Detection of micro-metastasis using cytokeratins (AE1/AE3) in haematoxylin & eosin-stained N0 lymph nodes of oral squamous cell carcinoma

Background & objectives: Oral squamous cell carcinoma (OSCC) is one of the most common malignancies affecting the head-and-neck region, regional lymph nodes being an important prognostication factor dictating the survival rate. Despite an array of modalities used, clinically, radiographically and routine histopathologically, the detection of micro-metastasis (2-3 mm tumour cell deposits) in the lymph nodes often escapes identification. The presence of few of these tumour epithelial cells in the lymph nodes drastically increases mortality and alters treatment plan. Hence, the identification of these cells is of major prognostic significance for a patient. Thus, the present study was aimed to evaluate and detect the efficacy of the immunohistochemical (IHC) marker [cytokeratin (CK) AE1/AE3] over routine Hematoxylin & eosin (H & E) staining in detecting micro-metastasis in the lymph nodes of OSCC cases. Methods: Hundred H & E-stained N0 lymph nodes of OSCC cases treated with radical neck dissection were subjected to IHC with marker AE1/AE3 antibody cocktail for detecting micro-metastasis. Results: The IHC marker CK cocktail (AE1/AE3) did not demonstrate any positive reactivity for the target antigen in all the 100 H & E stained lymph node sections evaluated in the present study. Interpretation & conclusions: This study was undertaken to check the efficacy of IHC (CK cocktail AE1/ AE3) in the detection of micro-metastasis in lymph nodes that are found to be negative in routine H&E stained sections. The findings of this study suggest that the IHC marker AE1/AE3 did not prove to be useful to detect micro-metastasis in this study population

Micrometástasis ganglionares en pacientes con cáncer ginecológico. Serie de casos y revisión de la bibliografía / Nodal micrometastasis in gynecological cancer patients. Case series and literature review

Resumen OBJETIVO: Identificar micrometástasis ganglionares en neoplasias malignas ginecológicas, y las características histopatológicas y clínicas asociadas con los hallazgos. MATERIALES Y MÉTODOS: Estudio observacional, descriptivo y retrospectivo efectuado en pacientes con uno o más ganglios con micrometástasis identificados en cirugías primarias etapificadoras por cáncer de endometrio, ovario o cervicouterino, linfadenectomía sistemática o ganglio centinela, atendidas en el Hospital de Ginecoobstetricia Dr. Luis Castelazo Ayala, de enero de 2014 a diciembre de 2018. Criterios de exclusión: ausencia micrometástasis ganglionares. Criterios de eliminación: información incompleta en el expediente clínico, sin seguimiento y falta de evidencia patológica de micrometástasis ganglionar. Variables de estudio: identificación de ganglios con micrometástasis, diagnóstico de cáncer ginecológico por tratamiento quirúrgico y tasa de supervivencia. Para la revisión bibliográfica se consultó la base de datos de PubMed, con MeSH o palabras clave: "micrometástasis ganglionares" y "cáncer de ovario"; "cáncer de endometrio", "cáncer cervicouterino" y "cáncer ginecológico con micrometástasis". RESULTADOS: Se registraron 11 casos de micrometástasis ganglionares, de un total de 433 con cáncer de ovario, endometrio o cervicouterino. No se aplicaron pruebas estadísticas por lo limitado de la muestra. En todos los casos se identificó, mínimo, un ganglio con micrometástasis, con ganglio centinela o linfadenectomía sistemática. Todas las pacientes recibieron tratamiento coadyuvante. CONCLUSIONES: Es importante efectuar la identificación de micrometástasis en linfadenectomías sistemáticas mediante la tinción con hematoxilina-eosina (es la metodología más accesible y económica para el sistema público de salud de México) o búsqueda de ganglio centinela, con la finalidad de determinar la frecuencia en población mexicana y establecer la etapa patológica real de la enfermedad.

