AIM:To investigate whether activated carbon nanoparticles suspension(ACNS) or methylene blue(MB) can increase the detected number of lymph nodes in colorectal cancer.METHODS:Sixty-seven of 72 colorectal cancer patient...AIM:To investigate whether activated carbon nanoparticles suspension(ACNS) or methylene blue(MB) can increase the detected number of lymph nodes in colorectal cancer.METHODS:Sixty-seven of 72 colorectal cancer patients treated at our hospital fulfilled the inclusion criteria of the study which was conducted from December 2010 to February 2012.Seven patients refused to participate.Eventually,60 patients were included,and randomly assigned to three groups(20 in each group):ACNS group(group A),MB group(group B) and non-stained conventional surgical group(group C).In group A,patients received subserosal injection of 1 mL ACNS in a 4-quadrant region around the mass.In group B,the main artery of specimen was identified and isolated after the specimen was removed,and 2 mL MB was slowly injected into the isolated,stretched and fixed vessel.In group C,no ACNS and MB were injected.All the mesentery lymph nodes were isolated and removed systematically by visually inspecting and palpating the adipose tissue.RESULTS:No difference was observed among the three groups in age,gender,tumor location,tumor diameter,T-stage,degree of differentiation,postoperative complications and peritoneal drainage retention time.The total number of detected lymph nodes was 535,476 and 223 in the three groups,respectively.The mean number of detected lymph nodes per patient was significantly higher in group A than in group C(26.8 ± 8.4 vs 12.2 ± 3.2,P < 0.001).Similarly,there were significantly more lymph nodes detected in group B than in group C(23.8 ± 6.9 vs 12.2 ± 3.2,P < 0.001).However,there was no significant difference between group A and group B.There were 50,46 and 32 metastatic lymph nodes dissected in 13 patients of group A,10 patients of group B and 11 patients of group C,without significant differences among the three groups.Eleven of the 60 patients had insufficient number of detected lymph nodes(< 12).Only one patient with T 4a rectal cancer had 10 lymph nodes detected in group B,the other 10 patients were all from group C.Based on the different diameter categories,the number of detected lymph nodes in groups A and B was significantly higher than in group C.However,there was no statistically significant difference between group A and group B.The metastatic lymph nodes were not significant different among the three groups.Similarly,tumor location,T stage and tumor differentiation did not affect the staining results.Body mass index was a minor influencing factor in the two different staining methods.The stained lymph nodes can easily be identified from the mesenteric adipose tissues,and the staining time for lymph nodes was not significantly different compared with unstained group.None of the patients in groups A and B had drug-related complications.CONCLUSION:Both activated carbon nanoparticles suspension in vivo and methylene blue in vitro can be used as tracers to increase the detected number of lymph nodes in colorectal cancer.展开更多
AIM： To investigate the clinicopathological roles of Bmil in esophageal squamous cell carcinoma （ESCC）.METHODS： Quantitative real-time polymerase chain reaction and immunohistochemical staining for Broil were perf...AIM： To investigate the clinicopathological roles of Bmil in esophageal squamous cell carcinoma （ESCC）.METHODS： Quantitative real-time polymerase chain reaction and immunohistochemical staining for Broil were performed in cancerous and adjacent non-cancerous paraffin-embedded esophageal specimens.RESULTS： The Bmil expression level was unaffected by gender and age. The level of Broil mRNA in ESCC was significantly higher than that in the adjacent non-cancerous tissues （2.181 ± 2.158 vs 0.931 ± 0.894, P = 0.0152）, and its over-expression was aggressively associated with lymph node metastasis （3.580 ± 2.487 vs 1.703 ± 0.758, P = 0.0003）, poorer cell differentiation （P = 0.0000） and advanced pathological stage （3.827± 2.673 vs 1.590 ± 0.735, P = 0.0001）. The patients were divided into high-expression and low-expression groups based on the median expression level of Bmi1 mRNA, and a shorter overall survival time in the former group was observed. Immunohistochemistry for Bmi1 oncoprotein showed diffusely positive, focally positive and negative expression in 44, 16 and 10 of 70 ESCC cases, respectively, compared with three, two and five of 10 adjacent non-cancerous cases （P = 0.027）. The positive rate of the oncoprotein in samples of histological grade Ⅲ was higher than that of grade Ⅱ（P = 0.031）, but its expression had no relation to the lymph node metastasis and pathological staging. In 70 ESCC samples, Bmi1 showed high intense expression in the cytoplasm and less or even no expression in the nucleus.CONCLUSION： Bmi1 was over-expressed in ESCC. Increased Bmi1 mRNA expression was significantly associated with ESCC progression, and the oncoprotein was largely distributed in the cytoplasm of tumor cells.展开更多
