细胞角蛋白20及端粒酶的表达在大肠癌微转移中的意义

目的 探讨大肠癌前哨淋巴结(sentinel lymph node,SLN)微转移(micrometastasis,MM)的检测方法及其临床意义.方法 前瞻性研究2004年9月至2005年7月在甘肃省人民医院64例行根治性手术的DukesB期大肠癌病人,对其中61例定位成功的122枚SLN应用常规HE染色联合免疫组化SP法检测其前哨淋巴结中细胞角蛋白20(CK20)及端粒酶的表达,随访满3年,记录病人的临床病理参数和生存资料,分析其相关性.结果 (1)61例中6例病人9枚SLN经常规HE检测阳性.(2)免疫组化法有27.3%05/55)病人其SLN存在CK20阳性,21.8%(12/55)的病人SLN存在端粒酶阳性表达.(3)两者联合检测微转移检出率为38.2%(21/55).(4)DukesB期SLN MM(+)病人癌复发转移率明显高于同期SLN MM(-)组(P<0.05),存活率则降低(P<0.05),与DukesC期对比差异无统计学意义;SLNMM(-)组的复发转移率、存活率与同期DukesC期病人对比,差异有统计学意义(P<0.05).结论 免疫组化法联合检测端粒酶和CK20可提高DukesB期大肠癌SLNMM的检出率.并且对于明确大肠癌病人Dukes分期,指导术后合理的辅助治疗和预后判断有重要的临床意义.     

淋巴结微转移及相关蛋白检测在大肠癌患者Dukes分期、治疗和预后中的意义

目的 探讨淋巴结微转移（LNMM）和nm23-H1、基质金属蛋白酶9（MMP9）、金属蛋白酶2组织抑制因子（TIMP2）蛋白检测及其相关性在大肠癌患者Dukes分期、治疗和预后中的意义。方法 应用免疫组化SABC法检测30例DukesB期大肠癌淋巴结细胞角蛋白20（CK20）和癌组织nm23-H1、MMP9、TIMP2蛋白表达,另对同期30例DukesC和D期大肠癌患者检测nm23-H1、MMP9和TIMP2;随访、记录患者的临床病理参数和生存资料,分析其相关性。结果 （1）26．7％DukesB期大肠癌患者、7．8％DukesB期大肠癌淋巴结存在CK20阳性。（2）DukesB期大肠癌nm23-H1、MMP9表达与DukesC和D期差异显著（P〈0．05）;nm23-H,表达下降和（或）MMP9表达增强与LNMM相关（P〈0．05）,两者预测大肠癌LNMM敏感性和特异性分别为62．5％和81．8％、75．0％和69．8％,联合检测特异性则达90．9％;而TIMP2与Dukes分期、LNMM无关。（3）DukesB期LNMM（＋）患者癌复发转移率明显高于同期LNMM（-）组（P〈0．05）,而生存率则降低（P〈0．05）;nm23-H1（-）LNMM（＋）、MMP9（＋）LNMM（＋）患者生存期明显短于nm23-H1（＋）LNMM（-）、MMPq（＋）LNMM（-）组（P〈0．05）。结论 CK20免疫组化可检出大肠癌LNMM;DukesB期大肠癌nm23-H1、MMP9表达与LNMM相关,且表达异常LNMM患者预后差;联合检测淋巴结CK20和癌组织rim23-H1、MMP9表达,对大肠癌Dukes分期、术后辅助化疗和预后判断有重要意义。     

Ⅱ期结直肠癌根治术淋巴结检出数目与患者预后的关系

目的探讨Ⅱ期结直肠癌根治术淋巴结检出数目与患者预后的关系。方法回顾性分析380例Ⅱ期结直肠癌患者的临床资料。结果本组术后5年内出现复发或转移的56例患者与无复发转移者平均淋巴结检出数分别为9．5枚／例和16．3枚／例（P〈0．01）．术后5年内死亡的97例患者与健在者平均淋巴结检出数分别为11．1枚／例和16．7枚／例（P〈0．01）．差异均有统计学意义。淋巴结检出大于或等于12枚／例组和小于12枚／例组的5年生存率分别为83．9％和62．0％（P〈O．01）,复发转移率分别为6．4％和25．7％（P〈0．01）,差异也均有统计学意义。单因素分析显示,Ⅱ期结直肠癌患者的预后与淋巴结检出数目有关（P〈0．05）。结论淋巴结检出数目多少影响Ⅱ期结直肠癌患者的预后．淋巴结检出数目多者复发转移率低．生存率较高。     

