Noorlag Rob, van Es Robert J J, de Bree Remco, Willems Stefan M
Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands.
Head Neck. 2017 Sep;39(9):1864-1868. doi: 10.1002/hed.24847. Epub 2017 Jun 23.
Intraoperative analysis of lymph nodes during a sentinel lymph node biopsy (SLNB) procedure could result in one-step surgery for early oral squamous cell carcinoma (OSCC) with an occult nodal metastasis. One-step nucleic acid amplification rapidly detects cytokeratin 19 (CK19) RNA with high accuracy. Sensitivity and specificity of CK19 expression in OSCC was evaluated.
Immunohistochemical CK19 expression was done in 207 patients with OSCC with 65 cases of paired nodal metastases.
CK19 was expressed in 65% of all OSCC and even less in early OSCC (56%), with poor correlation between primary tumor and (occult) nodal metastasis. Furthermore, ectopic glandular tissue in close proximity of lymph nodes showed strong CK19 expression.
CK19 lacks both sensitivity and specificity as a biomarker for nodal metastasis in OSCC, which questions the suitability for CK19-based one-step nucleic acid amplification in SLNB procedures. Therefore, future studies should focus on other biomarkers, because the concept of fast intraoperative diagnostics during SLNB remains attractive.
在前哨淋巴结活检（SLNB）手术过程中对淋巴结进行术中分析，可能会使早期口腔鳞状细胞癌（OSCC）伴隐匿性淋巴结转移的患者实现一步手术。一步核酸扩增可快速、准确地检测细胞角蛋白19（CK19）RNA。评估了CK19在OSCC中表达的敏感性和特异性。
对207例OSCC患者进行免疫组织化学检测CK19表达，其中65例伴有配对的淋巴结转移。
CK19在所有OSCC中的表达率为65%，在早期OSCC中表达率更低（56%），原发肿瘤与（隐匿性）淋巴结转移之间的相关性较差。此外，淋巴结附近的异位腺组织显示出强烈的CK19表达。
CK19作为OSCC淋巴结转移的生物标志物，既缺乏敏感性也缺乏特异性，这对基于CK19的一步核酸扩增在SLNB手术中的适用性提出了质疑。因此，未来的研究应关注其他生物标志物，因为SLNB术中快速诊断的概念仍然具有吸引力。