Abstract OBJECTIVE: To identify lymph node micrometastases in malignant gynecological neoplasms and their histopathological and clinical characteristics associated with the findings. MATERIALS AND METHODS: Observational, descriptive and retrospective study performed in patients with one or more lymph nodes with micrometastases in primary stage surgery for endometrial, ovarian or cervical cancer, systematic lymphadenectomy or sentinel node, attended at the Hospital de Ginecoobstetricia 4 Dr. Luis Castelazo Ayala, from January 2014 to December 2018. Exclusion criteria: no ganglion micrometastases. Elimination criteria: incomplete information in the clinical file, without follow-up and lack of pathological evidence of lymph node micrometastasis. The variables to be considered were: identification of lymph nodes with micrometastases, diagnosis of gynecological cancer by surgical treatment and survival rate. For the literature review, the PubMed database was consulted, with key words such as "ganglionic micrometastases" and "ovarian cancer", "endometrial cancer", "cervical cancer" and "gynecological cancer with micrometastasis". RESULTS: There were 11 cases of lymph node micrometastases, of a total of 433 with ovarian, endometrial or cervical cancer. No statistical tests were applied because of the limited sample. In all cases, a lymph node with micrometastasis, with a sentinel lymph node or systematic lymphadenectomy was identified. All patients received coadjuvant treatment. CONCLUSIONS: It is important to identify micrometastases in systematic lymphadenectomy by staining with haematoxylin-eosin (the most accessible and economical methodology for the public health system in Mexico) or sentinel lymph node search, in order to determine the frequency in the Mexican population and establish the actual pathological stage of the disease.

Research progress of lymph node micrometastasis detection and prognosis in stageⅠnon-small cell lung cancer / 医学研究生学报

Surgery is preferred for treating stage I non-small cell lung cancer (NSCLC). The main factors that affecting its prognosis are tumor metastasis and recurrence. In recent years, studies have revealed that the main cause of death in patients with stage I NSCLC is micrometastasis of lymph nodes. Micrometastasis has become a hot topic in modern precision medicine. Detection of micrometastasis as early as possible, early intervention and accurate assessment on prognosis of lung cancer have a great impact. The concept, methods and markers for clinical detection, as well as prognosis and adjuvant therapy of lymph node micrometastasis are reviewed in this article.

IMPACT OF MICROMETASTASIS AND ISOLATED TUMOR CELLS FOUND ON SENTINEL LYMPH NODES IN EARLY BREAST CANCER / Impacto do encontro de micrometástase e células tumorais isoladas nos linfonodos sentinela no câncer de mama precoce

The presence of axillary lymph node metastases is one of the most important prognostic factors in breast cancer and it is often used to guide locoregional and systemic therapy decisions. The question of whether axillary dissection (AD) can be safely omitted in patients with early breast cancer when isolated tumor cells (ITC) or micrometastasis is found in the sentinel node remains a controversial issue in the literature. On the basis of current evidence, AD could probably be safely omitted when micrometastasis or ITC are found. On making this decision, as micrometastasis and ITC are a sign of a biologically different disease, adjuvant radiotherapy and the adjuvant systemic treatment need to be considered

A presença de metástases linfonodais axilares é um dos fatores prognósticos mais importantes no câncer de mama e é freqüentemente utilizada para guiar as decisões da necessidade de terapias locorregional e/ou sistêmica adicionais. A questão se a dissecção axilar (AD) pode ser omitida com segurança em pacientes com câncer de mama precoce, quando células tumorais isoladas ou micrometástases são encontradas no linfonodo sentinela, permanece um assunto controverso na literatura. Com base nas evidências atuais, a AD poderia ser omitida quando micrometástases ou CTI são encontradas. Ao tomar essa decisão, deve-se levar em conta que a presença de micrometástases e CTI são sinais de uma doença biologicamente diferente, em que a radioterapia adjuvante e o tratamento sistêmico adjuvante precisam ser considerados

Detection of micrometastasis in axillary lymph nodes of breast carcinoma patients and its association with clinical outcome

