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目的:探讨131I标记抗胃癌单克隆抗体McAb3H11在胃癌放射免疫导向手术(RIGS)中的应用价值。方法:胃癌患者30例,在胃镜直视下将131I标记的McAb3H11注射于癌周围黏膜下,4～11d后手术;术中传统视触诊探查后,用手持式γ探测器行RIGS检测。手术切除标本(原发灶、切缘、淋巴结)除采用HE染色(连续切片)检查外,用免疫组织化学方法(CEAIHC)和RT-PCR(CK19RT-PCR)进一步实验室检测。选取60枚非肿瘤患者淋巴结设置为对照组。结果:RIGS与传统手术探查相比,对原发灶和切缘的判断一致,对淋巴结的判断,差异具有显著性意义。RIGS与HE染色相比,对原发灶及切缘癌浸润检测的特异性和准确率均为100%;在对淋巴结的检测中,RIGS的灵敏度和特异性分别为72.5%、96.2%,准确率为85.9%。CEAIHC和CK19RT-PCR进一步检测还发现,RIGS与HE染色对淋巴结的判断,差异具有显著性意义。结论:应用131I标记抗胃癌单克隆抗体McAb3H11进行胃癌RIGS,可有效判别胃癌浸润范围及淋巴结转移。RIGS对胃癌及其转移淋巴结的判别较传统的视触诊探查具有更高的特异性、敏感性和可靠性。RIGS对帮助发现隐匿转移的有一定意义。
Objective: To investigate the value of 131I labeled anti-gastric cancer monoclonal antibody McAb3H11 in radioimmunization guided gastric cancer surgery (RIGS). Methods: Thirty patients with gastric cancer underwent 131I-labeled McAb3H11 injection under the endoscope under endoscopy. Surgical procedures were performed after 4 to 11 days. The patients were treated with RIGS with hand-held gamma-detector after traditional palpation. Surgical resection specimens (primary tumor, margin, lymph nodes) were examined by HE staining (serial sections) and immunohistochemistry (CEAIHC) and RT-PCR (CK19RT-PCR). Sixty non-tumor patients were selected as the control group. Results: Compared with traditional surgical exploration, RIGS is consistent with the judgment of primary tumor and margin, and has significant significance for the judgment and difference of lymph nodes. The specificity and accuracy of RIGS in detecting infiltration of primary tumor and marginal carcinoma were 100% compared with HE staining. The sensitivity and specificity of RIGS in detecting lymph nodes were 72.5% and 96.2% respectively, which were accurate The rate was 85.9%. CEAIHC and CK19RT-PCR further tests also found that, RIGS and HE staining of lymph nodes to determine the difference was significant. Conclusion: 131I labeled monoclonal antibody McAb3H11 against gastric cancer RIGS can effectively differentiate the extent of gastric cancer invasion and lymph node metastasis. RIGS is more specific, sensitive and reliable than traditional palpation for gastric cancer and metastatic lymph nodes. RIGS is instrumental in helping find hidden transitions.