法和免疫组化法检测高危型HPVDNA和CK19的表达。结果：所有常规病理检查阴性的80个淋巴结中高危型HPVDNA的阳性检出率为45％（36／80）;CK19的检出率为25％（20／80）。常规病理光镜检查证实淋巴未转移患者的57个淋巴结中23个高危型HPVDNA阳性（43．5％）,来自15名患者中的9人（60%）;14个淋巴结CK19阳性（24．6％）,来自15名患者中的7名（46．6％）。患者的微转移检出率分别为60％和46．6％。两种检测方法的结果有较好的一致性。高危型HPVDNA的检出率高于CK19（P〈0．001）。结论：原位杂交法检测高危型HPVDNA,免疫组化法测CK19均可检测出早期宫颈癌淋巴微转移．玛班涤交法是分子水平的检测,在宫颈癌淋巴微转移的检测中可能更敏感可靠。     

Expression of high-risk HPV DNA and CK19 in pelvic lymph nodes in stage Ia-IIa cervical cancer and their clinical value

The aim of this study was to investigate the detection rate and methods of micrometastases in early-stage cervical cancer by detecting the expression of high-risk HPV DNA and CK19 in pelvic lymph nodes. A total of 104 lymph nodes with/without pathologically confirmed metastases, from 28 patients with early-stage cervical cancer, were included for detection of high-risk HPV DNA and CK19 expression using in situ hybridization and immunohistochemistry, respectively. The detection rate of high-risk HPV DNA and CK19 in lymph nodes in patients with pathologically-confirmed lymph node metastases was higher compared to that in lymph nodes in patients without pathologically-confirmed lymph node metastases (P<0.001). In all 80 pathologically-negative lymph nodes, the positivity rates of high-risk HPV DNA and CK19 detection were 45 and 25%, respectively. In 57 lymph nodes in patients without pathologically-confirmed lymph node metastases the positivity rates of high-risk HPV DNA and CK19 detection were 43.5 and 24.6%. The detection rate of high-risk HPV DNA and CDK19 in 15 patients without pathologically-confirmed lymph node metastases were 60 and 46.6%, respectively. The detection rates of high-risk HPV DNA and CK19 in 104 lymph nodes were 56.7 and 41.3% (KI=0.46). The results of the two detection methods showed good consistency. Both detection of high-risk HPV DNA by in situ hybridization, and CK19 by immunohistochemical method detected lymph node micrometastases in early-stage cervical cancer. As a method of detection on the molecular level, in situ hybridization was more sensitive for the detection of lymph node micrometastases in early-stage cervical cancer.     

PN0食管癌淋巴结微转移的检测及与预后的关系

目的探讨食管癌淋巴结微转移的免疫组化诊断方法并评价其预后意义.方法采用免疫组织化学方法,用细胞角蛋白19和粘蛋白1单抗检测56例经传统HE染色诊断为无转移(pN0)食管癌患者的118个淋巴结.对患者随访,应用x2检验比较患者的生存差别.结果淋巴结微转移率为25.0%(14/56),食管癌淋巴结微转移与TNM分期(T1/T2、T3)统计学处理结果显著相关(P＜0.05),而与其它临床病理特点无显著相关性(P＞0.05).有淋巴结微转移患者的3年生存率为53.85%,无转移者3年生存率83.63%,两组相比较差别非常显著(x2=7.24,P＜0.05).单变量与多变量分析结果显示,肿瘤浸润深度和淋巴结微转移是独立的预后因素.结论细胞角蛋白19和粘蛋白1单抗免疫组化染色方法较常规组织学检查方法敏感性更高,提高了淋巴结微转移的检出率,可以用来诊断淋巴结微转移,对pN0食管癌预后评价有一定价值.     

The efficiency of micrometastasis by sentinel node navigation surgery using indocyanine green and infrared ray laparoscopy system for gastric cancer

Background

The clinical application of sentinel node navigation surgery (SNNS) for patients with gastric cancer requires accurate intraoperative diagnosis of lymph node metastasis. However, the clinical significance of the diagnosis of lymph node micrometastasis for gastric cancer has not been established. In this study, we evaluated lymph nodes dissected during SNNS by immunohistochemistry with anti-cytokeratin antibody (IHC) staining for gastric cancer to investigate the usefulness of SNNS.

Patients and methods

The subjects were 130 patients with gastric cancer (3,381 lymph nodes) who underwent SNNS with infrared ray observation and lymph node dissection of D1+α or more. The dissected lymph nodes were stained with IHC (CAM 5.2), and the results were compared with intra- and postoperative diagnoses by hematoxylin and eosin (H&;E) staining. In addition, the association of metastatic lymph nodes and ICG-positive lymph nodes was examined.

