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目的检测早期宫颈鳞癌患者前哨淋巴结(sentinel lymph node,SLN)中人乳头瘤病毒(human papilloma virus,HPV)DNA和细胞角蛋白(CK)17的表达,探讨其在盆腔前哨淋巴结微转移中的临床意义。方法选取2012年1月至2013年1月山西医科大学第一医院早期宫颈鳞癌患者38例,其中ⅠB1期16例,ⅠB2期7例,ⅡA1期11例、ⅡA2期4例,实施经腹广泛性全子宫切除术+盆腔淋巴结清扫术。术中采用亚甲蓝方法识别前哨淋巴结,对前哨淋巴结进行常规淋巴结病理检查、第二代捕获杂交(HC2)方法检测HPV DNA、免疫组织化学方法检测CK17。结果 38例早期宫颈鳞癌患者中SLN的检出率为86.84%,获得85枚SLN。在85枚SLN中淋巴结转移阳性率为21.18%(18/85),高危型HPV DNA阳性率为34.12%(29/85),CK17表达阳性率为30.59%(26/85),二者均为阳性的有22枚。病理学检查为阳性的SLN,其高危型病毒检测和CK17检测均为阳性。病理组织学检查结果分别与高危型HPV DNA和CK17检测结果比较,差异有统计学意义(P<0.05)。结论宫颈鳞癌淋巴结存在常规病理检测难以发现的微小转移,联合检测高危型HPV DNA和CK17的表达可提高SLN微转移检出率的准确性和特异性。
Objective To detect the expression of human papilloma virus (HPV) DNA and cytokeratin (CK) 17 in the sentinel lymph node (SLN) of patients with early stage cervical squamous cell carcinoma and to explore its role in micrometastasis of pelvic sentinel lymph node Clinical significance. Methods From January 2012 to January 2013, 38 patients with early stage cervical squamous cell carcinoma of the First Hospital of Shanxi Medical University were selected, including 16 cases of stage IB1, 7 cases of stage IB2, 11 cases of stage IIA1 and 4 cases of stage A2A2. Hysterectomy + pelvic lymph node dissection. Intraoperative use of methylene blue method to identify sentinel lymph nodes, sentinel lymph node routine lymph node pathology, the second generation of hybridization (HC2) detection of HPV DNA, immunohistochemical detection of CK17. Results The positive rate of SLN in 38 patients with early cervical squamous cell carcinoma was 86.84%, and 85 SLNs were obtained. The positive rate of lymph node metastasis in 85 SLNs was 21.18% (18/85), the positive rate of high-risk HPV DNA was 34.12% (29/85), and the positive rate of CK17 was 30.59% (26/85) Positive 22. Pathologically positive for SLN, its high-risk virus test and CK17 test were positive. Pathological examination results were compared with high-risk HPV DNA and CK17 test results, the difference was statistically significant (P <0.05). Conclusion Lymph nodes in cervical squamous cell carcinoma have micrometastasis which is difficult to be found by routine pathological examination. Combined detection of high-risk HPV DNA and CK17 expression can improve the accuracy and specificity of SLN micrometastasis detection.