高危型HPV DNA联合CK17检测早期宫颈鳞癌前哨淋巴结微转移的意义

目的检测早期宫颈鳞癌患者前哨淋巴结（sentinel lymph node,SLN）中人乳头瘤病毒（human papilloma virus,HPV）DNA和细胞角蛋白（CK）17的表达,探讨其在盆腔前哨淋巴结微转移中的临床意义。方法选取2012年1月至2013年1月山西医科大学第一医院早期宫颈鳞癌患者38例,其中ⅠB1期16例,ⅠB2期7例,ⅡA1期11例、ⅡA2期4例,实施经腹广泛性全子宫切除术＋盆腔淋巴结清扫术。术中采用亚甲蓝方法识别前哨淋巴结,对前哨淋巴结进行常规淋巴结病理检查、第二代捕获杂交（HC2）方法检测HPV DNA、免疫组织化学方法检测CK17。结果 38例早期宫颈鳞癌患者中SLN的检出率为86.84%,获得85枚SLN。在85枚SLN中淋巴结转移阳性率为21.18%（18/85）,高危型HPV DNA阳性率为34.12%（29/85）,CK17表达阳性率为30.59%（26/85）,二者均为阳性的有22枚。病理学检查为阳性的SLN,其高危型病毒检测和CK17检测均为阳性。病理组织学检查结果分别与高危型HPV DNA和CK17检测结果比较,差异有统计学意义（P〈0.05）。结论宫颈鳞癌淋巴结存在常规病理检测难以发现的微小转移,联合检测高危型HPV DNA和CK17的表达可提高SLN微转移检出率的准确性和特异性。

The significance of combined CK17 and high risk HPV DNA detection in early cervical squamous cell carcinomas sentinel lymph node micrometastases

Objective To detect the expression of human papilloma virus （human papilloma virus, HPV） DNA and cytokeratin （CK） in sentinel lymph node （sentinel lymph node, SLN） of early cervical squamous cell car- cinomas, to explore the clinical significance of sentinel lymph node micrometastases in pelvic cavity. Methods A total of 38 patients with early cervical cancer who underwent laparotomy extensive hysterectomy and pelvic lymphadenectomy in the first hospital of Shanxi medical university from January 2012 to January 2013 recruited in this study, including 16 cases of 1 B1 phase, 7 cases ofⅡA1 phase, 4 cases of 1I A2 phase. Sentinel lymph nodes were identified using methylene blue intraoperatively. Hybrid- captured second generation （HC2） method was used to detect HPV DNA and immunohistochemical method was used to detect CK17 in the Sentinel lymph node. Results The detection rate of SLN was 86.84% in the 38 patients with early stage cervical cancer and totally 85 SLN were obtained. Positive rate of lymph node metastasis was 21.18% （18/85）, positive rate of high risk HPV DNA was 34. 12% （29/85）, positive rate of CK17 was 30.59%, 22 were both HPV DNA and CK17 positive, 7 SLN were only HPV DNA positive and 4 were only CK17 positive. CK17 and HPV DNA were both positive in the metastasis SLN. Conclusions It is difficult to find the existence of the micrometastasis with conventional pathology in the lymph nodes of cervical squamous cell carcinomas. The combination of highrisk type HPV DNA and CK17 detection in SLNs can improved the accuracy and specificity.