【摘要】 目的探讨RT-PCR在非小细胞肺癌(NSCLC)前哨淋巴结(SLN)微转移诊断中的可行性及其临床意义。方法选择24例c T1N0M0/c T2N0M0 NSCLC患者在术中行SLN定位活检,应用RTPCR检测SLN中CK19mRNA的表达来判断微转移的存在,与常规病理HE染色结果进行比较,并结合临床进行分析。结果 24例c T1N0M0/c T2N0M0 NSCLC患者(鳞癌15例,腺癌9例),术中共取得淋巴结146枚,平均6~8枚/例。其中SLN 67枚,非SLN 79枚,SLN敏感性为100%,准确率为91.7%(22/24),假阴性率为0%。SLN中常规病理HE染色检出3枚转移(阳性率为4.5%,3/67),RT-PCR检测SLN中21枚CK19阳性(阳性率为31.3%,21/67),显著高于常规病理HE染色对SLN微转移检出阳性率(4.5%),差异具有统计学意义(P<0.05)。79枚非SLN中,常规病理HE染色及RT-PCR均未检出微转移。结论 RT-PCR应用于检测NSCLC SLN微转移的诊断是可行的,联合应用SLN定位活检,可明显提高NSCLC淋巴结微转移的检出率。此方法可精确NSCLC TNM分期,指导术后辅助治疗,有望提高Ⅰ期NSCLC的生存率。更多还原

【Abstract】 Objective To investigate the feasibility and clinical significance of RT-PCR in diagnosis of micrometastasis of sentinel lymph node( SLN) in non-small cell lung cancer( NSCLC). Methods A total of 24 c T1N0M0 / c T2N0M0 NSCLC patients were intraoperatively using sentinel lymph node biopsy,for detecting the presence of micrometastasis,RT-PCR was applied to detect the expression of CK19 mRNA in SLN,pathological and clinical analysis was compared with the conventional HE staining results. Results In 24 c T1N0M0 /c T2N0M0 NSCLC cases( 15 squamous cell carcinoma cases,9 adenocarcinoma cases),intraoperatively obtained 146 lymph nodes( average 6 to 8),including 67 SLN and 79 non-sentinel lymph nodes. SLN sensitivity was 100%,accuracy was 91. 7%,and false negative rate was 0%. 3 sentinel lymph nodes were detected micrometastasis by conventional pathological HE staining( positive rate 4. 5%,3 /67),21 sentinel lymph nodes CK19-positive by RT-PCR( positive rate 31. 3%,21 /67). RT-PCR for detection of positive sentinel lymph node micrometastasis was 31. 3%,significantly higher than conventional pathological HE staining positive rate 4. 5%,the difference was statistically significant( P < 0. 05). Metastasis wasn’t detected in 79 non-sentinel lymph nodes. Conclusions Combined sentinel lymph node biopsy and RT-PCR technique can significantly improve the NSCLC detection rate of lymph node micrometastasis. This method can be accurate TNM staging NSCLC and guide adjuvant therapy to improve stageⅠ NSCLC survival.更多还原