Sentinel lymph node mapping and molecular staging in nonsmall cell lung carcinoma
Sentinel lymph node mapping and molecular staging in nonsmall cell lung carcinoma
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DOI：
10.1002/cncr.21325
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发表时间：
2005-10-01
期刊：
影响因子：
6.2
通讯作者：
Jacobson, DR
中科院分区：
文献类型：
--
作者：
Pulte, D;Li, E;Jacobson, DR
背景淋巴结（LN）受累预示着明显局限性非小细胞肺癌（NSCLC）切除术后复发。LN疾病的标准检测方法灵敏度较低，许多明显NO疾病状态的患者会出现疾病复发。分子技术可以提高微转移的检测，而前哨淋巴结（SLN）映射可以指示哪些LN可能包含微转移。这些方法，虽然可能是互补的，但据作者所知，以前没有一起使用过。作者使用SLN定位和分子分期来提高NSCLC患者LN微转移的检测。用逆转录聚合酶链反应（RT-PCR）分析正常肺和恶性肺中表达的细胞角蛋白7（CK 7），以鉴定LN-31中的肿瘤来源物质。对13例患者进行了SLN定位，每例患者确定了1-3个SLN，在这13例患者中的12例中获得了足够的RNA用于RT-PCR。12例肿瘤中有11例表达CK 7。总体而言，32例LN CK 7阳性，包括21例SLN中的13例。11例可评估SLN的患者中有10例至少有1个CK 7阳性SLN。常规病理显示8例患者为I期疾病，1例患者为T3 N 0疾病，2例患者为LN阳性疾病。根据常规病理学，通过RT-PCR评估的9例NO疾病患者中，8例患者通过该技术进行了升级。所有常规病理检查LN阳性且RT-PCR分析可评估的患者均为阳性。LN微转移常见于手术切除的NSCLC，包括常规病理诊断为N 0的患者。SLN定位对于识别含病淋巴结是有用的。这种方法可能是有用的分层组织学N 0患者为高风险和低风险组。
BACKGROUND. Lymph node (LN) involvement predicts recurrence in patients who have undergone resection of apparently localized nonsmall cell lung carcinoma (NSCLC). Standard detection methods for LN disease have a low sensitivity, and many patients with apparent NO disease status develop recurrent disease. Molecular techniques can improve the detection of micrometastases, whereas sentinel lymph node (SLN) mapping can indicate which LN may contain micrometastases. These methods, although potentially complementary, have not, to the authors' knowledge, been used together previously.METHODS. The authors used SLN mapping and molecular staging to improve the detection of LN micrometastases in patients with NSCLC. Reverse transcriptasepolyrnerase chain reaction (RT-PCR) analysis for cytokeratin-7 (CK7), expressed both in normal lung and in malignant lung, was used to identify tumor-derived material in LN.RESULTS. SLN mapping was performed in 13 patients, with 1-3 SLNs identified in each patient, and sufficient RNA for RT-PCR was obtained in 12 of these 13 patients. Eleven of 12 tumors expressed CK7. Overall, 32 LNs were positive for CK7, including 13 of 21 SLNs. Ten of 11 patients with evaluable SLNs had at least I CK7-positive SLN. Routine pathology showed Stage I disease in eight patients, T3N0 disease in one patient, and LN-positive disease in two patients. Of the nine patients with NO disease according to routine pathology that was evaluable by RT-PCR, eight patients were upstaged by this technique. All patients with positive LN status by routine pathology who were evaluable by RT-PCR analysis had positive RT-PCR results.CONCLUSIONS. LN micrometastases were common in resected NSCLC, including patients with N0 disease according to routine pathology. SLN mapping was useful for identifying disease-containing LNs. This approach may be useful for stratifying histologically N0 patients into higher risk and lower risk groups.