【作者】 李智伟；

【导师】 温放；

【作者基本信息】 中国医科大学 ， 妇产科学， 2009， 硕士

【摘要】 目的本文通过免疫组化法角蛋白CK(高分子量)、CK(低分子量)标记检测早期宫颈癌盆腔淋巴结微转移情况,来探讨免疫组织化学染色法(immuno-histochenmistry,IHC)检测常规病理检查无淋巴结转移的早期宫颈癌患者淋巴结微转移的可行性和可信度,分析与淋巴结微转移有关的临床病理因素,并对微转移检测的临床价值进行评估方法一、标本的采集收集中国医科大学附属第一医院妇科2006年1月-2008年6月收治的早期宫颈癌初治病例30例,所有患者术前均未行放化疗,并在我院妇科行广泛性全子宫切除术加盆腔淋巴结清扫术。回顾性分析这30例患者的临床资料,所有患者的年龄为28-55岁(平均41.5岁),其中宫颈腺癌6例、鳞癌24例。按FIGO分期:ⅠA期7例,ⅠB期20例,ⅡA期3例。共收集经常规病理证实的阴性淋巴结370枚,其中腺癌76枚,鳞癌294枚。二、实验方法免疫组织化学染色法(SP法):应用免疫组化SP法对切除后的盆腔淋巴结石蜡包埋组织用细胞角蛋白单克隆抗体CK(高分子量)、CK(低分子量)进行标记检测。其中CK(高分子量)、CK(低分子量)抗体的工作浓度为1∶100,具体步骤严格按照S-P免疫组化试剂盒说明书的操作规范进行,并同时设有空白、阴性对照。三、统计学分析应用SPSS13.0统计软件对所有数据进行分析,其淋巴结微转移与病理类型、临床分期之间的关系采用卡方检验,条件不满足者用Fisher确切概率检验,所有结果以P<0.05有统计学意义。结果1、30例患者的370枚淋巴结中,5例患者9枚淋巴结发现微转移,其病例总阳性率为16.67%,淋巴结总阳性率为2.43%。2、淋巴结微转移的分布情况:3枚分布于髂外淋巴结组,5枚分布于闭孔淋巴结组,1枚分布于腹股沟深淋巴结组,其中髂外淋巴结,闭孔淋巴结,腹股沟深淋巴结中的阳性检出率分别为3.19%,5.68%,1.61%。髂总淋巴结及髂内淋巴结组未发现微转移。在有转移的淋巴结中,闭孔淋巴结的转移率最高。3、在各种临床特征中,通过检测其淋巴结微转移发生率,本研究发现微转移发生率与临床分期密切相关,随着其临床分期的增加,微转移的检出率也逐渐增大(P<0.05),而对于其病理类型、原发灶大小等其它临床特征,其淋巴结微转移发生率却无显著性差异(P>0.05)。结论1、早期宫颈癌盆腔淋巴结中存在微转移,通过免疫组化法可检出,且随着淋巴结数目的增多,微转移检出率逐渐增大。2、在其发生淋巴结微转移中,闭孔淋巴结的微转移率最高。其微转移发生率可能与临床分期密切相关,随着临床分期的增加,微转移的发生率逐渐增大。3、这些对于指导临床治疗、判断预后都有重要的临床价值。更多还原

【Abstract】 ObjectiveBy immunohistochemistry cytokeratin CK (high-molecular)、CK (low-molecular) markers of early detection of pelvic lymph node micrometastasis in cervical cancer cases, to explore the immunohistochemical staining (immunohistochenmistry, IHC) detection of non-conventional pathological examination of lymph node metastasis patients with early cervical lymph node micrometastasis in the feasibility and reliability of analysis of lymph node micrometastasis and clinicopathological factors related to the detection of micrometastasis to assess the clinical value.Methods1. Tissue collectionCollect the First Affiliated Hospital of China Medical University, from the January 2006 to June in 2008, 30 cases of newly diagnosed case in the early stage of cervical cancer were admitted, all patients did not undergo pre-operative radiotherapy and chemotherapy .meanwhile, all patients were operated for a broad range hysterectomy pelvic lymph node dissection in my hospital. Retrospect the 30 cases patient of clinical data, all patients aged 28-55 years (average 41.5 years old) six cases of cervical adenocarcinoma, twenty-four cases of squamous cell carcinoma. According to FIGO stages: LA period of seven cases, IB period of 20 cases, IIA period of three cases. We collected by conventional pathology confirmed negative lymph nodes 370, 76 lymph nodes of adenocarcinomas, 294 lymph nodes of squamous cell carcinoma.2. MethodsParaffin-embedded pelvic lymphadenectomy specimens were serially sectioned and stained with anti-cytokeratin Cytokeratin(high Polymer) Cytokeratin(low- molecular-weight). The working concentration of antibodies Cytokeratin(high Polymer) Cytokeratin(low -molecular-weight), was 1:100. All procedures were implemented according to the product illustration.3. Statistical AnalysisThe data were evaluated by chi-square test and Fisher’s exact probabilities, SPSS13.0.Result1. The evidence of micrometastasis was found in 9(2.43%) of 370 lymph nodes from 5(16.67%) of 30 cases. Among the lymph nodes with micrometatasis, the positive rate of external iliac lymph nodes and obtutator lymph nodes was 3.19% and 5.68%. the positive rate of inguinal Lymph nodes was 1.61%. other lymph nodes has no micrometastasis.2. The Positive rate of obtutator lymph nodes was best.3. In some clinical features, we found the incidence of micrometastasis was related with clinical stage. The positive rate of micrometastasis increased.With the progression of clinical stage(P<0.05). In the other clinical features, such as tumor volume, depth of invasion, the incidence of micrometastasis was not significant differences.Conclusions1. There is micrometastasis in the pelvic lymph nodes around the cervical cancer of early stage, and the detection of micrometastasis by immunohistochemical staining in the negative lymph nodes. The positive rate of micrometastasis increased with the number of lymph nodes.2. The positive rate of obtutator lymph nodes was higer than other lymph nodes meanwhile, The micrometastasis increases with the progression of clinical stage.3. These results can be helpful for the tumor stages, treatment and prognosis evaluation.更多还原