DukesC期直肠癌Miles术后同步放化疗与单纯化疗的疗效对比分析

为对比分析DukesC期直肠癌患者行腹会阴联合切除术（Miles术）后同步放化疗与单纯化疗的疗效,本研究统计符合条件的临床病例132例,其中54例术后予以单纯化疗,78例术后予以同步放化疗。化疗方案：奥沙利铂130mg／m^2,d1;亚叶酸钙100mg／m^2,d1-5;氟尿嘧啶350mg／m^2,d1-5;每月化疗1次,连续化疗6个月。放射治疗方法：术后放射治疗定位采用CT模拟机,应用15MVX线,1．8Gy／次,4次／周,共7周,总剂量为50．4Gy。随访5年,观察患者局部复发、远处转移和5年生存情况。结果显示,（1）局部复发：单纯化疗组12例（22．22％）,同步放化疗组6例（7．69％）,两组局部复发率差异有统计学意义,P〈0．05。（2）远处转移：单纯化疗组28例（51．85％）,同步放化疗组37例（47．44％）,两组远处转移率差异无统计学意义,P〉0．05。（3）5年生存情况：单纯化疗组16例（29．63％）,同步放化疗组37例（47．44％）,两组5年生存率差异有统计学意义,P〈0．05。结果表明,DukesC期直肠癌患者Miles术后行同步放化疗,与单纯化疗相比,局部复发率降低,5年生存率升高,远处转移率相近。     

前哨淋巴结定位检测在直肠癌外科中的应用研究

目的探讨定位直肠癌前哨淋巴结（SLN）方法以及临床应用价值。方法运用体内或体外注射亚甲蓝定位47例SLN,采用术中冰冻切片检查、HE染色病理检查、CK-20免疫组化染色（S—P法）检查检测SLN中转移癌。结果体内定位SLN成功32例,体外定位15例,成功14例。47例患者总淋巴结数目为849枚,平均为18．86枚／例,总SLN定位成功率为97．87％,平均SLN为1．87枚／例。常规病理检测SLN转移阴性26例,其中免疫组织化学方法检测CK-20发现微转移6例,上调23．08％（6／26）淋巴结转移阴性患者的病理分期。结论直肠癌体内、体外SIN定位均可获得成功;SLN CK-20免疫组化染色（S-P法）检查有助于提高早期直肠癌的病理分期准确率;SLN术中冰冻切片检查有助于术中指导切除范围。     

前哨淋巴结活检在结直肠癌根治术中的应用研究

目的探讨前哨淋巴结活检（SLNB）在结直肠癌根治术中临床应用的可行性及其价值。方法应用美蓝对67例结直肠癌患者行前哨淋巴结（SLN）定位活检,分体内、体外组,采用HE染色病理检查法、CK-20免疫组化染色（SP法）检测SLN中转移癌。结果共检出淋巴结660枚,其中SLN130枚,检出率19．7％。腹腔镜结直肠癌根治术和开腹结直肠癌根治术对SLN的检出差异无统计学意义（P=0．742）;体内、体外两种SLN的标记方法差异无统计学意义（P=0．564）;SP法检测SLN癌转移的敏感性明显高于HE染色,而假阴性率明显低于后者;肿瘤细胞在SLN的转移率明显高于区域淋巴结的转移率（P〈0．01）。结论结直肠癌根治术中体内、体外SLN定位方法均可以获得成功,均具有切实的可行性,与手术方式无关,并能够预测区域淋巴结的转移状况;通过SP法检查有助于明确结直肠癌的病理分期,有利于判断预后和个体化治疗方案的制定。     

