Detection Of Sentinel Lymph Node Micrometastasis In DukesB Colorectal Carcinoma Patients And Its Clinical Significance

Objective: To investigate the detection of sentinel lymph node micrometastasis(SLNMM) and its clinical significance in patients with colorectal carcinoma of DukesB stage.Methods: In a prospective study,122 SLNs were searched and examined successfully in 61 among 64 cases of DukesB colorectal carcinoma,using the immunohistochemical(IHC) staining to detect cytokeratin20(CK20) and telomerase in proper order,while the SLNs were negative by routine hematoxylin and eosin(HE) staining.Following up at least 3 years,memorized these patients' clinical pathological parameters and survival numerical data, and analysis the dependablity.Results:1. 1 to 4 SLNs were identified in 61 of 64 patients(95.3%), Overall, 122SLNs were retrieved from the operative specimens, with a mean of 2.5 SLNs per patient.2. By the conventional HE staining, 9 SLNs were positive, 9.84 percent (6/61) of colorectal carcinoma patients were with sential lymph node micrometastasis.3. IHC(immunohistochemistry) was used to detective the micrometastasis in the surplus 113 SLNs in 55 patients, 19 SLNs of 15 cases(27.3%,15/55) were CK20 postive expression; Micrometastasis was also detected in 12 cases(21.8%,12/55) by IHC anti-telomerase staining.4. Combining the two methods can improve the micrometastasis rate as 38.2%(21/55)in cases.5. The percent of carcinoma recurrence or metastasis of the DukesB patients with SLNMM(+) was significantly higher than the patients with SLNMM(-)(P<0.05), but the survival rate of the patients with SLNMM(+) was significantly lower than the patients with SLNMM(-). However, compared with 45 DukesC patients, the percents were no significant difference. In contrary, the percents of recurrence or metastasis and survival between DukesC patients and SLNMM(-)DukesB patients were significantly different(P<0.05). By multivariate Logistic regression analysis, SLNMM was intimately correlated with post-operative recurrence or metastatsis, the value of Exp(B) was 144.000.Conclusion:1. Combining examination of immunohistochemical anti-CK20 and anti-telomerase staining can improve the detective rate of SLNMM in DukesB colonrectal carcinoma patients.2. In this study, SLNMM is an independent prognostic index for colorectal carcinoma patients, and it is intimately correlated with colorectal carcinoma recurrence or metastatsis.3. The detection of SLNMM is of important clinical significance for staging Dukes, selection of adjuvant treatment and evaluation of prognosis in patients with colcrectal carcinoma.