Lymphatic Mapping and Lymphatic Endothelial Cell Isolation in Colorectal Cancer Patients

背景：SLN活检已被确立为一种常见的手术，其在恶性淋巴瘤和乳腺癌患者中的临床应用已得到证实。然而，在结直肠癌中，SLN理论的应用并不多见，其临床意义也不清楚。此外，连接sln或淋巴内皮细胞的淋巴管的特征至今仍不清楚。方法：对36例可以根治切除的结直肠癌患者（0期2例，I期18例，II期4例，III期12例）行SLN活检，并行系统性淋巴结清扫。内皮细胞通过胶原酶II灌注法从SLN活检时鉴定的淋巴管中分离出来，我们试图将它们转移到内皮细胞特异性培养基的培养系统中。结果：34例（94%）单细胞神经网络确诊率较高。共切除淋巴结705个，其中72个（10.2%）确认为sln。sln中发现转移阳性淋巴结10个（13.9%），平均每例发现的sln数为2.0个。转移淋巴结检测的敏感性为86.1%，SLN活检对所有切除淋巴结的特异性为99.2%。没有观察到与染料注射相关的并发症或毒性。此外，从切除的淋巴管中分离的细胞形成具有内皮细胞特异性的集落，并观察淋巴内皮细胞特异性VEGFR-3的表达。结论：染色法结直肠癌SLN活检是一种敏感性高、准确性高、安全性好的方法，适用于晚期肿瘤。此外，我们还建立了一种仅从切除的淋巴管中分离淋巴内皮细胞并进行培养的方法。我们的结果有望成为确定结直肠手术中合理切除范围和未来澄清淋巴转移机制的另一个里程碑。少

Background : SLN biopsy has already been established as a common procedure, and its clinical usefulness has been confirmed in patients with malignant lymphoma and breast cancer. In colorectal cancer, however, the application of the SLN theory remains uncommon and its clinical significance is also unclear. In addition, the characteristics of the lymphatic vessels that connect SLNs or the lymphatic endothelial cells have been unclear until now.Methods : SLN biopsy by the subserous dye injection method (patent blue) was conducted in 36 patients with colorectal cancer for which curative resection was possible (stage 0 : 2 cases, stage I : 18 cases, stage II : 4 cases, stage III : 12 cases), with additional systematic lymph node dissection. Endothelial cells were isolated from lymphatic vessels identified at the time of the SLN biopsy by the collagenase II perfusion method, and we tried to transfer them into a culture system with an endothelial cell-specific medium.Results : SLNs could be i … More dentified in 34 cases (94%). The total number of resected lymph nodes was 705, and 72 of those nodes were confirmed as SLNs (10.2%). Ten metastasis-positive nodes were found in SLNs (13.9%), and the mean number of identified SLNs per case was 2.0. The sensitivity to detect metastatic lymph nodes and the specificity of the SLN biopsy for all removed lymph nodes was 86.1% and 99.2%, respectively. No complications or toxicity associated with the dye injection were observed. In addition, cells isolated from removed lymphatic vessels formed colonies with endothelial cell-specific properties, and the expression of lymphatic endothelial cell-specific VEGFR-3 was observed.Conclusion : The SLN biopsy by the dye method for colorectal cancer is a procedure with high sensitivity, accuracy and safety that is applicable to cases with advanced cancer. In addition, a method was established to isolate only lymphatic endothelial cells from resected lymphatic vessels and to culture them. Our results are expected to be another milestone in the determination of the rational margin of resection in colorectal surgery and the future clarification of the mechanism of lymphatic metastasis. Less