The Applied Research Of Micrometastasis Detection In Sentinel Lymph Node Of Early Stage Non-small Cell Lung Cancer

BACKGROUND AND OBJECTIVE:Lung cancer is one of the common malignant tumors in China，has the characteristics ofhigh incidence rate and poor prognosis. The regional lymph node metastasis are the mainfactors influencing early prognosis of non small cell lung. Surgical operation is the mainmethod for treatment of early stage non small cell lung cancer, The treatment principle is theprimary lesion resection and radical lymphadenectomy, Due to the complete lymph nodedissection large range of operations、big trauma、high postoperative complications, it hasdisadvantages of high mortality, reduced quality of life. So for whether patients need athorough lymph node dissection for early stage non small cell lung cancer, there are still manyarguments in clinical practice. Because of the sentinel lymph node biopsy can avoidunnecessary radical lymphadenectomy, reduced operation trauma and postoperativecomplications，received more and more attention in clinical practice. This study first in thecombined with intraoperative application of staining (isosulfan blue solution) and radioactiveisotope method (99technetium sulfur colloid detection) were detected for SLN, After theoperation to detect the expression of CK19, MAGE-A3antibody in SLN and non sentinellymph node.To explore the clinical value and their relationship with non small cell lungcancer SLN cells.METHODS:A total of32patients with clinical stage I toⅡ A NSCLC in my hospital were randomized selected in this prospective study, The combined application of staining (isosulfan bluesolution) and radioactive isotope method (99technetium sulfur colloid detection) to detectedthe SLN in operation.After the operation by immunohistochemistry staining labeled CK19,MAGE A3antibody expression in normal lung tissue, lung tumor, SLN and Non-SLN,And atthe same time,The positive control staining. Using SPSS18.0software package tocomparative analysis the differential expression of CK19and MAGE A3antibody in SLNgroup and Non-SLN group, transfer SLN group and non SLN group.RESULTS:32patients were detected the sentinel lymph node,A total of598lymph nodes wereexamined, including103SLNs and495non sentinel lymph nodes, An average of18.69士8.1lymph nodes per patient,3.22+1.74sentinel lymph nodes. Histopathologic examinationsdemonstrated the Presence of metastases in58nodes of17patients, Among them,26sentinellymph nodes were metastasis in16patients,32non sentinel lymph nodes were metastasis in6patients, One patient with false negative sentinel lymph node. Sentinel lymph node sensitivitywas94.12%, the accuracy rate was96.88%, false negative rate5.88%. However,Immunohistochemical method dctected the expression of CK19in44sentinel lymph nodesof20patinets were positive, The expression of MAGEA3in31sentinel lymph nodes of19patinets were positive; Immunohistochemical method dctected the expression of CK19in36sentinel lymph nodes of6patinets were positive,The expression of MAGEA3in33sentinellymph nodes of6patinets were positive. The positive rate of routine examination ofsentinel lymph nodes in25.24%cases, immunohistochemical examination positive ratewas42.72%, with statistical significance (P=0.008<0.05). Expression of CK19and MAGEA3in sentinel lymph nodes were significantly related to clinical stage (P <0.05), Expressionof CK19and MAGE A3in sentinel lymph nodes were not significantly associated with othercharacterristics such as the sex, age, clinical histopathology type, tumor location,differentiation degree, tumor size (P>0.05); The expression of CK19and MAGE A3insentinel lymph nodes was positively related adenocarcinoma.CONCLUSION：1. Compared with conventional histopathological,immunohistochemical detection theexpression of MAGEA3and CK19in sentinel lymph node can significantly improve the detection rate of micrometastasis。2. CK19and MAGEA3immunohistochemical method was applied to lung cancersentinellymph node biopsy, can provide a theoretical basis for molecular earlyNSCLC stage, and individual choice in favor of NSCLC lymph node dissection.