CAJ | 학술논문

目的探讨早期宫颈癌前哨淋巴结(SLN)微转移检测的临床意义.方法采用亚甲蓝示踪法术中检测30例早期宫颈癌患者的SLN.每例患者随机取可扪及的SLN以及盆腔其他组淋巴结(非SLN)1枚,共268枚,对半切开,一半组织进行实时荧光定量聚合酶链反应(PCR)检测细胞角蛋白19(CK19) mRNA的表达,以判断有无微转移；另一半进行常规HE染色.结果有28例(93.3％)患者检出了SLN,共67枚.6例患者盆腔淋巴结病理证实转移,SLN检测的敏感度为66.7％,准确率为96.4％,假阴性率为16.7％.实时荧光定量PCR的检测结果显示,268枚淋巴结(含9枚病理证实转移淋巴结)中,有68枚病理无转移但有微转移,占病理无转移淋巴结的26.3％ (68/259).病理无转移的24例患者中,16例存在微转移,占病理无转移者的66.7％.16例存在微转移的患者中,有3例SLN无微转移,但非SLN有微转移,SLN诊断的假阴性率升至18.2％.盆腔淋巴结的微转移与宫颈癌的淋巴血管间隙受侵、间质浸润深度以及组织学分级均无关(均P＞0.05).SLN微转移组的非SLN微转移率为100％,明显高于SLN无微转移组(27.3％,P＜0.01).结论实时荧光定量PCR是较为敏感的检测SLN微转移的方法,SLN微转移可作为SLN病理状态检测的有效补充以预测非SLN的转移；盆腔淋巴结的微转移与宫颈癌的病理高危因素及患者的预后无关.
목적 탐토조기궁경암전초림파결(SLN)미전이검측적림상의의.방법 채용아갑람시종법술중검측30례조기궁경암환자적SLN.매례환자수궤취가문급적SLN이급분강기타조림파결(비SLN)1매,공268매,대반절개,일반조직진행실시형광정량취합매련반응(PCR)검측세포각단백19(CK19) mRNA적표체,이판단유무미전이；령일반진행상규HE염색.결과 유28례(93.3％)환자검출료SLN,공67매.6례환자분강림파결병리증실전이,SLN검측적민감도위66.7％,준학솔위96.4％,가음성솔위16.7％.실시형광정량PCR적검측결과현시,268매림파결(함9매병리증실전이림파결)중,유68매병리무전이단유미전이,점병리무전이림파결적26.3％ (68/259).병리무전이적24례환자중,16례존재미전이,점병리무전이자적66.7％.16례존재미전이적환자중,유3례SLN무미전이,단비SLN유미전이,SLN진단적가음성솔승지18.2％.분강림파결적미전이여궁경암적림파혈관간극수침、간질침윤심도이급조직학분급균무관(균P＞0.05).SLN미전이조적비SLN미전이솔위100％,명현고우SLN무미전이조(27.3％,P＜0.01).결론 실시형광정량PCR시교위민감적검측SLN미전이적방법,SLN미전이가작위SLN병리상태검측적유효보충이예측비SLN적전이；분강림파결적미전이여궁경암적병리고위인소급환자적예후무관.
Objective To investigate the clinical significance of micrometastasis detection in sentinel lymph nodes (SLN) from patients with early cervical carcinoma.Methods Thirty patients with early cervical carcinoma were studied to identify SLN intraoperatively using methylene blue.One lymph node was removed randomly from palpable SLN and other pelvic lymph nodes (nSLN) in each patient,so 268 lymph nodes were collected and cut into two halves,one half of the lymph node was used to analyze the expression of cytokeratin 19 (CK19) mRNA by real-time fluorescence quantitative polymerase chain reaction to determine the presence of micrometastasis,the other half was examined by routine histology with HE staining.Results67 SLNs were detected in 28 cases (93.3％).Pelvic lymph nodes of 6 cases were confirmed pathological metastasis.The sensitivity of SLN detection was 66.7％,the accuracy rate was 96.4％,and the false negative rate was 16.7％.Among 268 lymph nodes (including 9 lymph nodes with pathological metastasis) detected by real-time fluorescence quantitative polymerase chain reaction,68 lymph nodes were pathological negative but had micrometastasis,accounting for 26.3％ (68/259) in pathologically negative lymph nodes.Among 24 patients with pathological negative lymph nodes,16 cases had micrometastasis,accounting for 66.7％ in those patients.Among 16 patients with micrometastasis,SLN of 3 cases were negative,but nSLN were micrometastasis,so the SLN false-negative rate rose to 18.2％.There were no significant relationships between pelvic lymph nodes micrometastasis and perivascular space involvement,deep stromal invasion and tumor grade (all P ＞ 0.05).The micrometastasis rate of nSLN in patients with SLN micrometastasis was 100％,significantly higher than that in the patients with SLN non-micrometastasis (27.3％,P ＜ 0.01).Conclusions Real-time fluorescence quantitative polvmerase chain reaction is a sensitive method to detect SLN micrometastasis.SLN micrometastasis may be an effective complement to SLN pathology to predict nSLN metastasis.Pelvic lymph nodes micrometastases have no significant relationship with pathological risk factors in cervical cancer and prognosis of patients.