Bembenek Andreas, Schneider Ulrike, Gretschel Stephan, Fischer Joerg, Schlag Peter M
Department of Surgery and Surgical Oncology, Charité-University Medicine Berlin, Robert-Rössle Cancer Center, Lindenbergerweg 80, Berlin 10437, Germany.
World J Surg. 2005 Sep;29(9):1172-5. doi: 10.1007/s00268-005-0094-x.
About 20% to 30% of colon cancer patients classified as node negative by routine hematoxylin-eosin (H&E) staining are found to have micrometastases (MM) or isolated tumor cells (ITC) in sentinel lymph nodes (SLNs) if analyzed by step sections and immunohistochemistry (IHC). Whether SLNs are in this respect representative for all lymph nodes was addressed in this study. SLNs were identified using the intraoperative blue dye detection technique. If all lymph nodes (SLNs and non-SLNs) of a patient were negative by routine H&E staining, they were step-sectioned and analyzed by IHC using pancytokeratin antibodies. We identified at least one SLN in 47 of the 55 patients (85%) and examined a median of 26 lymph nodes per patient (range 10-59). By routine H&E staining, 14 of the 47 patients showed lymph node metastases (30%); the remaining 33 were classified as node-negative. In this group (33 patients), 1011 lymph nodes were analyzed by step sections and IHC: 14 of 70 SLNs. (20%) but only 37 of 941 non-SLNs (4%) had MM/ITC (p < 0.001). Furthermore, 13 of the 33 H&E-negative patients were found to have MM/ITC (39%). In 11 of the 13 patients, MM/ITC were identified in both SLNs and non-SLNs in 1 patient in the SLN only, and in 1 patient in a non-SLN only (sensitivity for the identification of MM/ITC: 92%; negative predictive value: 95%). The SLN biopsy is a valid tool to detect, as well as exclude, the presence of MM/ITC in colon cancer patients. Our results may be of prognostic relevance and influence patient stratification for adjuvant therapy trials.
通过苏木精-伊红（H&E）常规染色被归类为淋巴结阴性的结肠癌患者中，若采用连续切片和免疫组织化学（IHC）分析，约20%至30%的患者在前哨淋巴结（SLN）中发现有微转移（MM）或孤立肿瘤细胞（ITC）。本研究探讨了在这方面SLN是否能代表所有淋巴结。采用术中蓝色染料检测技术识别SLN。如果患者的所有淋巴结（SLN和非SLN）经常规H&E染色均为阴性，则对其进行连续切片，并使用全细胞角蛋白抗体通过IHC进行分析。55例患者中有47例（85%）至少识别出1个SLN，每位患者检查的淋巴结中位数为26个（范围10 - 59个）。经常规H&E染色，47例患者中有14例出现淋巴结转移（30%）；其余33例被归类为淋巴结阴性。在这组（33例患者）中，通过连续切片和IHC分析了1011个淋巴结：70个SLN中有14个（20%），但941个非SLN中只有37个（4%）有MM/ITC（p < 0.001）。此外，33例H&E阴性患者中有13例发现有MM/ITC（39%）。在13例患者中的11例中，SLN和非SLN中均发现有MM/ITC，1例仅在SLN中发现，1例仅在非SLN中发现（MM/ITC识别的敏感性：92%；阴性预测值：95%）。SLN活检是检测以及排除结肠癌患者中MM/ITC存在的有效工具。我们的结果可能具有预后相关性，并影响辅助治疗试验的患者分层。