Context: There is heterogeneity in the clinical behavior of breast carcinoma patients with node negativity. Studies have analyzed different factors influencing the outcome in such patients. It is suggested that the presence of nodal micrometastasis can act as a tool in predicting the aggressiveness of these tumors. Aims: The aim of this study is to assess the yield of micrometastasis/isolated tumor cell (ITC) by ultrastaging the morphologically negative axillary nodes and staining them with immunohistochemistry for epithelial membrane antigen. The association of such metastasis with the clinical outcome is determined. Settings and Design: This was a retrospective analytical study. One hundred cases of node-negative breast carcinoma patients who underwent surgery along with axillary lymph node dissection were selected. Materials and Methods: The largest node from the axillary dissection was selected and subjected to ultrastaging and immunohistochemical staining (as sentinel node dissection was not a routine practice at that time), to look for occult metastasis in the form of micrometastasis or ITCs. Statistical Analysis: Occurrence of events in the form of recurrence or death was noted. Association of the parameters was analyzed using Fisher's exact test. Results: Among the 100 cases, 79 patients were followed up for a minimum period of 5 years. Two cases had micromets in one node each. These two patients were among the eight, who developed events subsequently (25%). Hence, a statistically significant association was found between the presence of micromets with events. Conclusions: There is a statistically significant association between the presence of micromets and disease recurrence. Hence, we suggest that ultrastaging of the negative axillary node (now sentinel node, as it is being routinely done) might prove effective in predicting the events/prognosis in clinically and morphologically node-negative breast carcinoma patients

Minimal residual disease in prostate cancer patients after primary treatment: theoretical considerations, evidence and possible use in clinical management

Minimal residual disease is that not detected by conventional imaging studies and clinically the patient remains disease free. However, with time these dormant cells will awaken and disease progression occurs, resulting in clinically and radiological detectable metastatic disease. This review addresses the concept of tumor cell dissemination from the primary tumor, the micrometastatic niche and tumor cell survival and finally the clinical utility of detecting and characterizing these tumor cells in order to guide management decisions in treating patients with prostate cancer.

Application of total mesoesophageal excision combined with sanye lymph node dissection in radical resection of esophageal carcinoma under thoracoscopy and laparoscopy / 中国综合临床

Objective To evaluate the clinical efficacy of total mesoesophageal excision and sanye lymph node dissection in the radical resection of esophageal carcinoma under thoracoscopy and laparoscopy,and to investigate its safety and feasibility, and to find a more reasonable and effective surgical treatment of esophageal carcinoma. Methods One hundred and twenty-six cases of esophageal cancer who underwent the minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer in Central Hospital of Hengyang from October 2015 to September 2017 were retrospectively analyzed. Among them,Sixty-four patients accepted total mesoesophageal excision and sanye lymph node dissection under thoracoscopy and laparoscopy (observation group ), Sixty-two cases accepted with conventional esophagectomy under thoracoscopy and laparoscopy ( control group) . The operation time, blood loss, indwelling time of thoracic drainage tube, postoperative drainage volume,postoperative hospitalization time,number of lymph node dissection,lymph node metastasis degree,perioperative complications of the two groups were analyzed and compared. The number of lymph node dissection and lymph node metastasis degree in different regions were compared between the two groups. The number of recurrence and death were recorded in the two groups. Results Compared with the control group,the operation time was longer in the observation group((264. 9±32. 9) min vs. (233. 5±30. 4) min,t= -5. 56,P<0. 001),but blood loss was less((152. 7±26. 4) ml vs. (235. 5± 30. 6) ml,t = 16. 27,P<0. 001). There was no significant difference in the indwelling time of thoracic drainage tube, postoperative drainage volume or postoperative hospitalization time between the two groups (P>0. 05). The number of lymph nodes in the observation group was significantly higher than that in the control group ((32. 7±15. 5) pieces vs. (20. 9±11. 2) pieces,t = - 4. 93,P< 0. 001),and lymph node metastasis degree in the observation group was smaller than that of the control group ( 6. 7% vs. 9. 3%, χ2 = 7. 22, P < 0. 01) . There were no significant differences in perioperative complications such as pulmonary complications, arrhythmia, anastomotic fistula, chylothorax,hemorrhage,recurrent laryngeal nerve injury,tracheal injury and perioperative death (P>0. 05). Left and right recurrent laryngeal nerve,thoracic esophagus,celiac artery lymph node dissection of the number of observation group was higher than that of the control group ((4. 7 ± 3. 2) pieces vs. (1. 5 ± 1. 4) pieces, t= -7. 25;(6. 0±2. 7) pieces vs. (3. 1±1. 7) pieces,t = -7. 12;(5. 7± 2. 4) pieces vs. (3. 2± 1. 9) pieces,t= -6. 48;P<0. 001). Left and right recurrent laryngeal nerve,thoracic esophagus lymph node metastasis degree in the observation group was smaller than that in the control group (8. 7%(26/ 300) vs. 18. 1%(17/ 94),χ2= 6. 53;8. 9%(34/ 382) vs. 17. 9%(35/ 195),χ2 = 10. 04;P<0. 05) . There were no significant differences in the recurrence rate of tumor recurrence at 1 and 24 months after operation in the observation group and the control group(3 cases(4. 7%) vs. 4 cases(6. 5%),χ2 = 0. 92,P > 0. 05) . There were no deaths in the two groups. Conclusion Total mesoesophageal excision and three-field lymph node dissection in radical resection of esophageal carcinoma under thoracoscopy and laparoscopy is safe and feasible,the recent effect does not increase the surgical complications, but its long-term effect need a lot of long-term follow-up. A relatively thorough cleaning of the esophageal mesentery and its lymph nodes can minimize the tumor in the subendothelial micrometastasis,and is beneficial for the prognosis of patients with esophageal cancer.