结直肠癌前哨淋巴结体外标本定位及其微转移免疫组化研究

目的探讨结直肠癌前哨淋巴结（SLN）体外定位技术方法及其可行性、准确性和临床价值。方法选择2003年3月至2003年10月间中山大学肿瘤防治中心腹科住院行根治手术的结直肠癌患者60例,62个肿瘤（2例患者为多原发）,进行体外SLN定位。标本离体后尽早进行异硫蓝SLN定位,传统病理检查阴性的SLN进行细胞角蛋白免疫组化检查。结果62例肿瘤成功检出SLN的59例,检出率95．2％。59例患者总共获得并检测1114枚淋巴结,平均每人18．9（4～46）枚。其中SLN157枚（14．9％）,平均每人2．7（1～9）枚。SLN敏感性39．1％（9／23）,假阴性率23．7％（14／59）,准确率76．3％（45／59）。50例SLN阴性的中有12例（24％）细胞角蛋白免疫组化检测阳性。36例HE和细胞角蛋白免疫组化检查全阴性者中4例（11．1％）SLN发现微转移灶。14例仅非SLN阳性中8例SLN发现微转移灶。结论结直肠癌异硫蓝SLN体外定位活检技术是可行的,结合免疫组化检测微转移可以提高术后分期,可以提高送检淋巴结个数,结合免疫组化技术,可以减少淋巴结转移漏诊发生率。但该方法假阴性率较高,不能完全取代常规淋巴结病理检查。     

结直肠癌前哨淋巴结定位检测及其临床意义

目的探讨定位结直肠癌（CRC）前哨淋巴结（SLN）方法以及临床应用价值。方法运用体内或体外注射亚甲蓝定位105例SLN，采用多层面HE染色检测SLN中转移癌，探讨对CRC分期的影响。结果体内定位SLN44例，成功41例，SLN平均数目为1．37枚，例，体外定位61例，成功58例，SLN平均数目为1．59枚，冽（P=0．1710）；SLN位置分布无差别（P=0．3450）。105例病人总淋巴结数目为1944枚，平均为18．51枚／例，总SLN定位成功率为95．24％，平均SLN为1．49枚／例。常规病理检测SLN转移阴性55例，其中行多层面HE染色发现微转移6例，提高7．40％淋巴结转移阴性病人的病理分期。结论结直肠癌体内、体外SLN定位均可获得成功，SLN多层面HE染色检测有助于提高早期结直肠癌的病理分期。     

壶腹周围癌淋巴结微转移的检测及其意义

目的探讨壶腹周围癌淋巴结微转移的检测及其意义。方法采用免疫组化法检测60例壶腹周围癌根治术患者HE染色阴性的淋巴结（220枚）中CK7、CK18及CK19的表达，并结合临床资料及随访结果进行分析。结果60例患者中有17例共43枚淋巴结有微转移；CK19、CK7及CK18的微转移检出率分别为19．55％（43／220）、14．55％（32／220）及11．36％（25／220）；CK19的微转移检出率高于CK7和CK18（P〈0．05）；CK7和CK19的检出率在临床Ⅲ、Ⅳ期高于Ⅰ、Ⅱ期（P〈0．05）；有微转移者比无微转移者的1年生存率低（P〈0．05）。结论壶腹周围癌淋巴结微转移可能是肿瘤转移的早期阶段。CK抗体是检测壶腹周围癌淋巴结微转移的有效指标，可为临床综合治疗与预后判断提供理论依据。     

检测细胞角蛋白19和20对结直肠癌微转移的诊断意义

目的探讨检测细胞角蛋白19（CK19）和CK20的表达对结直肠癌微转移的诊断意义。方法采用RT-PCR方法检测44例结直肠癌患者（结直肠癌组）及18例非恶性病变腹部手术患者（良性病变组）门静脉血和外周血CK19和CK20的表达。结果良性病变组患者门静脉血和外周血均无CK19或CK20阳性表达。结直肠癌组患者外周血和门静脉血中CK19和（或）CK20均阳性表达者34例（77．3％）。与良性病变组比较,差异有统计学意义（P〈0．05）。结直肠癌组外周血CK19和CK20的阳性表达率分别为36．4％和52．3％．门静脉血则分别为59．1％和72．7％,高于外周血的阳性表达率（P〈0．05）：Ⅲ期结直肠癌患者CK19和（或）CK20的阳性表达率明显高于Ⅰ、Ⅱ期患者（P〈0．05）。外周血CK19和（或）CK20阳性表达者术后转移或复发率61．5％,明显高于仅在门静脉血中CK19和（或）CK20阳性者的25．0％（P〈0．05）。结论外周血和门静脉血中CK19和CK20的RT—PCR检测是判断结直肠癌患者有无血行微转移的敏感和特异性诊断方法之一。     

