Real-time rapid reverse transcriptase-polymerase chain reaction for intraoperative diagnosis of lymph node micrometastasis: clinical application for cervical lymph node dissection in esophageal cancers.
BACKGROUND
New molecular techniques have been designed to detect cancer micrometastases that are otherwise missed by conventional histologic examination. The aim of this study was to establish a sensitive and rapid genetic assay to detect lymph node micrometastasis and to assess its usefulness clinically for cervical lymphadenectomy in esophageal cancer. We have recently shown that metastasis in the lymph node chain along the recurrent laryngeal nerves (rec LNs) is a predictor of cervical node metastasis in esophageal cancer. In our retrospective study, the positive rate of cervical lymph node metastasis with rec LNs metastasis was 51.6%, and the rate without rec LNs metastasis was 11.6%. There was a significant difference in both positive rates (P =.0002).


METHODS
Rec LNs obtained from 50 patients with esophageal cancer were assessed prospectively by intraoperative histopathologic examination (HE) and genetic analysis. The latter involved a real-time quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) system with multiple markers, carcinoembryonic antigen, squamous cell carcinoma, and melanoma antigen-3, whose messenger RNAs are highly and frequently expressed in esophageal cancers. Cervical lymphadenectomy was subsequently performed in a subset of these patients.


RESULTS
Ten of 50 patients (20%) were scored as node positive by HE, and 24 patients (48%) were scored positive by genetic diagnosis, including 9 HE-positive cases. Genetic diagnosis of rec LNs accurately predicted all 9 cases with cervical lymph node metastasis and 2 cases with cervical lymph node recurrence, whereas HE missed 2 cases with cervical lymph node metastasis and 2 cases with cervical lymph node recurrence.


CONCLUSIONS
Our real-time rapid RT-PCR assay can improve the sensitivity of HE for detection of lymph node metastasis and might be potentially useful for intraoperative genetic diagnosis for subsequent cervical lymphadenectomy in esophageal cancer surgery.
Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, Japan.
Setsuko
S
Yoshioka
Yoshiyuki
Y
Fujiwara
Yurika
Y
Sugita
Yoshihiro
Y
Okada
Masahiko
M
Yano
Shigeyuki
S
Tamura
Takushi
T
Yasuda
Shuji
S
Takiguchi
Hitoshi
H
Shiozaki
Morito
M
Monden
D000368:Aged; D000951:Antigens, Neoplasm / Q000032:analysis / Q000235:genetics; D002272:Carcinoembryonic Antigen / Q000032:analysis / Q000235:genetics; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000737:chemistry*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009363:Neoplasm Proteins / Q000032:analysis / Q000235:genetics; D011446:Prospective Studies; D012333:RNA, Messenger / Q000032:analysis; D012009:Recurrent Laryngeal Nerve; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D015843:Serpins; D014407:Tumor Cells, Cultured
D000951:Antigens, Neoplasm; D002272:Carcinoembryonic Antigen; C072013:MAGEA3 protein, human; D009363:Neoplasm Proteins; D012333:RNA, Messenger; D015843:Serpins; C051072:squamous cell carcinoma-related antigen