Clinical significance of peripheral blood metastasis and its relationship with BRMS1 / 中华内分泌外科杂志

Objective To investigate the clinical significance of peripheral blood metastasis in breast cancer and its relationship with the metastasis suppressor gene BRMS1.Methods Reverse transcription polymerase chain reaction (RT-PCR) was used to detect the expression of micrometastatic marker hMAM-RNA in the peripheral blood of 149 cases of invasive breast carcinoma.Immunohistochemical method was used to detect the expression of BRMS1 protein in breast cancer tissues after surgery.The recurrence was followed up.SPSS19.0 statistics software was used to analyze the data.Results Among the 149 cases of invasive breast carcinoma patients with preoperative peripheral blood,expression of hMAM-RNA was found in 71 cases,and the micrometastasis rate was 47.65％.Peripheral blood micrometastasis rate in breast cancer was closely related to tumor TMN stage,lymph node metastasis and postoperative recurrence (P＜0.05);while it had nothing to do with patients' age,tumor size,pathological types or tumor tissue typing (P＞0.05).The expression of BRMS1 in postoperative breast cancer tissue was detected in 56 cases,and the positive rate was 37.58％.For BRMS1 positive cases,16 cases had peripheral blood micrometastasis (the positive rate was 28.57％);For BRMS1 negative cases,55 cases had peripheral blood micrometastasis (the positive rate was 51.93％).The difference had statistical significance and the two showed a significant negative correlation(r=-0.296,P＜0.01).With the gradual increase of positive staining intensity of BRMS1 protein,the micrometastasis rate of peripheral blood of breast cancer showed a significant decrease (P＜0.05).At the same time,among patients with positive peripheral blood micrometastasis,the recurrence rate of patients with positive BRMS1 (12.5％) was significantly lower than that of patients with negative BRMS1 (43.64％),and the difference was statistically significant(P＜0.05).Conclusions BRMS 1 expression and breast cancer micrometastasis in peripheral blood is closely related.BRMS1 can also be used as an important molecular marker for determining micrometastasis in peripheral blood of breast cancer.Routine detection of BRMS1 expression in breast cancer tissue is helpful for clinical understanding of breast cancer patients,peripheral blood micrometastasis and postoperative recurrence,thus guiding clinical individualized treatment and prognosis.

Progress in the Study of Lymph Node Metastasis in Early-stage Cervical Cancer / 华中科技大学学报（医学）（英德文版）

Spread into regional lymph node is the major route of metastasis in cervical cancer.Although lymph node status is not involved in the International Federation of Gynecology and Obstetrics stagingsystem of uterine cervical cancer,the presence or absence of lymph node metastasis provides important information for prognosis and treatment.In this review,we have attempted to focus on the incidence and patterns of lymph node metastasis,and the issues surrounding surgical assessment of lymph nodes.In addition,the preoperative prediction of lymph node status,as well as the intraoperative assessment by sentinel nodes will be reviewed.Finally,lymph node micrometastasis also will be discussed.