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??Expression of CK20 and telomerase in colorectal carcinoma micrometastasis and its significance WANG Tao*, YANG Xiong Fei, ZHANG Wei-sheng , et al. *Lanzhou University, Lanzhou 730000 ??China Corresponding author:Wang Tao ,E-mail??wangtaolanda@yahoo.com.cn Abstract Objective To investigate the detection of sentinel lymph node micrometastasis(SLNMM) and its clinical significance in these patients. Methods In a prospective study,122 SLNs were searched and examined successfully in 61 among 64 cases of DukesB colorectal carcinoma,using the immunohistochemical(IHC) staining to detect cytokeratin20(CK20) and telomerase in proper order,while the SLNs were negative by routine hematoxylin and eosin(HE) staining.Following up at least 3 years,memorized these patients’ clinical pathological parameters and survival numerical data, and analysis the dependablity. Results 9 SLNs of 6 cases were postive by HE staining;27.3%(15/55) in cases,which were negative by HE staining, were CK20 postive expression by IHC; Micrometastasis was also detected in12cases(21.8%,12/55) byIHC anti-telomerase staining.Combining the two methods can improve the micrometastasis rate as 38.2%(21/55) (P<0.05);The percent of carcinoma recurrence or metastasis for the DukesB patients with SLNMM(+) was significantly higher than that for the patients with SLNMM(-)(P<0.05),but the survival percent for the patients with SLNMM(+) was significantly lower than that for the patients with SLNMM(-).However,compared with 45 DukesC patients,the percents were no significant difference.In contrary,the percents of recurrence or metastasis and survival between DukesC patients and SLNMM(-)DukesB patients were significantly different(P<0.05).Conclusion Combining examination of immunohistochemical anti-CK20 and anti-telometase staining can improve the detection rate of SLNMM in DukesB colonrectal carcinoma patients, and it is of important clinical significance for staging Dukes, selection of adjuvant treatment and evaluation of prognosis in patients with colcrectal carcinoma.     

Detection of Lymph Node Micrometastases and Isolated Tumor Cells in Sentinel and Nonsentinel Lymph Nodes of Colon Cancer Patients

About 20% to 30% of colon cancer patients classified as node negative by routine hematoxylin-eosin (H&E) staining are found to have micrometastases (MM) or isolated tumor cells (ITC) in sentinel lymph nodes (SLNs) if analyzed by step sections and immunohistochemistry (IHC). Whether SLNs are in this respect representative for all lymph nodes was addressed in this study. SLNs were identified using the intraoperative blue dye detection technique. If all lymph nodes (SLNs and non-SLNs) of a patient were negative by routine H&E staining, they were step-sectioned and analyzed by IHC using pancytokeratin antibodies. We identified at least one SLN in 47 of the 55 patients (85%) and examined a median of 26 lymph nodes per patient (range 10–59). By routine H&E staining, 14 of the 47 patients showed lymph node metastases (30%); the remaining 33 were classified as node-negative. In this group (33 patients), 1011 lymph nodes were analyzed by step sections and IHC: 14 of 70 SLNs. (20%) but only 37 of 941 non-SLNs (4%) had MM/ITC (p < 0.001). Furthermore, 13 of the 33 H&E-negative patients were found to have MM/ITC (39%). In 11 of the 13 patients, MM/ITC were identified in both SLNs and non-SLNs in 1 patient in the SLN only, and in 1 patient in a non-SLN only (sensitivity for the identification of MM/ITC: 92%; negative predictive value: 95%). The SLN biopsy is a valid tool to detect, as well as exclude, the presence of MM/ITC in colon cancer patients. Our results may be of prognostic relevance and influence patient stratification for adjuvant therapy trials.     

