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目的 研究早期肺癌患者纵隔淋巴结内癌细胞微小转移的发生发展规律及其临床意义。方法 收集 32例临床分期为Ⅰ期或Ⅱ期且未经任何术前治疗的肺癌患者的 181枚纵隔淋巴结 ,每枚淋巴结于两个不同层面切取冰冻切片 ,用抗上皮细胞抗原的Ber Ep4抗体进行免疫组化染色 ,同时行HE染色进行对照 ,观察早期肺癌纵隔淋巴结内微小转移的情况。结果 15例患者 (46 .9% )的2 1枚 (11.6 % )常规病理石蜡切片HE染色阴性的纵隔淋巴结 ,经Ber Ep4免疫组化染色发现有微小癌细胞转移灶 ,其中 6例患者冰冻切片HE染色也发现有微小转移灶。术后常规病理检查确定为N0、N1、N2的患者分别为 19,6 ,7例 ,Ber Ep4免疫组化染色后微小转移灶阳性的患者分别为 7,2 ,6例 ,即7例Ⅰb期 (N0 )和 2例Ⅱb期 (N1)患者上升为Ⅲa期 (N2 )。 32例早期肺癌患者术前临床分期、术后常规病理分期和免疫组化分期中 ,N2患者分别占 0、18.8%和 4 6 .9%。结论 病期愈晚 ,纵隔淋巴结微小转移愈多见 ,Ber Ep4免疫组化染色较两平面HE染色更易于发现淋巴结中微小转移灶。临床诊断为早期肺癌患者的临床分期和常规病理分期存在分期偏早现象。
Objective To study the occurrence and development of micrometastasis in mediastinal lymph nodes and its clinical significance in patients with early stage lung cancer. Methods Totally 181 mediastinal lymph nodes from 32 patients with stage Ⅰ or Ⅱ clinical stage lung cancer without any preoperative treatment were collected. Frozen sections were obtained from two lymph nodes of each lymph node, Immunohistochemical staining, at the same time HE staining control, observe the early lung cancer in the mediastinal lymph node micrometastasis. Results Twenty-one (11.6%) of 15 patients (11.6%) had histopathological paraffin sections of HE-negative mediastinal lymph nodes. Micro-cancer metastases were found by Ber Ep4 immunohistochemical staining. Six of them were frozen sections HE staining also found that there is a small metastasis. Postoperative routine pathological examination identified as N0, N1, N2 patients were 19,6,7 cases, Ber Ep4 immunohistochemical staining of micrometastases positive patients were 7,2,6 cases, that is, 7 cases of stage Ib (N0) and 2 patients with stage IIb (N1) were elevated to stage Ⅲa (N2). Among the 32 patients with early stage lung cancer, the preoperative clinical stage, routine pathological stage and immunohistochemical stage were 0, 18.8% and 46.6% respectively. Conclusions The later the disease stage, the more micrometastasis of mediastinal lymph nodes, Ber Ep4 immunohistochemical staining is more likely to find micrometastases in lymph nodes than the two-plane HE staining. Clinical diagnosis of early stage lung cancer patients with clinical staging and conventional pathological staging exist premature phenomenon.