Suwa H, Hosotani R, Kogire M, Doi R, Ohshio G, Fukumoto M, Imamura M
Department of Surgery, Otsu Red Cross Hospital, Japan.
Int J Pancreatol. 1999 Dec;26(3):155-62. doi: 10.1385/IJGC:26:3:155.
Neural invasion is known to be one of the aggressive characteristics of pancreatic adenocarcinoma. However, there have been no systematic studies on intraoperative examination of neural invasion of pancreatic carcinomas after wide dissection of the retroperitoneum, particularly at the surgical margin.
We performed intraoperative immunostaining on the frozen sections of several excised plexus specimens, using peroxidase-labeled anti-cytokeratin 19 antibody in 17 cases of resectable pancreatic carcinoma. Postoperatively, we also tried to detect occult micrometastasis by direct sequencing of the K-ras gene in the same samples.
Intraoperative staining for cytokeratin 19 was positive in 4 of 17 (23.5%) cases. Patients with margin-positive neural invasion had significantly worse prognosis than patients who were margin negative (P < 0.05). One patient had micrometastasis in the nerve plexus, revealed by K-ras mutation, whereas neither cytokeratin 19 staining nor postoperative pathological investigation detected involvement of the analyzed portion. In the four patients margin-positive for cytokeratin 19 staining, the diagnosis of neural invasion by cytokeratin 19 staining was in agreement with the K-ras gene analysis.
Intraoperative staining for cytokeratin 19 is useful for detecting pancreatic cancer involvement of the neural plexus margin. The results can be also utilized as a prognostic indicator during the follow-up period.
神经侵犯是胰腺腺癌侵袭性特征之一。然而，对于腹膜后广泛清扫术后胰腺癌神经侵犯的术中检查，尤其是手术切缘处，尚无系统研究。
我们对17例可切除胰腺癌患者切除的神经丛标本冷冻切片进行术中免疫染色，使用过氧化物酶标记的抗细胞角蛋白19抗体。术后，我们还尝试通过对同一样本的K-ras基因直接测序来检测隐匿性微转移。
17例患者中有4例（23.5%）术中细胞角蛋白19染色呈阳性。切缘阳性神经侵犯患者的预后明显差于切缘阴性患者（P < 0.05）。1例患者神经丛中有微转移，通过K-ras突变发现，而细胞角蛋白19染色及术后病理检查均未检测到所分析部位受累。在细胞角蛋白19染色切缘阳性的4例患者中，细胞角蛋白19染色诊断的神经侵犯与K-ras基因分析结果一致。
细胞角蛋白19术中染色有助于检测神经丛切缘处的胰腺癌侵犯。该结果也可作为随访期间的预后指标。