乳腺癌前哨淋巴结活检

目的 评价前哨淋巴结活检预测腋窝淋巴结有无肿瘤转移的准确性及其临床意义。方法 用^99m锝－硫胶体作为示踪剂,用γ探测仪导向,对70例临床分期为T1－2N0M0的乳腺癌患者进行前哨淋巴结活检,所有的患者均同时行腋窝淋巴结清扫,HE染色阴性的前哨淋巴结再切片,用CK8、CK19、KP－1行免疫组织化学染色。结果 70例患者中成功发现前哨淋巴结的有67例,发现率为95.7%（67／70）。前哨淋巴结的数量为1－5枚,平均每例1.6枚。非前哨淋巴结5－20枚,平均例12.3枚。67例前哨淋巴结活检成功的患者中,29例患者（43.3%）有腋窝淋巴结转移,其中前哨淋巴结有转移者24例（35.8%）,前哨淋巴结未发现转移而非前哨淋巴结有转移者5例（7.5%）。7例患者（10.4%）只有有淋巴结为阳性淋巴结,前哨淋巴结活检的准确性为100％。43例患者的65枚HE染色阴性一的前哨淋巴结,CK8及CK19免疫组织化学染色均为阴性。结论 前哨淋巴结检能较准确地预测腋窝淋巴结转移情况,对原发灶为T1的乳腺癌,前哨淋巴结活检的准确性为100％。同一层面切片行免疫组织化学染色并不能提高淋巴结微转移癌的发现率。     

腹腔镜下前哨淋巴结检测在早期宫颈癌中的应用

目的探讨早期宫颈癌腹腔镜下前哨淋巴结（Sentinel lymph node,SLN）检测的可行性及前哨淋巴结活检预测盆腔淋巴结转移状况的准确性,评价SLN活检在早期宫颈癌中的应用价值。方法选择诊断明确的早期宫颈癌患者26例,采用腹腔镜下广泛子宫切除术和盆腔淋巴结清扫术,术中从宫颈分4点注射1%亚甲蓝染料4ml行淋巴绘图,腹腔镜下识别和取蓝染淋巴结活检。蓝染淋巴结和手术的其他标本分别送病理检查,常规石蜡包埋切片、HE染色,以手术后所有切除的盆腔淋巴结常规HE染色病理检查结果为诊断金标准,观察SLN活检对预测盆腔淋巴结有无肿瘤转移的准确性、假阴性率等及SLN分布情况。结果26例宫颈癌中,23例成功检测出SLN,检出率为88.5%（23/26）。共检出SLN51枚,其中1个SLN者6例,2个SLN者9例,3个SLN者6例,4个SLN者1例,5个SLN者1例。双侧分布者占65.2%（15/23）。26例中,5例（19.2%）盆腔淋巴结有转移。23例SLN成功识别的患者中,3例（6枚）SLN存在转移。SLN转移且盆腔淋巴结有转移者2例,SLN是盆腔淋巴结唯一转移者1例,SLN无转移而盆腔淋巴结有转移者1例。SLN活检预测盆腔淋巴结的准确性为95.7%（22/23）,灵敏度为75%（3/4）,特异度为100%（19/19）,阴性预测值为95%（19/20）,SLN与盆腔淋巴结的转移有极好的一致性（κ=0.832）。结论采用腹腔镜技术可以较准确地检测出SLN,可以用于早期宫颈癌SLN活检;SLN能较准确地反映区域淋巴结的转移状况。     

