Detection and clinical significance of lymph node micrometastasis determined by reverse transcription-polymerase chain reaction in patients with esophageal carcinoma.
We investigated micrometastasis in lymph nodes by detecting carcinoembryonic antigen (CEA) mRNA. A total of 400 lymph nodes obtained from 21 patients with esophageal carcinoma were examined by CEA-specific reverse transcription-polymerase chain reaction (RT-PCR). Serial sections of positive lymph nodes were reexamined histologically and immunohistologically. Twenty-seven lymph nodes of 11 patients were diagnosed as being positive by conventional histologic examination. CEA-mRNA positivity was found in 18 of 21 patients. Among 373 histologically negative nodes, 79 (21.2%) were positive for CEA mRNA. Of these, micrometastasis was detected in 2 by histological reexamination and in 11 by immunohistochemical staining using cytokeratin antibody. Two of 6 RT-PCR-positive patients (33.3%) had recurrent disease. Four of 11 patients (36.4%) whose nodal involvement was discovered by routine histological examination also had recurrent cancer. CEA-specific RT-PCR detected micrometastasis in lymph nodes at a higher rate than histological or immunohistochemical analysis of serial sections. Since the incidence of CEA-mRNA positivity is high in the lymph nodes of esophageal cancer patients except for those with early cancer, these patients should be treated with adjuvant therapy.
Kijima
F
F
First Department of Surgery, Center for Chronic Viral Diseases, Kagoshima University School of Medicine, Kagoshima, Japan.
Natsugoe
S
S
Takao
S
S
Aridome
K
K
Baba
M
M
Yoshifumi
M
M
Eizuru
Y
Y
Aikou
T
T
D002272:Carcinoembryonic Antigen / Q000235:genetics*; D002277:Carcinoma / Q000276:immunology / Q000556:secondary*; D018076:DNA, Complementary / Q000032:analysis; D004938:Esophageal Neoplasms / Q000276:immunology / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D012313:RNA / Q000737:chemistry; D012333:RNA, Messenger / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014407:Tumor Cells, Cultured
D002272:Carcinoembryonic Antigen; D018076:DNA, Complementary; C034477:RNA primers; D012333:RNA, Messenger; D012313:RNA