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研究敏感的方法检测乳腺癌腋窝淋巴结微转移。方法:对15例乳腺癌者的61个腋淋巴结和5个正常对照淋巴结同时进行HE染色组织学检查和CKl9逆转录-聚合酶链式反应(CK19RT-PCR)检测。结果:15例乳腺癌组织均有CK19mRNA表达,而5个正常淋巴结中均末见表达。61个腋窝淋巴结中7个组织学检查证实转移,其CK19mRNA亦表达阳性。组织学检测无转移的54个淋巴结中有12个CK19RT-PCR表达阳性,42个阴性;提示该12个淋巴结存在微转移只能用CK19RT-PCR方法检测出。经统计学分析,CK19RT-PCR与组织学检查二者有显著差异(X~2检验,P<0.01)。结论:CK19表达于恶性乳腺细胞,正常淋巴细胞无表达,CK19能作为组织特异基因进行RT-PCR扩增以检测乳腺癌腋淋巴结微转移。CK19 RT-PCR方法比组织学方法更敏感,特别对在筛选组织学检查淋巴结阴性而具有高度复发危险性的病人将有实用价值。
A sensitive method for the detection of axillary lymph node micrometastases in breast cancer was investigated. METHODS: Sixty-one axillary lymph nodes and five normal control lymph nodes from 15 breast cancer patients were examined by histological examination and CK19 RT-PCR. Results: The expression of CK19 mRNA was detected in all 15 breast cancer tissues, but was found in all 5 normal lymph nodes. Seven histological examinations in 61 axillary lymph nodes confirmed metastasis, and CK19 mRNA was also positive. Twenty-four of the 54 lymph nodes without metastasis were positive for CK19RT-PCR and 42 were negative. This suggests that the presence of micrometastasis in the 12 lymph nodes can only be detected by CK19RT-PCR. After statistical analysis, there was a significant difference between CK19RT-PCR and histological examination (X~2 test, P<0.01). CONCLUSION: CK19 is expressed in malignant mammary gland cells, normal lymphocytes are not expressed, and CK19 can be used as a tissue-specific gene for RT-PCR amplification to detect micrometastasis of lymph nodes in breast cancer. The CK19 RT-PCR method is more sensitive than histological methods, and will be particularly useful for screening patients who are negative for histologic examination of lymph nodes and have a high risk of recurrence.