Progress in the Study of Lymph Node Metastasis in Early-stage Cervical Cancer / 华中科技大学学报（医学）（英德文版）

Spread into regional lymph node is the major route of metastasis in cervical cancer.Although lymph node status is not involved in the International Federation of Gynecology and Obstetrics stagingsystem of uterine cervical cancer,the presence or absence of lymph node metastasis provides important information for prognosis and treatment.In this review,we have attempted to focus on the incidence and patterns of lymph node metastasis,and the issues surrounding surgical assessment of lymph nodes.In addition,the preoperative prediction of lymph node status,as well as the intraoperative assessment by sentinel nodes will be reviewed.Finally,lymph node micrometastasis also will be discussed.

Advances in micrometastasis of sentinel lymph node in cervical cancer / 实用肿瘤学杂志

The main metastatic pathway for cervical cancer is lymph node metastasis. Sentinel lymph nodes are the first site of lymph node metastasis. Lymph node metastasis is a result of lymph node micrometastasis. However,lymph node micrometastasis is usu-ally neglected by traditional histopathology,and undetected lymph node micrometastases may lead to recurrence. This article will intro-duce the progress of research on sentinel lymph node micrometastasis in cervical cancer in recent years.

Research Progress of Lymph Node Micrometastasis in Non-small Cell Lung Cancer / 中国肺癌杂志

The incidence and mortality of lung cancer rank top in China. One important factor is the occurrence of metastasis. With the development of science technology, the effect of surgical treatment on lung cancer is improved. Moreover, the use of targeted therapy has achieved a new height for the treatment of lung cancer. However, the recurrence rate remains high even the tumor was completely resected at early stage. The occurrence of lymph node micrometastasis is considered as one of the plausible explanations. The difficulty indetecting micrometastasis has been greatly reduced. Although studies dig deeper into the lymph node micrometastasis, there are still some controversies including the selection of surgical procedures, the pathological staging and prognosis about patients with lymph node micrometastasis. This review manages to generalize the latest research progress of lymph node micrometastasis.
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Research progresses in occult lymph node metastasis of oral squamous cancer / 口腔疾病防治

@#Oral cancer is a common malignant tumor in head and neck cancers, and the metastasis of cervical lymph nodes directly affects the prognosis of patients with oral cancer. Exploration and study on the detection of occult lymph nodes in patients with negative cervical lymph nodes is of great importance to improve the prognosis of patients with early oral cancer. This article reviews some progresses of occult lymph node metastasis of oral cancer in ultrasound guided fine-needle aspiration cytology (US-FNAC)、 positron emission tomography and single-photon emission computed tomography/computed tomography (SPECT/CT) fusion technology, sentinel lymph node biopsy technique (SLNB) and molecular biological detection、 nanotechnology and quantum dot technology.

Detection of occult lymph node tumor cells in node-negative gastric cancer patients / Identificação de células tumorais ocultas em linfonodos de pacientes com câncer gástrico classificados como pn0

ABSTRACT Background: The presence of lymph nodes metastasis is one of the most important prognostic indicators in gastric cancer. The micrometastases have been studied as prognostic factor in gastric cancer, which are related to decrease overall survival and increased risk of recurrence. However, their identification is limited by conventional methodology, since they can be overlooked after routine staining. Aim: To investigate the presence of occult tumor cells using cytokeratin (CK) AE1/AE3 immunostaining in gastric cancer patients histologically lymph node negative (pN0) by H&E. Methods: Forty patients (T1-T4N0) submitted to a potentially curative gastrectomy with D2 lymphadenectomy were evaluated. The results for metastases, micrometastases and isolated tumor cells were also associated to clinicopathological characteristics and their impact on stage grouping. Tumor deposits within lymph nodes were defined according to the tumor-node-metastases guidelines (7th TNM). Results: A total of 1439 lymph nodes were obtained (~36 per patient). Tumor cells were detected by immunohistochemistry in 24 lymph nodes from 12 patients (30%). Neoplasic cells were detected as a single or cluster tumor cells. Tumor (p=0.002), venous (p=0.016), lymphatic (p=0.006) and perineural invasions (p=0.04), as well as peritumoral lymphocytic response (p=0.012) were correlated to CK-positive immunostaining tumor cells in originally negative lymph nodes by H&E. The histologic stage of two patients was upstaged from stage IB to stage IIA. Four of the 28 CK-negative patients (14.3%) and three among 12 CK-positive patients (25%) had disease recurrence (p=0.65). Conclusion: The CK-immunostaining is an effective method for detecting occult tumor cells in lymph nodes and may be recommended to precisely determine tumor stage. It may be useful as supplement to H&E routine to provide better pathological staging.