Sentinel Lymph Node Evaluation Does Not Improve Staging Accuracy in Colon Cancer

BACKGROUND: Lymph node involvement is an important prognostic factor in colorectal cancer. Sentinel lymph node (SLN) evaluation for assessing lymph node status in colorectal cancer remains controversial. Here we evaluated the sensitivity, predictive value, and accuracy of SLN evaluation for determining lymph node status in resectable colon cancer. METHODS: A prospective phase 2 cohort study of SLN evaluation in colon cancer was conducted from September 1998 to April 2006. Patients underwent resection and SLN mapping with 1% isosulfan blue and (m99)Tc sulfur colloid injection. SLNs were evaluated by hematoxylin and eosin (HE) staining and, if findings were negative, by additional thin HE sections and immunohistochemical (IHC) staining for pancytokeratin and MOC31. Overall survival for patients with IHC-positive disease was evaluated by Kaplan-Meier analysis and the log rank test. RESULTS: SLNs were identified in 119 (99%) of the 120 patients eligible for the study. Median number of SLNs identified was 4 (range, 0-13). Forty-nine patients (40%) had nodal metastases on HE. The SLN accurately identified nodal metastases in 29 (59%) of these 49 patients and was negative for metastases in 22 patients (41%). SLNs in eight patients (7%) were negative by HE but positive by IHC staining. Positive IHC status did not affect survival after a median follow-up of 33 months (P = .41). CONCLUSIONS: The low sensitivity and high false-negative rate of SLN evaluation does not support this technique for improving the accuracy of nodal staging for patients with colon cancer. The significance of IHC-positive SLNs remains uncertain.     

Microstaging of Breast Cancer Patients Using Cytokeratin Staining of the Sentinel Lymph Node

Background: Sentinel lymph node (SLN) mapping is an effective and accurate method of axillary nodal evaluation for metastatic disease. Cytokeratin (CK) immunohistochemical (IHC) staining of the SLN has found micrometastatic disease previously undetected by routine hematoxylin and eosin (H&E) stains. The purpose of this study is to determine the number of patients who were upstaged or microstaged, i.e., detected to have micrometastatic disease only by combined lymphatic mapping with CK IHC.Methods: Two hundred and ten patients with newly diagnosed breast cancer underwent intraoperative lymphatic mapping using a combination of vital blue dye and technetium-labeled sulfur colloid. The excised sentinel lymph nodes were examined grossly, by imprint cytology, by standard H&E histology, and by IHC stains for CK. SLNs that were only CK positive were confirmed to be malignant by histologic examination.Results: CK IHC staining was performed on 381 SLNs in 210 breast cancer patients. Forty-seven of 210 patients (22.4%) had positive nodes. Thirty of these 47 patients (63.8%) had both H&E- and CK-positive SLNs, and an additional 17 of the 47 positive patients (36.2%) had only CK-positive SLNs. Seventeen of the 180 patients (9.4%) who were negative on H&E staining were upstaged by CK IHC staining of malignant cells in the SLN. Comparison of tumor size with the total number of node-positive patients demonstrated that 16 of 30 node-positive T0 and T1 patients (53.5%) and 22 of 39 nodes (56.4%) were upstaged by CK IHC staining. T2 and T3 patients were less frequently upstaged by cytokeratin analysis of lymph nodes. Only one of 17 node-positive patients (5.9%) and seven of 34 nodes (20.6%) in patients with T2 and T3 tumors were upstaged.Conclusion: CK IHC staining of SLNs shifted 9.4% of patients from stage I to stage II. There was a significant upstaging influence noted in patients with tumor sizes under 2 cm. This microstaging shift or upstaging may account for the significant proportion of stage I breast cancer treatment failures. Microstaging of the SLNs using more sensitive assays may help identify a subgroup of patients with invasive breast cancer who would benefit from systemic adjuvant treatment, while sparing a disease-free subset of patients the additional risks of toxic adjuvant chemotherapy.     

乳腺癌患者腋窝前哨淋巴结微转移及孤立癌细胞的评价

目的 评价连续切片及免疫组化技术在乳腺癌前哨淋巴结(SLN)转移诊断中的价值,探讨微转移和孤立癌细胞的临床意义.方法 对80例腋窝淋巴结阴性的乳腺癌患者,用99mTc-SC和异硫蓝联合法进行前哨淋巴结活检(SLNB),对所有SLN和非SLN进行常规HE染色及免疫组织化学分析.结果 78例(97.5%)成功检出SLN,其中76.5%的SLN同位素和染料检查均为阳性.32例(41%)SLN转移阳性,其中13例(40.6%)为微转移.共有14例(43.8%)患者SLN是惟一阳性的淋巴结.SLN预测腋窝状态的敏感性、特异性和准确性分别为96.9%,100%和98.7%.SLN转移的患者,其SLN之外的转移率明显高于仅有微转移的患者(78.9%vs.23.1%).结论 连续切片及免疫组化技术是乳腺癌SLN转移诊断的敏感方法.仅有SLN微转移患者的SLN之外的腋窝淋巴结转移率低,但其预后意义及对手术方案的影响尚待进一步研究.     

