Hirayama Ryouichi, Seshimo Akiyoshi, Miyake Kunitomo, Nishizawa Masako, Kameoka Shingo
Department of Surgery II, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjyuku-ku, Tokyo, 162-8666, Japan.
Int J Clin Oncol. 2014;19(3):473-8. doi: 10.1007/s10147-013-0579-9. Epub 2013 Jun 14.
Increasing evidence has been accumulated to substantiate the clinical usefulness of quantitative evaluation of gene expression. This study was undertaken to assess diagnosis of metastasis in dissected lymph nodes through quantitative evaluation of the expression of carcinoembryonic antigen mRNA (CEA mRNA) by a rapid, simple transcription-reverse transcription concerted reaction (TRC) assay using dissected lymph node washings.
A total of 110 dissected lymph nodes from 40 patients undergoing surgery for gastric cancer were studied. Each dissected lymph node was cut crosswise and washed with physiological saline. The washings were assayed for CEA mRNA and the assay results were assessed in comparison with the pathological diagnosis [hematoxylin and eosin (H&E) staining]. All lymph nodes were also subjected to immunostaining for cytokeratin (CK staining) and assessed comparatively.
By H&E staining, 29 lymph nodes were found to be positive and 81 to be negative for metastasis. By TRC assay, 38 lymph nodes were found to be positive and 72 to be negative. According to the results of CK staining, there were 37 metastasis-positive lymph nodes and 73 negative nodes. The sensitivity and specificity of H&E staining relative to those of CK staining were 78.4 and 100 %, respectively, while the sensitivity and specificity of TRC assay relative to those of CK staining were 91.9 and 94.5 %, respectively.
The TRC assay method using lymph node washings is a rapid, simple genetic diagnosis with greater sensitivity than conventional diagnosis by H&E staining of permanent specimens, and enables conservation of lymph nodes in toto as permanent specimens. This TRC method would enable rapid diagnosis even in town hospitals where no pathologist is ordinarily stationed, and is considered to contribute to the clinical application of the sentinel node theory of gastric cancer treatment.
越来越多的证据证实了基因表达定量评估的临床实用性。本研究旨在通过使用切除淋巴结冲洗液的快速、简单转录 - 逆转录协同反应（TRC）测定法，对癌胚抗原mRNA（CEA mRNA）表达进行定量评估，以评估切除淋巴结中的转移情况。
对40例接受胃癌手术患者的110个切除淋巴结进行了研究。每个切除的淋巴结横向切开，并用生理盐水冲洗。对冲洗液进行CEA mRNA检测，并将检测结果与病理诊断[苏木精和伊红（H&E）染色]进行比较评估。所有淋巴结还进行了细胞角蛋白免疫染色（CK染色）并进行了比较评估。
通过H&E染色，发现29个淋巴结转移阳性，81个阴性。通过TRC测定，发现38个淋巴结阳性，72个阴性。根据CK染色结果，有37个转移阳性淋巴结和73个阴性淋巴结。H&E染色相对于CK染色的敏感性和特异性分别为78.4%和100%，而TRC测定相对于CK染色的敏感性和特异性分别为91.9%和94.5%。
使用淋巴结冲洗液的TRC测定法是一种快速、简单的基因诊断方法，比传统的永久标本H&E染色诊断具有更高的敏感性，并且能够将淋巴结整体保存为永久标本。这种TRC方法即使在通常没有病理学家驻诊的乡镇医院也能实现快速诊断，并被认为有助于胃癌治疗前哨淋巴结理论的临床应用。
