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目的探讨常规病理检查无淋巴结转移的胃癌淋巴结微转移的特点,并分析微转移与各种临床病理因素的关系。方法应用淋巴结组织连续切片和端粒酶RT-PCRELISA方法检测46例胃癌患者常规病理检查无淋巴结转移的No.7组淋巴结138个,并结合胃癌患者的临床病理资料进行统计学分析。结果本组13例(28.3%)32枚淋巴结(23.2%)经连续切片检出有微转移;而端粒酶阳性表达为20例(43.5%)49枚淋巴结(35.5%)。端粒酶RT-PCRELISA检测敏感性为100%,特异性为84%,阳性预测值为65%,阴性预测值为100%,诊断准确率为88%。淋巴结微转移与患者年龄、性别、原发肿瘤部位、组织学类型和转移淋巴结分型无关(P>0.05),但与原发肿瘤大体类型、大小及是否浸透浆膜有关(P<0.05)。结论对常规病理检查无淋巴结转移的胃癌患者,为客观评价胃癌临床病理分期及其预后,有必要监测其微转移,端粒酶RT-PCRELISA方法可以作为传统组织学检查方法的补充。
Objective To investigate the characteristics of lymph node micrometastasis in gastric cancer without lymph node metastasis by routine pathological examination and to analyze the relationship between micrometastasis and various clinicopathological factors. Methods A total of 138 lymph nodes in 46 cases of gastric cancer without lymph node metastasis were detected by serial sections of lymph node tissue and telomerase RT-PCR ELISA. Combined with the clinical and pathological data of gastric cancer patients, statistical analysis was made. Results Thirty-two lymph nodes (23.2%) were micrometastically detected by serial sections in 13 cases (28.3%). Twenty-four (35.5%) were confirmed by telomerase activity in 20 cases (43.5%). The sensitivity of telomerase RT-PCR ELISA was 100%, the specificity was 84%, the positive predictive value was 65%, the negative predictive value was 100%, and the diagnostic accuracy was 88%. Lymph node micrometastasis had no relation with age, sex, primary tumor location, histological type and metastatic lymph node type (P> 0.05), but was related to the gross type, size and infiltration of serosa (P <0.05). Conclusion For patients with gastric cancer who do not have lymph node metastasis by conventional pathology, it is necessary to monitor the micrometastasis in order to objectively evaluate the clinicopathological stage and prognosis of gastric cancer. Telomerase reverse transcriptase-polymerase chain reaction (RT-PCR) can be used as a complement to traditional histological examination.