结直肠癌前哨淋巴结微转移分子检测及临床意义

目的:探讨结直肠癌前哨淋巴结(sentinellymphnode,SLN)定位和前哨淋巴结微转移检测的临床意义。方法:对52例结直肠癌患者,术前用异硫蓝标记法标记SLN并定位,用RT-PCR法检测SLN中CK20mRNA的表达。同时与常规病检法比较其检测敏感性。并分析结直肠癌转移与各种病理因素关系。结果:SLN定位成功率为96%,SLN状态与非SLN的符合率为100%。RT-PCR法与常规病检法转移的检出率相比较差异有统计学意义,P=0·039。在常规病检阴性的40例淋巴结中,RT-PCR法检出8例有微转移。结直肠癌转移与肿瘤侵袭深度、分化程度、Duke’s分期密切关系。结论:SLN技术运用于结直肠癌将更方便、更准确判断淋巴结转移情况。RT-PCR法较常规病理检查更为敏感,通过SLN定位和RT-PCR的联合使用,可明显提高结直肠癌SLN微转移的检出率。并提高结直肠癌临床分期,为结直肠癌进一步治疗提供理论依据。

Molecule detection and its clinical significiance of micrometastasis of SLNs in colorectal carcinoma

OBJECTIVE:To investigate the clinical significance of location of sentinel lymph nodes (SLN) and detection of the sentinel lymgh node micrometastases in colorectal carcinoma. METHODS: In 52 colorectal carcinoma cases, the SLNs were identified by Isosulfan Blue and located, and furthermore RT-PCR was used to examined the expression of CK20 mRNA of SLNs. The sensitivity of the method of RT-PCR was compared with that of the routine pathological examination. At the same time, the relation between various clinical pathological parameters and the metastasis of coloretal carcinoma was studied. RESULTS: SLN was successfully identified in 50 of 52 cases (96%), the positive predictive value of 100 percent was found when sentinel lymph nodes were identified. The metastasis detection of SLN with RT-PCR had significant difference with the routine pathologic examination (P=0.039). Eight out of 40 metastasis negative patients detected by the routine pathological examination were CK20 gene positive detected by RT-PCR examination. The metastasis of colorectal carcinoma had a positive correlation with Dukes' stage, differentiation and invasion of cancer. CONCLUSIONS: Application of the sentinel lymph node technique to colorectal carcinoma may make it easier to identify lymph nodes most likely to contain mestastatic disease.The examination of RT-PCR is more sensitive than the routine pathological examination for the detection of micrometastasis. The combinated utilization of locating SLN and RT-PCR can greatly improve the efficiency of micrometastasis in SLNs, which improves accuracy rate of staging in colorectal carcinoma. Furt-hmore, it will offer theoretical foundution in the treatment of colorectal carcinoma.