使用免疫組織化學染色檢查口腔鱗狀細胞癌病人頸部淋巴結之微小轉移

Abstract

背景和目的：例行性的病理切片檢查利用H&E染色，有時很難檢查出頸部淋巴結之微小轉移(小於三公釐)，我們的實驗評估是否細胞角質免疫組織化學染色,可以比傳統H&E染色法，更容易檢查出微小轉移,研究口腔鱗狀細胞癌病人頸部微小轉移的特徵，及僅有頸部微小轉移口腔鱗狀細胞癌病人的臨床預後. 材料和方法：利用傳統H&E染色和細胞角質免疫組織化學染色, 檢查取自94例口腔鱗狀細胞癌病人，共2486顆頸部淋巴結的癌轉移情況. 結果：傳統H&E染色可檢查出十五顆淋巴結具微小轉移，四十顆淋巴結有明顯轉移。而使用細胞角質免疫組織化學染色，可多檢查出五顆微小轉移的淋巴結和一顆明顯轉移的淋巴結。數據顯示對淋巴結微小轉移而言，細胞角質免疫組織化學染色，沒有比傳統H&E染色有較佳之檢出率(P = 0.497)。利用細胞角質免疫組織化學染色檢查出的二十個微小轉移，九個發生在八個病人之頸部淋巴結,十一個發生在十一個有明顯轉移病人之頸部淋巴結。只有微小轉移的八個病人中,兩人(25%)有頸部復發的情況，且一人死於頸部癌轉移。二十個微小轉移，有十四個發生在小於十公釐的淋巴結,且十個(50%)發生在五到十公釐的淋巴結。而二十個微小轉移有十一個(55%)發生在淋巴結的邊緣腔中,其它九個(45%)發生在淋巴結的內部髓腔中. 結論：細胞角質免疫組織化學染色，確實可以增加微小轉移的發現率,但和傳統H&E染色比，沒有顯著的差異。口腔鱗狀細胞癌病人之頸部癌轉移中，約百分之三十為微小轉移。微小轉移較常發生在淋巴結的邊緣腔，且通常發生在小於十公釐的淋巴結，基於我們的研究結果發現,我們認為微小轉移可能造成頸部復發疾病，也可能造成口腔鱗狀細胞癌病人之死亡。

Background and purposes: Micrometastases (< 3 mm in diameter) in lymph nodes (LNs) are sometimes difficult to detect by routine hematoxylin and eosin (H&E) stain. Our study was designed to find out whether pan-cytokeratin immunostain could have a better detection rate of micrometastasis than H&E stain, to study the characteristic features of micrometastasis in cervical LNs of oral squamous cell carcinoma (OSCC) patients, and to understand the outcome of patients with only micrometastases. Materials and methods: A total of 2486 cervical LNs from 94 OSCC patients were examined by both H&E stain and pan-cytokeratin immunostain. Results: H&E stain detected 15 LNs with micrometastasis and 40 LNs with overt metastasis. Pan-cytokeratin immunostain identified 5 additional LNs with micrometastasis and 1 additional LN with overt metastasis. Pan-cytokeratin immunostain did not have a significantly better detection rate of micrometastasis than H&E stain (P = 0.497). Of these 20 micrometastases detected by pan-cytokeratin immunostain, 9 occurred in 8 patients with only micrometastases and 11 occurred in 11 patients with both overt metastases and micrometastases. Two (25%) of the 8 patients with only micrometastases developed recurrent disease in the neck and one of the 8 died of neck metastasis. Fourteen (70%) of the 20 micrometastases occurred in LNs smaller than 10 mm in diameter, and 10 (50%) occurred in LNs between 5 mm and 10 mm in diameter. Eleven (55%) of 20 micrometastatic foci were located in the marginal sinuses of the LNs, whereas the remaining 9 (45%) micrometastatic foci were observed in the medullary sinuses of the LNs. Conclusions: Pan-cytokeratin immunostain can increase the detection rate of micrometastasis but it has no significant diagnostic superiority to H&E stain. Approximately 30% of positive cervical LNs of OSCC patients have only micrometastases. Micrometastases are frequently located in the marginal sinuses of the LNs and often found in the LNs smaller than 10 mm in diameter. Based on our findings, we suggest that micrometastatic foci can subsequently result in a recurrent neck disease or finally cause the mortality of the OSCC patient.