Stojanovic D, Milenkovic S M, Mitrovic N, Marinkovic D, Stevanovic D, Radovanovic D
Department of Surgery, University of Belgrade, Belgrade, Serbia.
J BUON. 2013 Jan-Mar;18(1):162-8.
The prediction of outcome for patients with gastric cancer is determined largely by the presence of lymph node metastases, which could be detected by sentinel lymph node (SLN) biopsy (SLNB). The purpose of this work was to determine the feasibility of SLNB in patients with gastric cancer for the assessment of regional lymph node status, including performing immunohistochemical (IHC) staining of SLN tissue.
We reviewed 137 consecutive patients with operable gastric cancer over a 10-year period using a retrospective (to examine skip metastases) and prospective (to evaluate successful mapping) study design. SLNs were mapped, biopsied and subsequently explored by routine hematoxylin & eosin (H&E) staining and by IHC staining using a cytokeratin 8/18 antibody.
The retrospective study showed a low incidence of skip metastases (3.7%). Mapping of SLNs in the prospective study was highly successful (98.2%). During the prospective study, IHC examination of SLNs from 56 patients showed statistically significant change in disease stage.
This study demonstrated highly successful mapping and biopsy of SLNs (98.2%), as well as highest specificity (100%), sensitivity (100%) and accuracy (100%) to predict metastasis in the surrounding lymph nodes of gastric carcinoma. In addition, we believe that IHC study might enable "ultra staging" and additional selection of patients for further cancer treatment.
胃癌患者的预后预测很大程度上取决于是否存在淋巴结转移，而前哨淋巴结活检（SLNB）可检测到这种转移。本研究的目的是确定SLNB在胃癌患者中评估区域淋巴结状态的可行性，包括对前哨淋巴结（SLN）组织进行免疫组织化学（IHC）染色。
我们采用回顾性（检查跳跃转移）和前瞻性（评估成功定位）研究设计，回顾了137例连续的可手术胃癌患者，研究时间跨度为10年。对SLN进行定位、活检，随后通过常规苏木精和伊红（H&E）染色以及使用细胞角蛋白8/18抗体进行IHC染色来进行探查。
回顾性研究显示跳跃转移的发生率较低（3.7%）。前瞻性研究中SLN的定位非常成功（98.2%）。在前瞻性研究期间，对56例患者的SLN进行IHC检查显示疾病分期有统计学上的显著变化。
本研究表明SLN的定位和活检非常成功（98.2%），并且在预测胃癌周围淋巴结转移方面具有最高的特异性（100%）、敏感性（100%）和准确性（100%）。此外，我们认为IHC研究可能有助于“超分期”以及进一步筛选适合进行癌症治疗的患者。
