前哨淋巴结连续切片及免疫组化检查在cN0期口腔鳞癌分期诊断中的意义

目的：评价前哨淋巴结活检（Sentinel lymph node biopsy．SLNB）、淋巴结连续切片及免疫组化检查在口腔鳞癌分期诊断中的价值。方法：cN0期口腔癌患者31例，分别采用蓝染法、SPECT淋巴显像法、术中γ探测法定位前哨淋巴结。淋巴结常规病理检查，同时对常规切片阴性者采用连续切片，分别进行HE染色．和细胞角蛋白AE1／AE3免疫组化检测。评价其对cN0口腔鳞癌颈部淋巴结转移状态的意义。结果：蓝染法、γ探测、SPECT淋巴显像三种方法分别检测出25（80％）、31（100％）、30（96．5％）例，SLN55枚，平均每例1．4（1～3）枚。非SLN1302枚。常规病理检查SLN转移阳性6枚／6例，其中1例伴有非SLN转移阳性。连续切片＋常规HE染色．检出1例SLN转移阳性．连续切片＋AE3免疫组化染色，检出2例SLN转移阳性。未发现单独的NSLN阳性病例。结论：使用连续病理切片及免疫组化检测可提高SLNB的诊断准确率。     

乳腺癌前哨淋巴结临床病理的研究

目的：探讨乳腺癌前哨淋巴结能否准确反映腋窝淋巴结转移情况,方法对36例例早期乳腺癌,常规HE染色检测腋窝淋巴结,对HE染色阴性的前哨淋巴结及所属非前啉巴结,连续切片、免疫组化染色,检测其肿瘤的转移情况,结果常规病理检测36例中,10例腋窝有转移,其中2例仅哨淋巴结有肿瘤转移,连续切片,组化检测26例阴性的前哨淋巴结共61例,非前哨淋巴结406枚,2例（2枚）仅前哨淋巴结发现有肿瘤转移,余245例前哨淋巴结及非前哨淋巴结无肿瘤转移,HE染色的检测阴性的前哨淋巴结患者假阴性率为7．7％（2／26）。结论早期腺癌前哨淋巴结可以准确反映腋窝巴结转移情况。     

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.     

cN0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。本研究探讨临床颈部阴性(cN0)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cN0舌癌分期上升至pN1期,2例cN0上升至pN2b期;IHC染色将3例cN0舌癌分期上升至pN1期,16例cN0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。     

口腔鳞癌术中前哨淋巴结冰冻切片的诊断价值及临床意义

目的：探索N0口腔鳞癌术中颈部前哨淋巴结冰冻切片诊断的准确性及可行性。方法：16例N。口腔鳞癌患者,使用亚甲蓝染色法对前哨淋巴结进行染色识别,并对前哨淋巴结进行术中冰冻病检,同时对常规清扫的淋巴结进行常规石蜡封埋病理检查。结果：16例口腔鳞癌中有13例能检测出前哨淋巴结,共检测出26个淋巴结,平均每例2．16个,检出成功率为81．3％（13／16）,连续冰冻切片发现其中5位患者的8个前哨淋巴结发生癌转移,与术后常规染色病理检查结果一致。结论：临床N0口腔鳞癌术中对前哨淋巴结进行冰冻病理检查能准确反映淋巴结的转移情况,对指导颈淋巴清扫术有一定的临床应用价值。     

逆转录聚合酶链反应检测结直肠癌淋巴结微转移的临床意义

背景与目的:结直肠癌淋巴结微转移灶是否有预测预后价值目前尚有争议,本文对结直肠癌患者淋巴结微转移情况进行逆转录聚合酶链反应(RT-PCR)检测,研究微转移对临床分期和预后的影响。方法:用RT-PCR技术检测56例结直肠癌患者肠旁及系膜淋巴结中细胞角质蛋白CK20mRNA,揭示微转移灶的存在,并与常规病理苏木精伊红(HE)染色和免疫组化染色结果进行比较;分析HE染色和RT-PCR检测结果对判定临床病理分期和统计生存率的影响。结果:共检测432个淋巴结,HE染色、免疫组化染色和RT-PCR法淋巴结转移检出率分别为57.2%、62.3%和73.1%。HE染色和免疫组化的检出率无显著性差异(P>0.05),而HE染色和RT-PCR法检测结果有显著性差异(P<0.05)。56例患者中,按HE染色结果确定的PN0、PN1和PN2期,其5年无复发转移生存率分别为80%、60%和50%;通过RT-PCR技术检测,升级后的PN0、PN1和PN2期5年无复发转移生存率分别为100%、61.9%和55.6%,两种方法分析的结果有显著性差异(P<0.05)。结论:HE染色未确切指出淋巴结微转移癌;RT-PCR法检测CK20mRNA可以推断淋巴结微转移癌的存在,从而有助于确定结直肠癌临床分期和预测预后。     

