The Studies And Significance In Quantitative Pathology Of Gastric Lymph Nodes Which Are Micrometastasis

Objective:Modern studies have shown that surgery is the only possible way to cure gastric cancer. The lymph node metastasis is important for gastric cancer treatment and prognosis, and a thorough lymph node dissection don't only make an effect on the prognosis of patients, but also decide the scope of surgical resection of the primary basis. Because of gastric lymph node distribution of a wide range, of large number of groups, of complex sub-station, complete lymph node dissection around the stomach is more difficult, to expand the scope of the excessive cleaning will increase the surgical complications, to reduce the scope of lymph node dissection may be omitted the lymph node metastasis. Therefore, how to identify the gastric lymph nodes in surgery, especially lymph node metastasis are the most crucial problem. Existing MRI, CT and endoscopic ultrasonography, such as the means to check the surrounding of lymph node metastasis of gastric cancer the preoperative assessment of the situation are lack of accuracy and sensitivity; The last century 90's in our country,someone have used methylene blue dye and other such studies done , but ineffective. In addition, the current program of gastric cancer surgery has tended to design rationalization, procedure standardization, and one of the most important requirement is to achieve its full radical resection, I.e. R0 resection. R0 resection has required target quality control, including surgical methods, enbloc resection and quantitative histopathological examination, the latter are the most objective surgical quality control target, which includes the tumor diameter, growth pattern, depth of invasion, stump 0.5cm slices, the total number of lymph node dissection, positive number, negative number, anatomical site, and analysis of DNA content, PCNA, tumor gene protein mutant inspection, these results have decisive significance to the staging, surgical resection level assessment, treatment and prognosis of postoperative decide. The purpose of this study is through the use of nano-carbon stain gastric lymph nodes , to further the accumulation of lymph nodes of gastric cancer metastatic lymph nodes and to look for lymph node dissection experience; to further explore the law of lymph node metastasis of gastric cancer; to introduct the Cytokeratin (CK) mouse anti-AE1/AE3 immunohistochemical detection of micrometastases in lymph nodes to guide lymph node dissection, to assess the level and quality of surgical resection, to improve the therapeutic effect of gastric cancer.Methods:Elect 63 case gastric cancer patients who are after pathology confirmed between September 2007 and December 2008, after exploratory surgery to determine the tumor can be removed,inject carbon nanoparticles suspension injection 1ml along the tumor around 4~6 points. Along the cardia - lesser curvature of stomach - pylorus- gastric greater curvature order to seize the groups of the left gastric, lesser curvature of stomach, pylorus up and down,stomach greater curvature lymph node after the operation, and the other groups lymph node are seized in the operation. Record each anatomical location of lymph nodes and whether or not to be dye-stained. All of the lymph nodes are conventional preparation, HE staining, microscopy, and the Cytokeratin (CK) mouse anti-AE1/AE3 immunohistochemical staining to detect the micrometastasis of lymph node.Results:In 63 cases of gastric cancer patients, gastric lymph nodes found that the transfer of conventional pathological examination of the positive rate was 38.6% (413/1071): being a successful carbon nanoparticles suspension injection black dye from the positive rate of 40.9% ( 392/959); not happen and the transfer of dye from the positive rate is 18.8% (21/112). By immunohistochemical staining detected positive lymph node metastasis rate was 62.1% (665/1071): being a successful nano-carbon black dye transfer from the positive rate is 63.5% (609/959); not happen and polluter The positive rate of transfer is 50% (56/112). Immunohistochemical detection of gastric cancer in patients with lymph node seized is better and accurate than the conventional pathological examination; being a successful carbon nanoparticles suspension injection black dye of lymph node metastasis was significantly higher than the chances of not black dye lymph nodes.Conclusions:(1)Carbon nanoparticles suspension injection is a good dye tracer materials of lymph nodes of gastric cancer, and it can be used to guide the dissection of the lymph node in surgen ; (2)The transfer rate of black lymph node is much higher than undyed one, and we can not leave out of the black-stained lymph node;(3)The transfer rate of the Cytokeratin (CK) mouse anti-AE1/AE3 immunohistochemical staining is much higher than the conventional pathological examination, and if we introduct the method into the conventional pathological examination, it can help us finding more lymph nodes of micrometastasis to guide the surgery and the comprehensive treatment after surgery,to judge the prognosis.