OBJECTIVE To evaluate the feasibility of intra-operativedetection of sentinel lymph nodes (SLN) in the patient withendometrial cancer (EC).METHODS Thirty-one patients with Stage Ⅰ and Ⅱ endometrialcancer, who underw...OBJECTIVE To evaluate the feasibility of intra-operativedetection of sentinel lymph nodes (SLN) in the patient withendometrial cancer (EC).METHODS Thirty-one patients with Stage Ⅰ and Ⅱ endometrialcancer, who underwent a hysterectomy and a lymphadenectomy,were enrolled in the study. At laparotomy, methylene blue dyetracer was injected into the subserosal myometrium of corpusuteri at multiple sites, and dye uptake into the lymphatic channelswas observed. The blue nodes which were identified as SLNs weretraced and excised. The other nodes were then removed. All of theexcised nodes were submitted for pathological hematoxylin andeosin (H&E) staining examination.RESULTS Failure of dye uptake occurred in 4 of the 31 cases(12.9%) because of spillage, and no lymphatic coloration wasobserved there. Lymphatic staining was clearly observable as bluedye diffused to the lymphatic channels of the uterine surface andthe infundibulopelvic ligaments in 27 (87.1%) cases. Concurrentcoloration in the pelvic lymphatic vessels was also observed in 22of the 27 patients. The SLNs were identified in 23 of the 27 (85.2%)cases with a lymphatic staining, with a total number of 90 SLNs,and a mean of 3.9 in each case (range, 1-10). Besides one SLN (1.1%)in the para-aortic area, the other 89 (98.9%) were in the nodes ofthe pelvis. The most dense locations of SLNs included obturator in38 (42.2%) and interiliac in 19 (21.1%) cases. In our group, pelviclymphadenectomy was conducted in 27 (87.1%) patients andpelvic nodal sampling in 4 (12.9%). Of the 31 cases, a concurrentabdominal para-aortic lymph node sampling was conducted in7. A total of 926 nodes were harvested, with an average of 39.8 ineach case (range, 14-55). Nodal metastases occurred in 3 patients(9.7%), 2 of them with SLN involvement and the other withoutSLN involvement. Adverse reactions or injury related to the studywas not found.CONCLUSION Application of methylene blue dye is feasible inan intra-operative SLN identification of endometrial cancer. Thetechnology is convenient, safe, and worth further investigation.展开更多
Objective： To explore whether the conventional pathologic stages of some non-small cell lung cancer （NSCLC） patients were underestimated. Methods： 195 lymph node samples were taken from 25 NSCLC patients during th...Objective： To explore whether the conventional pathologic stages of some non-small cell lung cancer （NSCLC） patients were underestimated. Methods： 195 lymph node samples were taken from 25 NSCLC patients during the operations. Firstly, each resulting tissue block was processed for routine paraffin embedding. Then the 6- 10 serial sections were chosen, each 5/am thick, from every paraffin block of the lymph node. Finally, the first and the second last sections of each lymph node were stained by hematoxylin eosin （HE）, and the other serial sections were used for the immunohistochemical （IHC） staining examination with the monoclonal antibody against cyokeratin 19. Results： With HE staining, 30 of the 195 regional lymph nodes revealed dominant nodal metastases, and none showed micrometastases. IHC staining was performed on 135 lymph nodes that were identified as free of metastases by HE staining, 31 showed micrometastases; none showed gross nodal metastases. There was a significant difference between HE staining staging and IHC staining staging （P〈0.05）. Conclusion： Conventional HE staining can accurately detect gross nodal metastases in the lymph nodes of NSCLC patients, but is unfit for detecting lymph nodal micrometastases. IHC staining analysis can significantly facilitate the detection of occult micrometastatic tumor cells in lymph nodes, and its assessment of nodal micrometastases can provide a refinement of TNM stage for NSCLC patients. Our results provide a rationale for extensive lymph nodes sampling展开更多