区域淋巴结微小转移对非小细胞肺癌临床分期的影响

目的检测非小细胞肺癌(NSCLC)根治术后常规病理诊断转移区域淋巴结中微小转移的发生规律,研究微小转移对临床分期、生存率等的影响。方法经根治术后常规病理证实为T1～T4N0～N1M0期NSCLC 107例,用广谱抗细胞角蛋白抗体AE1/AE3行Envision~(TM)二步法检测,并设阴性、阳性及空白对照。结果判断标准为≥1个细胞的细胞膜或细胞浆出现棕黄色为染色阳性,且细胞形态有恶性特征,即为区域淋巴结微小转移。设肺门淋巴结有微小转移灶可调整分期为pCK-N1期,纵隔淋巴结则为pCK-N2期。分析微小转移病例的中位生存期和1、3、5年生存率及其与临床分期的关系。结果NSCLC中微小转移阳性率为29.9%,其中p-Ⅰ、p-Ⅱ、p-Ⅲ期的分别为27%(21/78)、30%(7/23)、67%(4/6)。病理分期的分层分析显示,非微小转移病例1、3、5年生存率及中位生存期较微小转移组明显延长。将p-Ⅰ～Ⅱ期病例发生纵隔淋巴结微小转移的调整为pCK-ⅢA期,与无微小转移的p-Ⅰ～Ⅱ期病例1、3、5年生存率和中位生存期比较显著下降。将p-ⅠB期肺门淋巴结微小转移者调整为pCK-ⅡB期,与无微小转移的p-ⅠB期生存率比较也有明显减低趋势。将pCK-ⅢA期与p-Ⅲ期、pCK-ⅡB期与无微小转移的p-ⅡB期的长期生存比较无差异。结论NSCLC淋巴结微小转移可能随病情进展检出率增加,淋巴结微小转移是影响长期生存的不利因素,提示pCK-N1可能会等同于p-N1,pCK-N2可能会等同于p-N2,对现有的UICC分期产生影响。     

甲状腺癌前哨淋巴结的临床及病理研究

目的：探讨甲状腺癌前硝淋巴结的检测及其对颈淋巴结转移的预测价值。方法：用手术中注射蓝染料的方法,对30例甲腺癌患者进行了手术中前哨淋巴结的临床研究,手术中取前哨淋巴结作快速冻冻病理,并与手术后常规石蜡切片病理对照,观察冰冻病理前哨淋巴结转移与常规病理颈淋巴结转移的相关性,及其对颈淋巴结转移的预测价值。手术后以抗角蛋白单抗行一步法免疫组化染色,并与常规HE染色对照,结果：30例甲腺癌中27例成功的显示了前哨淋巴结,成功率90％,27例前哨淋巴结平均每例4枚,13例前哨淋巴结阳性的患者,其中2例有前哨淋巴结以外的颈淋巴结转移;2例假阴性,前哨淋巴结对颈淋巴结转移的总的阳性预测值86．7％,结论：前哨淋巴结检测对甲状腺癌的颈淋巴结转移有重要的预测价值。     

非小细胞肺癌前哨淋巴结活检术的临床研究

目的探讨前哨淋巴结（sentinel lymph node,SLN）活检术在非小细胞肺癌（non small cell lung cancer,NSCLC）诊断与分期中的作用和应用可行性。方法研究对象共14例,男性10例,女性4例,平均年龄66．4岁,临床病理分期为Ⅰ—Ⅱ期,术中将4mL亚甲蓝分别等量注射于肿瘤边缘4个象限,然后均常规行肺门、纵隔淋巴结清扫术,标本送常规HE染色,病理免疫组化检查。结果14例中7例检出SLN,共24枚,阳性19枚,阳性检出率79．17％（19／24）、假阴性率20％（1／5）。结论SLN活检术在寻找有早期转移可能的淋巴结方面具有较大临床价值。     