RESUMO Racional: A presença de metástase em linfonodos é um dos indicadores prognósticos mais importantes no câncer gástrico. As micrometástases têm sido estudadas como fator prognóstico no câncer gástrico, sendo relacionadas à diminuição da sobrevida global e aumento do risco de recidiva da doença. Entretanto, sua identificação é limitada pela metodologia convencional, uma vez que podem não ser identificadas pela rotina histopatológica por meio da coloração de H&E. Objetivo: Investigar a presença de células tumorais ocultas através de imunoistoquimica utilizando as citoqueratinas (CK) AE1/AE3 em pacientes com câncer gástrico com linfonodos histologicamente classificados como negativos por H&E. Métodos: Quarenta pacientes (T1-T4N0) submetidos à gastrectomia potencialmente curativa com linfadenectomia D2 foram avaliados. A presença de metástases, micrometástases e células tumorais isoladas foram correlacionadas com características clínicopatológicas e impacto no estadiamento. Os depósitos tumorais nos linfonodos foram classificados de acordo com o sistema TNM (7º TNM). Resultados: Um total de 1439 linfonodos foi obtido (~36 por paciente). Células tumorais foram detectadas por imunoistoquimica em 24 linfonodos de 12 pacientes (30%). As células neoplásicas estavam presentes na forma isolada ou em cluster. Invasão tumoral (p=0,002), venosa (p=0,016), linfática (p=0,006) e perineural (p=0,04), assim como resposta linfocítica peritumoral (p=0,012) foram correlacionadas com linfonodos CK-positivos que originalmente eram negativos à H&E. Dois pacientes tiveram o estadiamento alterado, migrando do estádio IB para IIA. Quatro dos 28 CK-negativos (14,3%) e três dos 12 CK-positivos (25%) tiveram recorrência da doença (p=0,65). Conclusão: A imunoistoquimica é meio eficaz para a detecção de células tumorais ocultas em linfonodos, podendo ser recomendada para melhor determinar o estágio do tumor. Ela pode ser útil como técnica complementar à rotina de H&E, de modo a fornecer melhor estadiamento patológico.

Cutaneous metastases in a patient with no previous diagnosis of cancer: diagnostic challenge

Abstract: On rare occasions, skin lesions are the first local of metastatic manifestation of internal malignancies. In case of no previous diagnosis of these tumors, the approach of suspicious skin lesions becomes a challenge, especially in differentiating cutaneous metastases and adnexal primary neoplasms. Currently, besides epidemiologic, dermoscopic and histopathologic aspects, the evaluation also integrates immunohistochemical exams and cell markers such as p40 and p63, highly specific for skin metastases. This article describes the case of cutaneous metastases as the sole obvious sign of breast cancer in a previously asymptomatic woman. The diagnosis was made by the finding of neoplastic cells in the dermis and immunohistochemistry compatible with ductal carcinoma.

Micrometastasis in Gastric Cancer / 대한소화기학회지

Although the incidence and mortality rate of gastric cancer have been steadily declining, gastric cancer is still the fourth most common cancer in the world and more than 50% of cases occur in Eastern Asia. In Korea, gastric cancer is the second most common cancer and third cause of cancer related death. The standard surgical procedure for resectable advanced gastric cancer is D2 lymphadenectomy with radical gastrectomy. Even though R0 resection was completed, recurrence is relatively common, and contributes to the limited survival of the patients in gastric cancer. As a clinically relevant factor for detection of the recurrence, the presence of isolating tumor cells has been introduced and it is so called as ‘micrometastasis’. Numerous immunohistochemistry and molecular studies have shown that micrometastasis can be demonstrated not only in lymph nodes but also in such body compartments as the bone marrow, peritoneal cavity and blood. Herein, we review the current knowledge and evidence of the prognostic significance of micrometastasis in peritoneal, lymph node, bone marrow. Also, we discuss the current state of research on the circulating tumor cell in peripheral blood.

