Clinical Significance of Circulating Tumor Cells and Lymph Node Micrometastases in Gastrointestinal cancer

(1)CellSearch系统检测胃癌患者外周血和门静脉血中的肿瘤细胞本研究的目的是应用CellSearch系统检测胃癌患者外周血和门静脉血中的CTCs，并探讨其与胃癌复发的关系。[方法]50例T1-3期胃癌患者，术前采集外周血10ml，术中采静脉血10ml。[结果]外周血中CTCs的阳性率为18%，PV中CTCs的阳性率为24%，PB和/或PV中CTCs的阳性率为28%。T1期CTC发生率为8%，T2期为26%，T3期为44%。CTC的发现率与临床分期(p=0.007)、血管侵犯(p=0.008)、淋巴侵犯(p=0.007)和淋巴结转移(p=0.007)相关。有11例(78.5%)复发率为78.5%，有无复发者的总生存率差异有统计学意义(p=0.0049)。[结论]CTCs的鉴定对…的随访有重要意义(2)-1多重实时RT-PCR快速诊断胃癌淋巴结转移的价值本研究的目的是评价在SmartCycler[0！R]上运行的一种原型RT-PCR方法的实用性，它可以在40分钟内快速诊断胃癌的淋巴结转移。本研究的目的是验证SmartCycler^[0！R]与使用LightCycler^[0！R]的传统RT-PCR相比的实用性。[患者和方法]在知情同意的情况下，获取8例进展期胃癌患者的47个显性转移淋巴结和22个非恶性肿瘤患者的良性淋巴结。我们利用LightCycler^[0！R]和SmartCycler^[0！R]使用CEA和CK19的多个标记物对转移的淋巴结进行RT-PCR检测。[结果]在单层试验中，CEA和CK19在LightCycler[0！R]中的灵敏度分别为91.5%和70.2%，在原型系统中分别为97.9%和95.7%。在多重检测中，LightCycler^[0！R]系统的灵敏度为91.5%，SmartCycler^[0！R]系统的灵敏度为97.9%。[结论]SmartCycler[0！R]RT-PCR快速诊断淋巴结转移与常规LightCycler[0！R]具有同样高的准确率。在这项研究中，SmartCycler^[0！R]在原型检测的情况下有利于诊断胃癌的淋巴结转移。(2)基因搜索BLN检测在乳腺癌前哨淋巴结快速评估中的应用我们的目标是通过与常规病理检查的比较，评估乳腺癌前哨淋巴结转移的实时RT-PCR检测方法--乳房淋巴结法(BLN)的临床应用。[方法]对117例乳腺癌患者行SLN活检术。每个SLN沿着最长维度的平面被切成两半。每个结节的一半用BLN法的2种标志物--乳头球蛋白(MG)和细胞角蛋白19(CK19)检测，另一半用苏木精-伊红染色(HE)和免疫组织化学染色(IHC)检测泛角蛋白。[结果]117例患者共获得204枚SLN。他发现31个SLN(15.2%)有转移，IHC发现6个SLN有转移；BLN检测32例患者的40个SLN为阳性。检测结果与HE和IHC的病理诊断结果相关(p&lt；0.001)。BLN检测对肿瘤大转移的敏感性为95.7%，对微转移的敏感性为60.0%，对分离的肿瘤细胞的敏感性为55.6%。[结论]双标记物BLN检测的性能与常规病理检查相当，分析的组织比常规病理检查更多。因此，临床术中使用BLN检测SLN可能会减少腋窝淋巴结清扫的第二次手术。较少

(1) Circulating tumor cells in blood detected by CellSearch System in gastric cancer The purposes of this study are to evaluate CTCs of peripheral blood (PB) and portal vein blood (PV) with gastric cancer patients using CellSearch System (CSS), and to investigate the relation of the recurrence. 【Methods】 In 50 patients with T1-3 gastric cancer, PB was collected 10ml before the gastrectomy, and PV was collected 10ml during operation. 【Results】CTCs were detected in 18% from PB, 24% from PV and 28% from PB and/or PV. CTCs were found in 8% with T1, 26% with T2, 44% with T3. Detection rate of CTCs were correlated with the results of Stage (p=0.007), vessel invasion (p=0.008), lymphatic invasion (p=0.007) and lymph node metastasis (p=0.01). The recurrences were detected in 11 patients (78.5%) with CTCs, and there was statistically significant difference in over all survival between patients with or without CTCs (p=0.0049). 【Conclusions】The identification of CTCs is very useful to follow up a … More fter operation and to perform the adjuvant chemotherapy in gastric cancer.(2)-1 The utility of rapid diagnosis of lymph node metastasis in gastric cancer using a multiplex real-time RT-PCR assayThe purpose of this study was to evaluate the utility of a prototype RT-PCR assay run on the SmartCycler^[○!R] that enables the rapid diagnosis of lymph node metastasis in gastric cancer within 40 minutes. The purpose of this study was to verify the utility of the SmartCycler^[○!R] as compared to conventional RT-PCR using the LightCycler^[○!R]. 【Patients and methods】47 overt metastatic lymph nodes from 8 patients with advanced gastric cancer and 22 benign lymph nodes from patients without malignant tumor who received surgery were obtained with informed consent. We examined the metastatic lymph nodes by RT-PCR using multiple markers using CEA and CK19 by the LightCycler^[○!R] and SmartCycler^[○!R]. 【Results】 In the singlex assay, the sensitivity of CEA and CK19 was 91.5% and 70.2% in the LightCycler^[○!R], and 97.9% and 95.7% in the prototype assay system, respectively. In the multiplex assay, the sensitivity was 91.5% in the LightCycler^[○!R] system and 97.9% in the SmartCycler^[○!R], respectively. 【Conclusion】Rapid diagnosis for lymph node metastasis using RT-PCR by the SmartCycler^[○!R] has equally high precision for detecting lymph node metastasis as the conventional LightCycler^[○!R]. In this study the SmartCycler^[○!R] is advantageous for the diagnosis of lymph node metastasis in gastric cancer when run with the prototype assay.(2)-2 Utility of the GeneSearch BLN Assay for Rapid Evaluation of Sentinel Lymph Nodes in Breast CancerOur goal was to evaluate the clinical application of the Breast Lymph Node (BLN) assay, a real-time RT-PCR assay for SLN metastases, by comparing this test with routine pathological examination. 【Methods】One hundred seventeen patients with breast cancer underwent breast surgery with SLN biopsy. Each SLN was cut in half along the plane of the longest dimension. Half of each node was examined by the BLN assay's 2 markers, mammaglobin (MG) and cytokeratin 19 (CK19), and the other half was examined by hematoxylin and eosin staining (HE) and immunohistochemical staining (IHC) for pancytokeratins. 【Results】A total of 204 SLNs were obtained from 117 patients. HE identified metastases in 31 SLNs (15.2%), and IHC detected metastases in 6 SLNs ; 40 SLNs from 32 patients were positive for metastasis by the BLN assay. The assay results correlated with the pathological diagnoses by HE and IHC (p<0.001). BLN Assay sensitivity compared with pathological findings classified according to TNM was 95.7% for macrometastases, 60.0% for micrometastases, and 55.6% for isolated tumor cells. 【Conclusion】The 2-marker BLN assay has performance comparable to, and analyzes more tissue than, routine pathological examination. Therefore, clinical intraoperative use of the BLN assay for SLNs may result in reduction of the second surgery for axillary lymph node dissections. Less