文摘AIM:To investigate whether activated carbon nanoparticles suspension(ACNS) or methylene blue(MB) can increase the detected number of lymph nodes in colorectal cancer.METHODS:Sixty-seven of 72 colorectal cancer patients treated at our hospital fulfilled the inclusion criteria of the study which was conducted from December 2010 to February 2012.Seven patients refused to participate.Eventually,60 patients were included,and randomly assigned to three groups(20 in each group):ACNS group(group A),MB group(group B) and non-stained conventional surgical group(group C).In group A,patients received subserosal injection of 1 mL ACNS in a 4-quadrant region around the mass.In group B,the main artery of specimen was identified and isolated after the specimen was removed,and 2 mL MB was slowly injected into the isolated,stretched and fixed vessel.In group C,no ACNS and MB were injected.All the mesentery lymph nodes were isolated and removed systematically by visually inspecting and palpating the adipose tissue.RESULTS:No difference was observed among the three groups in age,gender,tumor location,tumor diameter,T-stage,degree of differentiation,postoperative complications and peritoneal drainage retention time.The total number of detected lymph nodes was 535,476 and 223 in the three groups,respectively.The mean number of detected lymph nodes per patient was significantly higher in group A than in group C(26.8 ± 8.4 vs 12.2 ± 3.2,P < 0.001).Similarly,there were significantly more lymph nodes detected in group B than in group C(23.8 ± 6.9 vs 12.2 ± 3.2,P < 0.001).However,there was no significant difference between group A and group B.There were 50,46 and 32 metastatic lymph nodes dissected in 13 patients of group A,10 patients of group B and 11 patients of group C,without significant differences among the three groups.Eleven of the 60 patients had insufficient number of detected lymph nodes(< 12).Only one patient with T 4a rectal cancer had 10 lymph nodes detected in group B,the other 10 patients were all from group C.Based on the different diameter categories,the number of detected lymph nodes in groups A and B was significantly higher than in group C.However,there was no statistically significant difference between group A and group B.The metastatic lymph nodes were not significant different among the three groups.Similarly,tumor location,T stage and tumor differentiation did not affect the staining results.Body mass index was a minor influencing factor in the two different staining methods.The stained lymph nodes can easily be identified from the mesenteric adipose tissues,and the staining time for lymph nodes was not significantly different compared with unstained group.None of the patients in groups A and B had drug-related complications.CONCLUSION:Both activated carbon nanoparticles suspension in vivo and methylene blue in vitro can be used as tracers to increase the detected number of lymph nodes in colorectal cancer.
基金Supported by Nanjing First Hospital,Nanjing Medical University and Nanjing Health Bureau,No. ZKX0114
文摘AIM： To investigate the clinicopathological roles of Bmil in esophageal squamous cell carcinoma （ESCC）.METHODS： Quantitative real-time polymerase chain reaction and immunohistochemical staining for Broil were performed in cancerous and adjacent non-cancerous paraffin-embedded esophageal specimens.RESULTS： The Bmil expression level was unaffected by gender and age. The level of Broil mRNA in ESCC was significantly higher than that in the adjacent non-cancerous tissues （2.181 ± 2.158 vs 0.931 ± 0.894, P = 0.0152）, and its over-expression was aggressively associated with lymph node metastasis （3.580 ± 2.487 vs 1.703 ± 0.758, P = 0.0003）, poorer cell differentiation （P = 0.0000） and advanced pathological stage （3.827± 2.673 vs 1.590 ± 0.735, P = 0.0001）. The patients were divided into high-expression and low-expression groups based on the median expression level of Bmi1 mRNA, and a shorter overall survival time in the former group was observed. Immunohistochemistry for Bmi1 oncoprotein showed diffusely positive, focally positive and negative expression in 44, 16 and 10 of 70 ESCC cases, respectively, compared with three, two and five of 10 adjacent non-cancerous cases （P = 0.027）. The positive rate of the oncoprotein in samples of histological grade Ⅲ was higher than that of grade Ⅱ（P = 0.031）, but its expression had no relation to the lymph node metastasis and pathological staging. In 70 ESCC samples, Bmi1 showed high intense expression in the cytoplasm and less or even no expression in the nucleus.CONCLUSION： Bmi1 was over-expressed in ESCC. Increased Bmi1 mRNA expression was significantly associated with ESCC progression, and the oncoprotein was largely distributed in the cytoplasm of tumor cells.
