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经常规病理检查切除淋巴结内无癌转移的350例早期癌症病人(肺癌94例、乳腺癌112例、食管癌115例及外阴癌29例)3 715枚淋巴结,用连续切片、免疫组化染色重新检查、单克隆抗细胞膜(EMA)、抗细胞角蛋白(AEI/AE3)、多克隆抗角蛋白抗体免疫染色,查出部分淋巴结内存在微小癌灶或/及单个癌细胞.肺癌病人阴性率为56.4%(53/94 ),淋巴结为16.6%(123/739);乳腺癌病人阳性率为27.7%(31/112),淋巴结为2.72%(50/1840);食管癌病人阳性率为22,6%(26/115),淋巴结为7.0%;处阴癌病人阳性率为10.3%,淋巴结为1.4%.所有癌症病人总阴性率为32.3%,淋巴结为5.5%.肺鳞癌病人阳性率(58.0%)大大高于食管鳞癌(22.5%)与外阴鳞癌(10.3%)(P<0.05);肺腺癌病例阳性率(53%)也明显高于乳腺腺癌(P<0.05).随访材料显示局部淋巴结内存在隐匿性很小癌灶的病例预后较差(P<0.05).研究结果表明:应用连续切片及免疫组化染色可大大提高淋巴结内微小癌灶的检出率.淋巴结内隐匿性微小癌灶可能是恶性肿瘤广泛扩散的第一步.若能在外科手术时尽可能清除这类淋巴结,或许可以防止癌广泛转移、播放.从而能更有效地控制恶性肿瘤以提高治愈率.
After routine pathological examination, 3,715 lymph nodes were detected in 350 patients with early-stage cancer who had no cancer metastases in the lymph nodes (94 lung cancers, 112 breast cancers, 115 esophageal cancers, and 29 vulvar cancers). They were stained with serial sections and immunohistochemistry. Examination, monoclonal anti-cell membrane (EMA), anti-cytokeratin (AEI/AE3), and polyclonal anti-keratin antibody immunostaining revealed that there were microscopic lesions or/and single cancer cells in some lymph nodes. 56.4% (53/94), lymph node was 16.6% (123/739); breast cancer patient positive rate was 27.7% (31/112), lymph node was 2.72% (50/1840); positive rate of esophageal cancer was 22, 6% (26/115), lymph node was 7.0%; positive lymph node cancer rate was 10.3%, lymph node was 1.4%. The total negative rate of all cancer patients was 32.3%, lymph nodes was 5.5%. Positive rate of lung squamous cell carcinoma patients ( 58.0%) was significantly higher than esophageal squamous cell carcinoma (22.5%) and vulvar squamous cell carcinoma (10.3%) (P <0.05); the positive rate of lung adenocarcinoma cases (53%) was also significantly higher than that of breast adenocarcinoma (P <0.05). The follow-up materials showed a poor prognosis in patients with localized lymph nodes with small occult carcinomas (P<0.05). The results showed that the application of serial sections and immunohistochemical staining can greatly improve the prognosis. The detection rate of microscopic foci in lymph nodes. Occult microscopic foci in lymph nodes may be the first step in the widespread spread of malignant tumors. If these lymph nodes can be removed as much as possible during surgery, it may be possible to prevent cancer from widespread metastasis and play. This can more effectively control malignant tumors to improve the cure rate.