The Detection of Messenger RNA for Carcinoembryonic Antigen and Cytokeratin 20 in Peritoneal Washing Fluid in Patients with Advanced Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: Peritoneal micrometastasis is known to play an important role in the recurrence of gastric cancer. However, its effects remain equivocal. Herein, we examine the messenger RNA (mRNA) as tumor markers, carcinoembryonic antigen (CEA), and cytokeratin 20 (CK20), in peritoneal washing fluid. Moreover, we evaluate whether these results could predict the recurrence of gastric cancer following curative resection. METHODS: We prospectively enrolled 132 patients with gastric cancers, who had received an operation, between January 2010 and January 2013. The peritoneal lavage fluid was collected at the operation field and semi-quantitative PCR was performed using the primers for CEA and CK20. We excluded patients with stage IA (n=28) early gastric cancer, positive cytologic examination of peritoneal washings (n=7), and those who were lost during follow up (n=18). RESULTS: A total of 79 patients with gastric cancers were enrolled, and the mean follow-up period was 39.95±19.25 months (range, 5-72 months). According to the multivariate analysis, T4 stage at the initial diagnosis was significantly associated with recurrence. All cases of recurrence were CEA positive and 6 cases were CK20 positive. The positive and negative predictive values of CEA were 32.0% and 100%, respectively, whereas those of CK20 were 37.5% and 71.4%, respectively. Disease free survival of CK20-negative cases was 36.17±20.28 months and that of CK20-positive cases was 32.06±22.95 months (p=0.39). CONCLUSIONS: It is unlikely that the real time polymerase chain reaction results of mRNA for CEA and CK20 in peritoneal washing fluid can predict recurrence. However, negative results can convince surgeons to perform curative R0 resection.

Clinical application of circulating tumor cells in breast cancer / 临床外科杂志

Recurrence and metastasis is the main cause of death in breast cancer patients. Early detection and treatment of malignant breast cancer cells and metastasis are the hotspots of current resear-ches. The discovery of circulating tumor cells(CTC)may provide new ideas for the diagnosis and treatment of breast cancer. Detection of CTC will help the early detection of micrometastasis,the guidance of individ-ual treatment,and the evaluation of therapeutic effect and prognosis. Domestic and foreign research pro-gress of CTC was reviewed in this paper.

Lymph node micrometastasis in stage I and II rectal cancer

PURPOSE: The aim of this study was to determine the rate of lymph node (LN) micrometastasis in patients with stage I and II rectal cancer.METHODS: One hundred eighty patients with either stage I or II rectal carcinoma who underwent curative resection between 1995 and 2010 were included. Forty-eight patients received neoadjuvant chemoradiotherapy. Two sections from each LN were stained with hematoxylin and eosin (H&E) and with CK20 by immunohistochemistry (IHC), respectively.RESULTS: A total of 2,257 LNs with a median of 12.5 LNs per patient were examined. For IHC staining, CK20-positive neoplastic cells were found in 4 of the 2,257 LNs (0.2%) from 3 of the 180 patients (1.7%), and all corresponding H&E re-stained sections confirmed that these neoplastic cells were present. Three of four neoplastic cells were micrometastasis, and one was macrometastasis. All occult neoplastic cells were found in 3 of the 85 patients (3.5%) with stage II disease.CONCLUSION: We observed a 3.5% rate of occult neoplastic cells in stage II rectal cancer. Interestingly, the results of IHC staining corresponded with those of H&E re-stained sections, suggesting that the examination of H&E stained section by a competent pathologist may replace IHC staining.

Research progress in effects and mechanisms of anesthesia on toumr micrometastasis / 医学研究生学报

[Abstract ] Tumor, with its high morbidity and mortality, has been gained increasingly high attention from the world .Current-ly, the main treatment for solid tumor is still surgical resection , during which surgery , anesthesia and other factors may have such side effects as releasing tumor cells into blood , lymphatic , bone marrow even organs and then resulting in the formation of micrometastatic lesion, increasing the risk of tumor recurrence and metastasis and finally affecting the postoperative survival rate .Recently, studies have shown that most anesthetic agents can influence the function of immune system and the activity of tumor cells , and then impact the tumor micrometastasis .This paper will summarize the research progresses in the impacts of anesthetic agents on tumor micrometastasis during perioperative period .