结直肠癌中前哨淋巴结（SLN）与非-SLN 的超高分期——我们都需要吗？
Ultrastaging of sentinel lymph nodes (SLNs) vs. non-SLNs in colorectal cancer--do we need both?
机构信息
Department of Surgical Oncology, McLaren Regional Medical Center, Michigan State University, Flint, MI, USA.
出版信息
Am J Surg. 2010 Mar;199(3):354-8; discussion 358. doi: 10.1016/j.amjsurg.2009.08.032.
BACKGROUND
The aim of this study to analyze whether ultrastaging of initially negative nonsentinel lymph nodes (non-SLNs) would increase nodal positivity in colon cancer and rectal cancer.
METHODS
After SLN mapping (SLNM), SLNs were ultrastaged by 4 hematoxylin and eosin and 1 immunohistochemistry sections. A blinded pathologist reexamined initially negative non-SLNs by 3 additional hematoxylin and eosin and 1 immunohistochemistry sections.
RESULTS
In 156 colon cancer and 44 rectal cancer patients, 2,755 nodes were identified (494 SLNs and 2,261 non-SLNs). Metastases were detected in 20.9% of SLNs and 8.6% of non-SLNs (P<.0001). After ultrastaging non-SLNs, only .58% became positive for metastases in 12 patients. Of these, 10 already had positive lymph nodes, hence no change of staging occurred. Ultrastaging upstaged only 2 of 200 patients (1%).
CONCLUSIONS
The chance of finding additional metastases by ultrastaging of all non-SLNs is extremely low (<1%) and of little benefit.
背景
本研究旨在分析对初始阴性非前哨淋巴结（non-SLNs）进行超分期是否会增加结肠癌和直肠癌的淋巴结阳性率。
方法
在进行前哨淋巴结绘图（SLNM）后，通过 4 张苏木精和伊红以及 1 张免疫组织化学切片对 SLNs 进行超分期。由 3 张额外的苏木精和伊红以及 1 张免疫组织化学切片对最初阴性的非前哨淋巴结进行盲法病理复查。
结果
在 156 例结肠癌和 44 例直肠癌患者中，共确定了 2755 个淋巴结（494 个前哨淋巴结和 2261 个非前哨淋巴结）。前哨淋巴结转移率为 20.9%，非前哨淋巴结转移率为 8.6%（P<.0001）。对非前哨淋巴结进行超分期后，仅在 12 名患者的 58%的淋巴结中发现转移灶。其中 10 名患者已有阳性淋巴结，因此分期未发生变化。仅在 200 名患者中的 2 名（1%）中进行超分期才会使分期升级。
结论
对所有非前哨淋巴结进行超分期发现额外转移灶的可能性极小（<1%），且获益不大。
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