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目的:建立较能接受真实地反应胃癌淋巴结转移(LNM)而又省时、简便、可推行的方法。方法:对35例胃癌根治性切除标本进行全数、逐个淋巴结(LN)检查.平均每例获得76.89个淋巴结。用连续切片≥6张H.E染色(SSHES)和细胞角蛋白免疫组化染色(CK-IHS)的方法确定LNM和淋巴结微转移(LNMM)。数据用u检验和t检验。结果:用SSHES方法共检查出2691个LN,查出539个LN有转移。本组病例最小转移度2.86％(2~+/70),最大转移度88.14％(52~+/59),相差幅度巨大。35例中,早期胃癌6例、无1例LNM.进展期胃癌29例、24例有LNM、转移率为82.76％,CK-IHS方法共检查1783个LN,查出226个LN有转移,其中与SSHES结果一致的为137个LN,单独被CK-IHS查出89个LN.SSHES漏诊5.41％。LNMM的2例均为跳跃转移。CK-IHS对LNM,LNM的检出率明显高于SSHES(P<0.01),对散在分布的少数转移癌细胞的检出率也明显高于SSHES(P<0.01)。结论:连续6张切片H.E.染色的检查方法有良好的可靠性、准确性,但IHS检查优于连续切片。IHS能提高LN转移度和增加转移率,结果可靠、省时、并且直接影响胃癌的分期、治疗和预后。
OBJECTIVE: To establish a more time-saving, simple, and feasible method that is more likely to truly reflect lymph node metastasis (LNM) in gastric cancer. Methods: Totally and lymph node (LN) examinations were performed on 35 cases of radical resection of gastric cancer. 76.89 lymph nodes were obtained in each case. LNM and lymph node micrometastasis (LNMM) were determined by serial sections of ≥ 6 H.E stainings (SSHES) and cytokeratin immunohistochemical staining (CK-IHS). The data was tested using u and t tests. Results: A total of 2691 LNs were detected by SSHES, and 539 LNs were found to have metastases. The minimum degree of metastasis in this group was 2.86% (2~+/70), and the maximum degree of metastasis was 88.14% (52~+/59). Of the 35 cases, there were 6 cases of early gastric cancer, no case of LNM, 29 cases of advanced gastric cancer, 24 cases of LNM, metastasis rate of 82.76%, and 1783 LNs were examined by CK-IHS method. 226 LN were found to have metastases. Consistent with SSHES results, 137 LNs were detected, and CK-IHS alone detected 89 LN.SSHES missed 5.41%. Two cases of LNMM were skip transitions. The detection rate of CK-IHS on LNM and LNM was significantly higher than that of SSHES (P<0.01). The detection rate of scattered metastatic cancer cells was also significantly higher than that of SSHES (P<0.01). Conclusion: The continuous 6-slice H.E. staining method has good reliability and accuracy, but the IHS examination is better than continuous slice. IHS can increase the degree of LN transfer and increase the rate of metastasis. The result is reliable, time-saving, and directly affects the staging, treatment, and prognosis of gastric cancer.