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目的 探讨12 5I标记抗胃癌单克隆抗体MAb 3H11在胃癌放射免疫导向手术 (RIGS)中的应用价值。 方法 胃癌患者 35例 ,在胃镜直视下将12 5I标记的MAb 3H11注射于癌周围粘膜下 ,4～ 11d后手术 ;术中使用手持式γ探测仪对靶部位 (T)及对照本底 (NT)进行放射性计数 ,T/NT比值≥ 3 5为判别胃癌及癌浸润胃壁的标准 ,T/NT≥ 3 0为判定转移淋巴结的标准 ;对RIGS阳性、而术后常规病理检查阴性的 19组淋巴结 ,采用免疫组织化学方法检测微转移癌。 结果 本组病例中 ,33例RIGS获得成功 ,RIGS判别切缘癌浸润的总特异性和准确率分别为 98 5 %和 97 0 % ;注射标记抗体后 6～ 8d手术的患者 (n =2 5 ) ,RIGS判别区域淋巴结转移的敏感度、特异性及准确率分别为 83 6 %、95 0 %和 91 3% ;免疫组织化学染色从 10组 (5 2 6 % )RIGS阳性 ;而术后常规病理检查阴性的淋巴结中检出胃癌微转移灶。 结论 应用12 5I标记抗胃癌单克隆抗体MAb 3H11进行胃癌RIGS ,可有效判别胃癌浸润范围及区域淋巴结转移程度。
Objective To investigate the value of monoclonal antibody MAb 3H11 labeled with 12 5I in gastric cancer radioimmunoguided surgery (RIGS). Methods Thirty-five patients with gastric cancer underwent endoscopic examination. 12 5I-labeled MAb 3H11 was injected into the submucosa of the cancer and the operation was performed 4 to 11 days later. The hand-held γ-detector was used for the target site (T) and the control background. NT) radioactivity counting, T/NT ratio ≥ 3 5 is a criterion for distinguishing gastric cancer and cancer infiltrating the stomach wall, T/NT ≥ 30 is a criterion for determining metastatic lymph nodes; 19 groups are positive for RIGS and negative after routine pathological examination. Lymph nodes were examined by immunohistochemistry for micrometastases. Results In this group of patients, 33 cases of RIGS were successfully performed. The total specificity and accuracy of RIGS in distinguishing marginal cancer infiltration were 98.5% and 97.0%, respectively; patients who had been operated for 6 to 8 days after injection of labeled antibody (n = 2 5 The sensitivity, specificity, and accuracy of RIGS in identifying regional lymph node metastases were 836%, 95%, and 91%, respectively; Immunohistochemical staining was positive from 10 groups (52.6%) of RIGS; postoperative routine Micrometastases in gastric cancer were detected in lymph nodes with negative pathological examination. Conclusion The application of 125I-labeled anti-gastric cancer monoclonal antibody MAb 3H11 in gastric cancer RIGS can effectively distinguish the extent of gastric cancer invasion and regional lymph node metastasis.