文摘OBJECTIVE To evaluate the feasibility of intra-operativedetection of sentinel lymph nodes (SLN) in the patient withendometrial cancer (EC).METHODS Thirty-one patients with Stage Ⅰ and Ⅱ endometrialcancer, who underwent a hysterectomy and a lymphadenectomy,were enrolled in the study. At laparotomy, methylene blue dyetracer was injected into the subserosal myometrium of corpusuteri at multiple sites, and dye uptake into the lymphatic channelswas observed. The blue nodes which were identified as SLNs weretraced and excised. The other nodes were then removed. All of theexcised nodes were submitted for pathological hematoxylin andeosin (H&E) staining examination.RESULTS Failure of dye uptake occurred in 4 of the 31 cases(12.9%) because of spillage, and no lymphatic coloration wasobserved there. Lymphatic staining was clearly observable as bluedye diffused to the lymphatic channels of the uterine surface andthe infundibulopelvic ligaments in 27 (87.1%) cases. Concurrentcoloration in the pelvic lymphatic vessels was also observed in 22of the 27 patients. The SLNs were identified in 23 of the 27 (85.2%)cases with a lymphatic staining, with a total number of 90 SLNs,and a mean of 3.9 in each case (range, 1-10). Besides one SLN (1.1%)in the para-aortic area, the other 89 (98.9%) were in the nodes ofthe pelvis. The most dense locations of SLNs included obturator in38 (42.2%) and interiliac in 19 (21.1%) cases. In our group, pelviclymphadenectomy was conducted in 27 (87.1%) patients andpelvic nodal sampling in 4 (12.9%). Of the 31 cases, a concurrentabdominal para-aortic lymph node sampling was conducted in7. A total of 926 nodes were harvested, with an average of 39.8 ineach case (range, 14-55). Nodal metastases occurred in 3 patients(9.7%), 2 of them with SLN involvement and the other withoutSLN involvement. Adverse reactions or injury related to the studywas not found.CONCLUSION Application of methylene blue dye is feasible inan intra-operative SLN identification of endometrial cancer. Thetechnology is convenient, safe, and worth further investigation.
文摘Objective： To explore whether the conventional pathologic stages of some non-small cell lung cancer （NSCLC） patients were underestimated. Methods： 195 lymph node samples were taken from 25 NSCLC patients during the operations. Firstly, each resulting tissue block was processed for routine paraffin embedding. Then the 6- 10 serial sections were chosen, each 5/am thick, from every paraffin block of the lymph node. Finally, the first and the second last sections of each lymph node were stained by hematoxylin eosin （HE）, and the other serial sections were used for the immunohistochemical （IHC） staining examination with the monoclonal antibody against cyokeratin 19. Results： With HE staining, 30 of the 195 regional lymph nodes revealed dominant nodal metastases, and none showed micrometastases. IHC staining was performed on 135 lymph nodes that were identified as free of metastases by HE staining, 31 showed micrometastases; none showed gross nodal metastases. There was a significant difference between HE staining staging and IHC staining staging （P〈0.05）. Conclusion： Conventional HE staining can accurately detect gross nodal metastases in the lymph nodes of NSCLC patients, but is unfit for detecting lymph nodal micrometastases. IHC staining analysis can significantly facilitate the detection of occult micrometastatic tumor cells in lymph nodes, and its assessment of nodal micrometastases can provide a refinement of TNM stage for NSCLC patients. Our results provide a rationale for extensive lymph nodes sampling