乳腺癌腋窝淋巴结微小转移灶对预后影响的研究

 目的　研究乳腺癌腋窝淋巴结微小转移灶对预后的影响。方法　将45例Ⅰ～Ⅱ期常规病理检查腋窝淋巴结转移阴性并随访10年以上的原发性乳腺癌分成死亡和生存两组,以单克隆抗体细胞角蛋白19为标志物,采用“准”连续切片免疫组化染色方法进行淋巴结微转移的回顾性对比研究。结果　死亡组的25例中查出微转移13例(52%),生存组的20例无1例微转移检出,两组比较有极显著性差异(P<0.01)。结论　本研究结果说明微转移严重影响病人预后,检查淋巴结微小转移灶具有理论与应用价值,“准”连续切片方法值得推广。     

The accuracy of clinical evaluative intrathoracic staging in lung cancer as assessed by postsurgical pathologic staging

The records of 103 patients undergoing thoracotomy for carcinoma of the lung between 1985 and 1988 were reviewed. All patients underwent a uniform staging protocol in the construction of a clinical evaluative stage (cTNM). Using information obtained at thoracotomy supplemented by pathological examination a more accurate stage was constructed (pTNM). We have evaluated the accuracy of cTNM staging using the pTNM staging constructed following thoracotomy. In 46.6% patients cTN and pTN concurred. When comparing T subsets alone 81.6% patients remained unchanged. On comparing nodal staging alone 55.3% patients remained unchanged. Pre-operative evaluation underestimated far more commonly than it overestimated. Mediastinal node involvement was not overestimated since any suggestion of such involvement was confirmed by mediastinal exploration. Construction of a cTNM stage remains a crude evaluation, but we remain convinced that the major aspect of pre-operative evaluation is the exclusion of gross mediastinal gland involvement by mediastinal exploration.     

Cancer of the Esophagus and Esophagogastric Junction: An Eighth Edition Staging Primer

This primer for eighth edition staging of esophageal and esophagogastric epithelial cancers presents separate classifications for the clinical (cTNM), pathologic (pTNM), and postneoadjuvant pathologic (ypTNM) stage groups, which are no longer shared.For pTNM, pT1 has been subcategorized as pT1a and pT1b for the subgrouping pStage I adenocarcinoma and squamous cell carcinoma. A new, simplified esophagus-specific regional lymph node map has been introduced. Undifferentiated histologic grade (G4) has been eliminated; additional analysis is required to expose histopathologic cell type. Location has been removed as a category for pT2N0M0 squamous cell cancer. The definition of the esophagogastric junction has been revised. ypTNM stage groups are identical for both histopathologic cell types, unlike those for cTNM and pTNM.     

Possible predictive markers related to micro-metastasis in breast cancer patients

Despite significant advances in micro-metastasis detection methods, little is known about the relationship between micro-metastasis and primary tumors. The purpose of this study was to assess the ability of expression of the breast cancer-related markers, HER-2/neu, COX-2, VEGF and PDGF-B, as a predictor for micro-metastasis. As destination sites for micro-metastasis, we examined the peripheral blood (BD), bone marrow (BM) and sentinel lymph node (SLN) from 53 breast cancer patients. Protein and gene expression of the markers at the primary site were determined by immunohistochemistry (IHC) and quantitative RT-PCR. BD and BM samples were processed using magnetic-activated cell separation and immunocytochemistry. SLNs were examined by hematoxylin and eosin (H&E) staining and IHC. The percentages of patients with micro-metastasis were 24.5% in BD, 56.6% in BM, 26.4% in SLN by H&E and 41.5% in SLN by IHC. COX-2 gene amplification was significantly associated with SLN micro-metastasis by H&E (P=0.03). Overexpression of HER-2/neu predicts the presence of SLN micro-metastasis as detected by H&E (P=0.005) and COX-2 overexpression predicts the presence of micro-metastasis in BM (P=0.005) and SLN by H&E (P<0.001) and IHC (P<0.001). Similarly, PDGF-B overexpression predicts micro-metastasis in BD (P=0.002), BM (P=0.003) and SLN by H&E (P=0.017), whereas VEGF overexpression predicts only the presence of SLN micro-metastasis by IHC (P=0.001). Our results indicate the possible value of using these markers to predict the risk of micro-metastasis in breast cancer.     

