Establishment and Optimization of Rapid Diagnostic Methods for Cervical Lymphatic Metastasis during Oral Carcinoma Operation
|Keywords||Oral cancer Sentinel lymph node Cytokeratin Lymph node metastasis|
More than 80% of oral cancer is squamous cell carcinoma, lymph node metastasis is a major cause of death of oral cancer. Clinical treatment of oral cancer is the primary tumor resection and neck dissection. The widespread clinical neck dissection over phenomenon, the patient has paid a huge, unnecessary costs in physical, mental, and economic aspects. How to correctly evaluate the status of cervical lymph node metastasis, to select neck dissection reasonable surgical treatment of patients with moderate, the problem is solved in the field. [Objective] To explore a high accuracy, short time, ease of operation, low cost of surgery in the diagnosis of cervical lymph node metastasis of oral cancer detection method. 【Methods】 Shandong University Qilu Hospital inpatient surgical treatment of oral and maxillofacial surgery oral cancer patients with lymph node, respectively, with the following five methods to detect lymph node, the time required to record each method, the accuracy of the difficulty of the operation and costs : HE staining of paraffin sections: embedded in paraffin, serial sections, HE staining; 2 the cell printing HE staining: production cell imprints, HE staining; 3. cells printing immunohistochemistry (IHC): cells printing method in accordance with the two-step rabbit / mice Universal immunohistochemical detection kit staining, detection of cytokeratin; 4 HE staining of frozen sections: production of frozen section, HE staining; immunohistochemical staining of frozen sections ( IHC): staining of frozen sections in accordance with the immunohistochemical methods used internationally, to detect cell keratin. Neck dissection specimens pathological findings as standard neck lymph node metastasis, several methods, accuracy, cost, difficulty of the operation of four indicators compare optimized to meet the requirements of the detection method. 【Results】 A total of 27 cases of oral cancer patients with lymph node specimens underwent surgery in May 2007 - January Qilu Hospital of Shandong University, Oral and Maxillofacial Surgery ward 71. Clinicopathological report the actual number of positive cases was 29, consistent with the experimental results of paraffin sections HE, as a positive standard. ① frozen sections HE: The accuracy rate of 96.55%, and 3.45% false negative rate, false positive rate of 2.3% misdiagnosis rate of 2.82%, a cost of 2.0 yuan, simple operation, the time is only 15 minutes; ② frozen section IHC: 100% accuracy, false negative rate of 0% and a false positive rate of 2.38% and 1.41%, the rate of misdiagnosis, the highest cost 50.5 yuan, more dyeing process steps, moderate difficulty and takes about one hour; ③ The cell printing HE: 93.1% accuracy rate, false-negative rate of 12.9%, 0% false positive rate, misdiagnosis rate of 5.63%, the lowest cost only 0.5 yuan, the time is at least 10 minutes, the operation is very simple, but read the piece requires high need who can confirm the diagnosis ; ④ cell printing IHC: accuracy rate of 96.55%, O%, false negative rate and false positive rate of 4.65%, 2.82% misdiagnosis rate, costs 39.5 yuan simple producer staining of moderate difficulty, many steps, the diagnosis is easy, read the piece those requirements low. The frozen slices HE joint IHC diagnostic accuracy rate can be increased to 100%. 2 test, p> 0.05, in various ways, the accuracy of the various methods of application paired χ 2 tables ~~ no significant difference. Conclusion 1. Intraoperative frozen section HE staining the operation is simple, with high accuracy, low cost and short time, can be used as intraoperative rapid diagnosis of cervical lymph node metastasis of oral cancer; 2. Intraoperative frozen section HE joint immunohistochemistry (IHC), may improve the diagnostic accuracy, reduce misdiagnosis; 3. impression cytology method with fast, simple, and economic advantages of surgery as the preferred method of diagnosis of lymph node metastasis in the primary hospital, plus immune were diagnosed.