Results

The number of patients (lymph nodes) with lymph node metastasis by HE and IHC staining was 16 (52 nodes) and 31 (91 nodes), respectively. Fifteen patients (27 nodes) diagnosed with pN0 by HE staining were diagnosed to be metastatic by IHC staining. The tumor depth of these patients was pT1 in ten patients (m, 3; sm, 7) and pT2 in five (mp, 4; ss, 1). Regarding the histological type, three patients were classified as well-differentiated type, while six patients each had moderately and poorly differentiated types. The grade of lymphatic invasion was ly0 in 5, ly1 in 6, and ly2 in 4, respectively. Histological assessment of 27 IHC-positive and HE-negative cells indicated 5 single cells, 16 clusters, and 6 micrometastases. These lymph nodes were all included in the sentinel nodes (SN) identified during surgery. All but one patient (0.8%) were recurrence-free at 2–8?years after surgery (median 74.7?months). The one patient developed anastomotic recurrence 4.5?years after the first operation and died.

Conclusion

Since all 27 lymph nodes in 15 patients with metastasis by IHC staining but not by HE staining were micrometastasis or less and included in the SN, ICG-positive lymphatic basin dissection by SNNS with infrared ray observation seems to be an adequate method of lymph node dissection for gastric cancer.     

Prognostic value of nodal micrometastases in patients with cancer of the gastro-oesophageal junction.

AIMS: Aim of this study was to examine the presence and the prognostic impact of immunohistochemically identified nodal micrometastases in patients with gastro-oesophageal junction (GEJ) carcinomas. METHODS: Between January 1988 and December 2000, 148 patients underwent a radical (R0) resection with a two-field lymphadenectomy for a GEJ carcinoma. Specimens of 60 patients in whom conventional haematoxylin and eosin (H & E) examination did not demonstrate lymph-node metastases (pN0) were available for immunohistochemical (IHC) analysis using antibodies AE1/AE3 directed against cytokeratins. Paraffin embedded material of all retrieved lymph nodes in these patients were serially sectioned and analysed by one pathologist after H & E examination for the presence of micrometastases by IHC. RESULTS: In 60 resection specimens initially staged as pN0 a total of 524 lymph nodes were available for IHC analyses. Micrometastases were detected in 126 out of 524 lymph nodes (24%), corresponding with 18 of the 60 patients (30%) who were upstaged by this technique. Compared with the pN0 group, the disease free survival (DFS) was significantly lower in patients with nodal involvement at IHC (p<0.001). Survival of patients with IHC identified micrometastatic disease was comparable to those with H & E positive lymph nodes. CONCLUSIONS: Micrometastases in regional nodes were detected by cytokeratin-specific IHC in 30% of radical resected GEJ tumours without overt nodal involvement. Their presence conveys a worse prognosis with a significant reduced DFS, suggesting that the finding of micrometastases should be included in the staging system.     

早期乳腺癌腋淋巴结转移的多因素分析

目的：探讨早期乳腺癌腋淋巴结转移（ALNM）的相关因素,并对阴性腋淋巴结行角蛋白19（CK19）检测以发现微转移癌.方法：收集乳腺癌病例138例,建立数据库,用Logistic回归进行单因素和多因素分析,并对有意义的指标进行相关分析,对40例患者441枚阴性腋淋巴结再切片,用CK19行免疫组织化学染色.结果：多因素分析显示肿瘤大小、肿瘤部位、癌抗原153（CA153）、人类表皮生长因子受体-2（HER2）4个指标进入Logistic回归方程,40例患者中有3例患者的腋窝淋巴结CK19免疫组织化学染色阳性.结论：肿瘤大小、肿瘤部位、CA153和HER2为乳腺癌患者ALNM的高危因素;CK19免疫组织化学染色可发现乳腺癌腋淋巴结微转移癌.     

CK19表达与子宫颈癌前哨淋巴结转移的关系

目的 观察CK19表达与子宫颈癌前哨淋巴结转移的关系.方法 回顾性分析行宫颈癌根治术治疗的46例宫颈癌患者的临床资料,采用mRNA和免疫组化检测CK19在子宫颈前哨淋巴结中的表达.结果 RT-PCR分析结果显示82个淋巴结中,11个淋巴结CK19高表达,71个淋巴结CK19低表达.免疫组化染色结果显示,11个CK19高表达淋巴结免疫组化染色阳性,71个CK19低表达淋巴结免疫组化染色阴性.多因素分析结果表明CK19高表达与前哨淋巴结转移呈正相关(P<0.05).结论 CK19表达与宫颈癌患者淋巴结转移呈正相关,CK19有可能称为宫颈癌转移的分子标记物.