乳腺癌内乳淋巴结活检的临床研究

背景与目的:内乳淋巴结(intemal mammary node,IMN)是乳腺癌重要的转移途径之一,其状况将影响乳腺癌患者的分期、治疗、预后及疗效评价,本研究旨在探讨内乳前哨淋巴结活检(intemal mammary sentinel node biopsy,IMSNB)和经肋间IMN第Ⅰ～Ⅳ肋间活检、以及IMN微转移灶检测在临床应用的意义.方法:在行常规乳腺癌切除术中,采用核素示踪法经肋间隙行IMSNB,然后对患侧第Ⅰ～Ⅳ肋间的IMN均行活检(经肋间隙,非扩大根治术),所有IMN均行常规单一切面HE染色病理检查,阴性病例的IMN采用多层切片加免疫组化的方法检测微转移.结果:全组38例病人中发现内乳前哨淋巴结(internal mammary sentinel node,IMSN)17例,占44.7%,均成功行IMSNB,其中4例IMSN常规病理阳性,1例IMSN发现微转移,2例发现孤立的肿瘤细胞群,10例为阴性,均与对应病例经第Ⅰ～Ⅳ肋间IMN活检的病理结果一致;无发现IMSN 21例,占55.3%,经第Ⅰ～Ⅳ肋间IMN活检,常规病理阳性5例,阴性16例,未发现微转移.结论:对发现IMSN者,IMSN能够准确评价IMN状况,但对无发现IMSN者,尤其是对IMN转移可能性大者,应经肋间隙行IMN第Ⅰ～Ⅳ肋间活检,以减少假阴性的发生;多层切片加免疫组化技术有助于IMN微转移灶的检出.     

肺癌纵隔淋巴结转移及广泛廓清的价值

目的研究肺癌纵隔淋巴结转移（Ｎ２）频度、分布范围及特点,为广泛廓清提供依据。方法总结９年间手术切除３８６例肺癌患者的临床资料。术中按Ｎａｒｕｋｅ肺癌淋巴结分布图对肺门、同侧纵隔淋巴结进行广泛廓清。结果Ｎ２１４７例,占３８．１％,清除转移Ｎ２２８９组。Ｎ２转移率在鳞癌、腺癌、小细胞癌及大细胞癌分别为３０．１％、４４．１％、４８．０％及５０．０％。肺上叶Ｎ２７１例,清除转移Ｎ２１４６组。上纵隔转移１２４组,占８４．９％;下纵隔转移２２组,占１５．１％。肺下叶（包括中叶）Ｎ２７６例,清除转移Ｎ２１４３组。下纵隔转移６７组,占４６．９％;上纵隔转移７６组,占５３．１％。跳跃式转移７９例,占Ｎ２转移的５３．７％。跳跃式纵隔转移１６例,占１０．９％。结论肺癌纵隔淋巴结转移具有跳跃性、多发性。只有广泛清除了上下纵隔淋巴结,才有可能达到根治。     

纵隔镜手术在临床N2期肺癌中的应用价值

背景与目的探讨纵隔镜手术在临床N2期肺癌纵隔淋巴结病理分期中的应用价值。方法回顾性总结1999年9月-2008年4月87例经纵隔镜检查的肺癌患者的临床资料,其中颈部纵隔镜手术83例,胸骨旁视纵隔镜手术4例。术前所有患者胸部CT均发现同侧纵隔和(或)隆突下淋巴结肿大(直径>1.0cm)。结果本组87例患者,经纵隔镜检查证实纵隔淋巴结转移(阳性)者61例,未见纵隔淋巴结转移(阴性)者26例。纵隔镜检查阴性者中转开胸行肺叶切除或肺楔型切除加纵隔淋巴结清扫,术后病理证实24例纵隔淋巴结未见转移,2例隆突后淋巴结可见癌转移(纵隔镜检查假阴性)。纵隔镜手术敏感性、特异性和准确性分别为96.8%、100%和97.7%。本组术中发生无名动脉撕裂1例,并发症发生率为1.1%(1/87)。无围手术期死亡。结论纵隔镜手术安全、可靠,是明确临床N2期肺癌纵隔淋巴结是否转移的有效方法。     