Sentinel Node Biopsy in Ductal Carcinoma In Situ Patients

Background: Sentinel lymph node (SLN) mapping is an effective and accurate method of evaluating the regional lymph nodes in breast cancer patients. The SLN is the first node that receives lymphatic drainage from the primary tumor. Patients with micrometastatic disease, previously undetected by routine hematoxylin and eosin (H&E) stains, are now being detected with the new technology of SLN biopsy, followed by a more detailed examination of the SLN that includes serial sectioning and cytokeratin immunohistochemical (CK IHC) staining of the nodes.Methods: At Moffitt Cancer Center, 87 patients with newly diagnosed pure ductal carcinoma in situ (DCIS) lesions were evaluated by using CK IHC staining of the SLN. Patients with any focus of microinvasive disease, detected on diagnostic breast biopsy by routine H&E, were excluded from this study. DCIS patients, with biopsy-proven in situ tumor by routine H&E stains, underwent intraoperative lymphatic mapping, using a combination of vital blue dye and technetium-labeled sulfur colloid. The excised SLNs were examined grossly, by imprint cytology, by standard H&E histology, and by IHC stains for CK. All SLNs that had only CK-positive cells were subsequently confirmed malignant by a more detailed histological examination of the nodes.Results: CK IHC staining was performed on 177 SLNs in 87 DCIS breast cancer patients. Five of the 87 DCIS patients (6%) had positive SLNs. Three of these patients were only CK positive and two were both H&E and CK positive. Therefore, routine H&E staining missed microinvasive disease in three of five DCIS patients with positive SLNs. In addition, DCIS patients with occult micrometastatic disease to the SLN underwent a complete axillary lymph node dissection, and the SLNs were the only nodes found to have metastatic disease. Of interest, four of the five nodepositive patients had comedo carcinoma associated with the DCIS lesion, and one patient had a large 9.5-cm low grade cribriform and micropapillary type of DCIS.Conclusions: This study confirms that lymphatic mapping in breast cancer patients with DCIS lesions is a technically feasible and a highly accurate method of staging patients with undetected micrometastatic disease to the regional lymphatic basin. This procedure can be performed with minimal morbidity, because only one or two SLNs, which are at highest risk for containing metastatic disease, are removed. This allows the pathologist to examine the one or two lymph nodes with greater detail by using serial sectioning and CK IHC staining of the SLNs. Because most patients with DCIS lesions detected by routine H&E stains do not have regional lymph node metastases, these patients can safely avoid the complications associated with a complete axillary lymph node dissection and systemic chemotherapy. However, DCIS patients with occult micrometastases of the regional lymphatic basin can be staged with higher accuracy and treated in a more selective fashion.Presented at the 52nd Annual Meeting of Society of Surgical Oncology, Orlando, Florida, March 4–7, 1999.     

Dukes A、B期大肠癌淋巴结微转移的检测及其对预后的影响

目的：探讨Dukes A、B期大肠癌淋巴结微转移的检测和淋巴结微转移对预后的影响.方法：于前瞻性研究31例行根治性手术的Dukes A、B期大肠癌病人,应用逆转录聚合酶链反应（RT-PCR）检测所清除的398枚淋巴结中细胞角蛋白（cvtokeratin,CK）20 mRNA的表达以检出微转移;经5年以上的随访,探讨淋巴结微转移对预后的影响和术后复发的可能原因.结果：在31例Dukes A、B期大肠癌病人的398枚淋巴结中,有15例（48.39%）共46枚（11.56%）淋巴结检出微转移.单因素分析提示微转移的淋巴结数量、位置及肿瘤生长方式与术后复发有关;Logistic多元回归模型提示,3枚以上淋巴结发生微转移与复发紧密联系.结论：CK20 RT-PCR是检测Dukes A、B期大肠癌淋巴结微转移灵敏而特异的方法.3枚以上淋巴结发现微转移是预示复发的独立因素.