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目的：应用反转录聚合酶链反应（ reverse transcriptase polymerase chain reaction, RT PCR）法检测大肠癌的淋巴结微转移。方法： 17例行根治性手术的大肠癌患者，应用 RT PCR法检测切除的 205个淋巴结中细胞角蛋白 20（ cytokeratin20, CK20） mRNA的表达，另取 4例良性胃肠道疾病患者的 31个淋巴结作为阴性对照；并采用系列稀释试验检测本法的敏感性。结果：大肠癌患者的 205个淋巴结中有 35个检测到 CK20 mRNA的表达，而病理组织学检查仅发现 18个淋巴结存在肿瘤转移； 4例良性胃肠道疾病的 31个淋巴结 RT PCR结果均为阴性。系列稀释试验提示 CK20 RT PCR的敏感性为每 105个正常淋巴细胞中检测到 1个肿瘤细胞存在。结论： CK20 RT PCR是检测大肠癌淋巴结微转移灵敏而又特异的方法，较病理组织学检出淋巴结转移敏感性更高，其结果可能对改进分期和治疗方案具有积极的临床意义。
Objective: To detect lymph node micrometastasis in colorectal cancer by reverse transcriptase polymerase chain reaction (RT PCR). Methods: Seventeen patients with colorectal cancer who underwent radical surgery were examined for the expression of cytokeratin20 (CK20) mRNA in 205 lymph nodes removed by RT-PCR. Another 31 patients with benign gastrointestinal disease were enrolled. Lymph nodes served as negative controls; serial dilution tests were used to test the sensitivity of this method. Results: The expression of CK20 mRNA was detected in 35 out of 205 lymph nodes of patients with colorectal cancer, and only 18 lymph nodes were found to have tumor metastasis by pathological examination; 31 lymph node RT PCR results in 4 cases of benign gastrointestinal disease were negative. A series of dilution tests suggested that the sensitivity of CK20 RT PCR was the presence of one tumor cell per 105 normal lymphocytes. Conclusion: CK20 RT PCR is a sensitive and specific method for the detection of lymph node micrometastasis in colorectal cancer. It is more sensitive to the detection of lymph node metastasis than histopathology. The results may have positive clinical significance for improving the staging and treatment.