肺部微小结节的诊治分析

目的 了解肺部微小结节（2cm）良、恶性情况、诊断方法及治疗措施。方法 回顾性分析80例经手术切除，病理证实为恶、良肺部结节资料。结果 手术切除肺部微小结节占同期肺手术的17．7％。80例微小结节中，恶性肿瘤占73．3％（59／80）良性为26．3％（21／80）。恶性中最多为鳞癌和腺癌良性病变中最多为结核为炎性假瘤。pTNM分期：pT2N0M028例，pT1N1M019例，pT1N1M11例，pT1N2M010例，pT1N2M11例。结论 对于CT发现的肺部2cm的结全，CT值在37HU，性质不能明确的应行手术切除。     

Significance of Sentinel Lymph Node Biopsy and Immunohistochemistry in Diagnosis and Staging of Stage-cNO Oral Squamous Cell Carcinoma

OBJECTIVE To assess the significance of sentinel lymph node biopsy （SLNB）, serial section and cytokeratin immunohistochemical staining in the diagnosis and staging of Stage-cNO oral squamous cell carcinoma （OSCC）, METHODS A blue stain, 99mTc-dextran SPECT lymphoscintigrapgy and intraoperative y-ray probes were used to examine the sentinel nodes in 31 cases with Stage-oNO oral cancer, The H＆E staining and a cytokeratin AE1/ AE3 immunohistochemistry （IHC） assessment, with serial sections, were conducted to provide results obtained from a routine pathological examination of lymph nodes, The value of the routine pathological examination of the sentinel lymph node （SLN）, serial sections and IHC determination for cervical lymph node metastasis of Stage-cN0 OSCC was appraised, RESULTS A total of 45, 55 and 51 SLNs were examined in 25 （80%）, 31 （100%） and 30 （96,5%） of the cases, by using the blue stain, y-ray probes, and SPECT lymphoscintigraphy, respectively, The average SLNs found in each case of the groups was 1,4 （1 to 3） and there were 1,302 non-NSLNs, Six positive SLN metastases were detected by routine pathological examination, among which 1 case was found to be an accompanied positive metastasis of non-SLN, One positive SLN metastasis was found after examination of serial sections plus routine H＆E staining and 2 were detected using serial sections plus AE3 immunohistochemical staining methods, No positive NSLNs were found in the study, CONCLUSION In order to make more progress in accurate SLNB diagnosis, serial sections and IHC （AE1/AE3） methods can be used for examination of the micrometastases which are difficult to identify by routine pathological sections and H＆E staining.     

纵隔镜手术在肺癌分期中的应用价值

目的:探讨纵隔镜手术在肺癌纵隔淋巴结分期中的应用价值.方法:回顾性总结1999年11月至2003年7月69例经纵隔镜检查肺癌患者的临床资料,其中颈部纵隔镜手术57例,胸骨旁纵隔镜手术7例,颈部加胸骨旁纵隔镜手术5例.术前所有患者胸部CT均发现纵隔淋巴结肿大(最小直径大于1.0cm).结果:本组69例患者,经纵隔镜检查证实纵隔淋巴结转移(阳性)者50例,未见纵隔淋巴结转移(阴性)者19例.阳性者放弃手术,予以化疗.阴性者中15例中转开胸行肺叶切除或肺楔型切除加纵隔淋巴结清扫,术后病理证实14例纵隔淋巴结未见转移,1例隆突后淋巴结可见癌转移(纵隔镜检查假阴性).纵隔镜手术敏感性、特异性和准确性分别为98.0%、100%和98.5%.全组术后发生声音嘶哑1例,并发症发生率为1.4%(1/69).无围手术期死亡.结论:纵隔镜手术安全、可靠,可作为明确肺癌分期的常规方法.