Establishment And Optimization Of Rapid Diagnostic Methods For Cervical Lymphatic Metastasis During Oral Carcinoma Operation

Pathologically,about 80%of oral carcinoma is squamous cell carcinoma,and lymphatic metastasis remains the main lethal reason.At present,the main treatment of oral carcinoma is primary focus excision and neck dissection.Excessive neck dissection widely exists in clinic,and makes patients bear enormous and unnecessary price in health,spirit and economy.How to assess the state of cervical lymphatic metastasis,select reasonable operation type of neck dissection and make moderate therapy are needed to be solved questions in this field.ObjectiveTo compare the current diagnostic methods for cervical lymphatic metastasis,and optimize method(s)for intraoperative detection with the feature of high-accuracy,short-time consumption,easy-manipulation and low-cost.MethodsTo collect lymphonodes from patients with oral carcinoma,receiving operation treatment in oral and maxillofacial surgery wards in QiLu hospital of Shandong University,detect every one lymphonode with the following five methods,and record the time,accuracy,manipulation difficulty and cost respectively: 1.Paraffin section Haematoxylin and eosin-stained(HE):paraffin imbedding routinely,make serial sections and haematoxylin and eosin-stained2.Cell printing slice HE:to make cell printing slice and Haematoxylin and eosin-stained3.Cell printing slice Immunohistochemistry(IHC):to detect cytokeratin(CK) expression by immunohistochemistry,provided by EnVision^TMDetection Kit, Peroxidase/DAB,Rabbit/Mouse4.Frozen section HE:to make frozen section and Haematoxylin and eosin-stained5.Frozen section IHC:to detect cytokeratin expression by immunohistochemistry,according to international immunohistochemical methodUsing the clinical pathological report of neck dissection specimens as the standard of lymphatic metastasis state,we compare the time consumption,accuracy, manipulation difficulty and cost of every detection method,and optimize the method(s)according with the requirements above.Results71 lymphonodes from 27 patients with oral carcinoma,receiving operation treatment in oral and maxillofacial surgery wards in QiLu hospital of Shandong University from May 2007 to January 2008,were detected.29 lymphonodes were reported positive by clinicopathology,in accordance with the results of paraffin section HE in the study,which was used as the(+)standard.â‘ Frozen section HE:accuracy 96.55%,false negative rate 3.45%,false positive rate 2.3%, misdiagnosis rate 2.82%,cost 2.0 yuan,manipulated easily,only need 15 minutes to finish;â‘¡Frozen section IHC:accuracy 100%,false negative rate 0%,false positive rate 2.38%,misdiagnosis rate 1.41%,cost the most 50.5 yuan,various procedures need about 1 hour,moderate difficulty;â‘¢Cell printing slice HE: accuracy 93.1%,false negative rate 12.9%,false positive rate 0%,misdiagnosis rate 5.63%,cost only 0.5 yuan,needs 10 minutes,manipulated most easily,but required senior pathologists to diagnose definitely;â‘£Cell printing slice IHC:accuracy 96.55%,false negative rate 0%,false positive rate 4.65%,misdiagnosis rate 2.82%, cost 39.5 yuan,easy slice production,various procedures,moderate difficulty,easy diagnosis,low requirement of slice readers.Frozen section HE,combined with IHC, can make accuracy raise to 100%.Chi-square test(x²-test)of matched fourfold table data was used to compare every two detection methods,P＞0.05,display no significant difference of accuracy between different methods.Conclusions1.Intraoperative frozen section HE has the feature of easy manipulation,high accuracy,low cost and less time,can be used as rapid diagnostic method of lymphatic metastasis during oral carcinoma operation2.Intraoperative frozen section HE,combined with IHC,can raise accuracy and reduce misdiagnosis3.Imprint cytology has the advantages of fastness,simpleness and low cost, can be used as the preferred intraoperative diagnostic method for lymphatic metastasis in primary hospital,and make final diagnosis combined with immunohistochemistry.