前哨淋巴结活检在早期胃癌中应用及微转移检测.docVIP

前哨淋巴结活检在早期胃癌中应用及微转移检测 　 作者：尤建权，马利林，朱建伟，孙锦卫，于嘉伟，陈玉泉 【摘要】 目的：探讨前哨淋巴结活检(SLNB)技术在早期胃癌中的应用及前哨淋巴结(SLN)微转移检测的临床意义。方法：34例早期胃癌术中亚甲蓝定位活检前哨淋巴结，术后行常规HE病理和角蛋白单克隆抗体AE1/AE3免疫组化（ELIVISION二步法）检查。结果：34例中33例检出SLN，检出率为97.1%。由SLN 状态预测胃周淋巴结转移情况的准确率为93.9%(31/33)，敏感性为88.9%(16/18),特异性为100.0%(16/16),假阴性率为11.1%(2/18)。免疫组化法与常规HE法对SLN转移的检出率相比较，差异有统计学意义（P= 0.034)，免疫组化法共检出12枚/8例SLN存在微转移现象。结论: SLN能较准确反映早期胃癌的淋巴结转移状况，免疫组化法较常规HE病理检查更为敏感,AE1/AE3免疫组化法能提高SLN微转移的检测, 对确定临床分期、诊疗及判断预后有积极临床意义。 【关键词】 胃癌； 前哨淋巴结；微转移；AE1/AE3; 免疫组织化学法 [Abstract] Objective: To investigate the application of sentinel lymph node biopsy to early gastric carcinoma and clinical significance of sentinel lymph node micrometastasis detection. Methods: 34 patients with early gastric carcinoma intraoperatively underwent sentinel lymph node biopsy with methylene blue. All SLNs were studied with HE and keratin monoclonal antibody AE1/AE3 immunohistochemistry. Results: The stained SLNs could be identified in 33(97.1%) of 34 patients. The accuracy of the SLN status in diagnosis of the lymph node status of the patients was 93.9%. Sensitivity was 88.9%. The specificity and false-negative rate were 100.0% and 11.1%, respectively. The metastasis detection of SLN with immunohistochemistry had significant difference, compared with the routine pathologic examination （P=0.034).12 SLNs were found to have micrometastasis in 8 patients by immunohistochemical technology. Conclusions: SLN can explore the feature of lymph node metastasis in early gastric carcinoma, immunohistochemistry is more sensitive than HE in the exploration of lymph node metastasis. AE1/AE3 immunohistochemistry can improve the efficiency of detecting micrometastasis in SLNs , which has positive clinical significance for definition of clinical stage, treatment and prognosis in early gastric carcinoma. [Key words] Gastric carcinoma; Sentinel lymph node； Micrometastasis; AE1/AE3; Immunohistochemistry 前哨淋巴结( sentinel lymph node, SLN)是指局部淋巴结中最先接受肿瘤淋巴回流的淋巴结,也是最先发生肿瘤转移的淋巴结。本研究运用亚甲蓝对早期胃癌患者