Ultrastaging of early colon cancer using lymphatic mapping and molecular analysis
Ultrastaging of early colon cancer using lymphatic mapping and molecular analysis
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DOI：
10.1016/s0959-8049(02)00058-8
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发表时间：
2002-05-01
影响因子：
8.4
通讯作者：
Hoon, DSB
中科院分区：
文献类型：
--
作者：
Bilchik, AJ;Nora, D;Hoon, DSB
大约三分之一的淋巴结阴性结肠癌会复发，可能是由于分期不足和淋巴结病理检查不充分。我们评估了原发性结直肠癌患者基于淋巴结作图、集中检查和前哨淋巴结（SN）分子分析进行分期的敏感性、准确性和可行性。1996年至2000年间，100例结肠癌（CRC）患者在瘤周注射1.0 cc异磺胺蓝染料后立即进行了淋巴测图。所有结直肠癌标本均行常规血红素和伊红（H&E）染色。前哨淋巴结通过分级连续切片、细胞角蛋白免疫组化（CK-IHC）和/或逆转录聚合酶链反应（RT-PCR）分析进行检查，试图识别隐匿的微转移性疾病。97%的病例淋巴测图成功。假阴性5例，以T3/T4肿瘤为主。8例患者（8%）发现异常淋巴引流改变了手术入路。26例h&e阳性。在74例常规H&E检查结节阴性的患者中，18例（24%）有隐匿性淋巴结微转移，常规H&E检查未发现，但通过集中分析SN发现。对40例患者进行RT-PCR分析，其中26例H&E和CK-IHC阴性。在这些患者中，有12/26（46%）存在微转移性疾病的额外证据。在这项研究中，集中检查SN并结合RT-PCR分析，在大量淋巴结阴性患者中发现了微转移性疾病。这在选择辅助治疗方案的患者时可能具有重要意义。(C) 2002 Elsevier Science Ltd.版权所有。
Approximately one-third of node-negative colon cancers will recur, possibly due to understaging and inadequate pathological examination of lymph nodes (LNs). We evaluated the sensitivity, accuracy and feasibility of staging based on lymphatic mapping, focused examination, and molecular analysis of the sentinel node (SN) in patients with primary colorectal carcinoma. Between 1996 and 2000, 100 patients with colon carcinoma (CRC) underwent lymphatic mapping immediately after peritumoral injection of 1.0 cc of isosulphan blue dye. All LNs in the CRC specimen were examined by routine haematoxylin and eosin (H&E) staining. Sentinel nodes were examined by step serial sectioning, cytokeratin immunohistochemistry (CK-IHC) and/or reverse transcriptase-polymerase chain reaction (RT-PCR) analysis in an attempt to identify occult micrometastatic disease. Lymphatic mapping was successful in 97% of the cases. There were 5 false-negative cases, predominately associated with T3/T4 tumours. Aberrant lymphatic drainage was identified in 8 patients (8%) altering the operative approach. 26 patients had H&E-positive LNs. In 74 patients who were node-negative by routine H&E, 18 (24%) had occult nodal micrometastases missed on routine H&E examination, but detected by focused analysis of the SN. RT-PCR analysis of the SN was performed in 40 patients, 26 of which were negative by H&E and CK-IHC. In 12/26 (46%) of these patients, there was additional evidence of micrometastatic disease. In this study, focused examination of the SN in conjunction with RT-PCR analysis identified micrometastatic disease in a significant number of node-negative patients. This may have important implications when selecting patients for adjuvant treatment protocols. (C) 2002 Elsevier Science Ltd. All rights reserved.