Significance of metastasis detected by molecular techniques in sentinel nodes of patients with gastrointestinal cancer.
The clinical significance of micrometastasis in sentinel nodes (SNs) may differ in various organs. In particular, the prognostic value of SN micrometastases detected by reverse transcriptase-polymerase chain reaction (RT-PCR) is still controversial. We investigated the diagnostic and therapeutic significance of nodal molecular metastasis detected by nested RT-PCR for cytokeratin (CK) 19 mRNA in gastrointestinal cancer. In 51 cases with GI tract cancer treated by standard curative resection, SNs were identified by a radio-guided method. In 10 of 51 patients, 25 SNs and 3 non-SNs were histologically negative and RT-PCR positive. Three non-SNs with positive CK19 mRNA were randomly sampled from the same basin where histologically positive SNs were identified. Immunohistochemical analysis of six additional step sections obtained at 30- micro m intervals with use of an anticytokeratin antibody showed clearly recognizable histological metastases in 4 of 25 histologically negative/RT-PCR-positive SNs (16%). In one case of esophageal squamous cell carcinoma with nodal micrometastasis identified by CK19 RT-PCR, extranodal local recurrence in the SN basin (left supraclavicular basin) was observed 6 months postoperatively. These findings suggest that nodal micrometastasis detected by nested RT-PCR has some clinical significance in GI cancer. Molecular assessment of the SN may be a valuable tool to complement routine histological examination for GI cancers.
Matsuda
Jun-Ichi
J
Department of Surgery, School of Medicine, Keio University, Tokyo, Japan. kitagawa@sc.itc.keio.ac.jp
Kitagawa
Yuko
Y
Fujii
Hirofumi
H
Mukai
Makio
M
Dan
Katsuaki
K
Kubota
Tetsuro
T
Watanabe
Masahiko
M
Ozawa
Soji
S
Otani
Yoshihide
Y
Hasegawa
Hirotoshi
H
Shimizu
Yoshimasa
Y
Kumai
Koichiro
K
Kubo
Atsushi
A
Kitajima
Masaki
M
D004938:Esophageal Neoplasms / Q000473:pathology*; D005770:Gastrointestinal Neoplasms / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000032:analysis; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy
D007633:Keratins