臨床外科66巻10号

2011年10月発行

特集 進歩する癌転移診断―外科臨床はどう変わるのか

〔転移巣別〕

リンパ節微小転移の診断

著者： 有上貴明¹ 上之園芳一¹ 柳田茂寛¹ 有馬豪男¹ 平田宗嗣¹ 萩原貴彦¹ 原口尚士¹ 舩迫和¹ 松本正隆¹ 喜島祐子¹ 石神純也¹ 夏越祥次¹

所属機関： ¹鹿児島大学大学院医歯学総合研究科消化器・乳腺甲状腺外科学分野

ページ範囲：P.1290 - P.1296

文献概要

【ポイント】

◆リンパ節微小転移の診断法としては，分子生物学的手法を用いて形態学的に癌細胞を検索する免疫組織学的検出法やRT-PCRに代表される遺伝子学的検出法などがある．

◆リンパ節微小転移の診断では，標的遺伝子マーカーの選択が極めて重要であり，特にRT-PCR法では，感度および特異度の面からmultiple-markerによる診断がその精度を向上させるものと期待される．

◆今後，リンパ節郭清範囲の省略を伴う縮小手術を行う際には，微小転移を含めた正確な術中リンパ節転移診断の確立が必須であり，その臨床応用にあたっては，簡便かつ迅速な診断システムの構築が重要である．

参考文献

1）Aikou T, Kitagawa Y, Kitajima M, et al：Sentinel lymph node mapping with GI cancer. Cancer Metastasis Rev 25：269-277, 2006

2）Sobin LH, Wittenkind C, ed：International Union Against Cancer. TNM Classification of Malignant Tumors, 6th ed. New York, John Wiley-Blackwell, 2002

3）Yanagita S, Natsugoe S, Uenosono Y, et al：Sentinel node micrometastases have high proliferative potential in gastric cancer. J Surg Res 145：238-243, 2008

4）Chao C, Wong SL, Ackermann D, et al：Utility of intraoperative frozen section analysis of sentinel lymph nodes in breast cancer. Am J Surg 182：609-615, 2001

5）Natsugoe S, Aikou T, Shimada M, et al：Occult lymph node metastasis in gastric cancer with submucosal invasion. Surg Today 24：870-875, 1994

6）Isozaki H, Okajima K, Fujii K：Histological evaluation of lymph node metastasis on serial sectioning in gastric cancer with radical lymphadenectomy. Hepatogastroenterology 44：1133-1136, 1997

7）Maehara Y, Oshiro T, Endo K, et al：Clinical significance of occult micrometastasis lymph nodes from patients with early gastric cancer who died of recurrence. Surgery 119：397-402, 1996

8）Kikuchi Y, Tsuchiya A, Ando Y, et al：Immunohistochemical detection of lymph node microinvolvement in node-negative gastric cancer. Gastric Cancer 2：173-178, 1999

9）Saragoni L, Gaudio M, Morgagni P, et al：Identification of occult micrometastases in patients with early gastric cancer using anti-cytokeratin monoclonal antibodies. Oncol Rep 7：535-539, 2000

10）Harrison LE, Choe JK, Goldstein M, et al：Prognostic significance of immunohistochemical micrometastases in node negative gastric cancer patients. J Surg Oncol 73：153-157, 2000

11）Morgagni P, Saragoni L, Folli S, et al：Lymph node micrometastases in patients with early gastric cancer：experience with 139 patients. Ann Surg Oncol 8：170-174, 2001

12）Nakajo A, Natsugoe S, Ishigami S, et al：Detection and prediction of micrometastasis in the lymph nodes of patients with pN0 gastric cancer. Ann Surg Oncol 8：158-162, 2001

13）Fukagawa T, Sasako M, Mann GB, et al：Immunohistochemically detected micrometastases of the lymph nodes in patients with gastric carcinoma. Cancer 92：753-760, 2001

14）Yasuda K, Adachi Y, Shiraishi N, et al：Prognostic effect of lymph node micrometastasis in patients with histologically node-negative gastric cancer. Ann Surg Oncol 9：771-774, 2002

15）Morgagni P, Saragoni L, Scarpi E, et al：Lymph node micrometastases in early gastric cancer and their impact on prognosis. World J Surg 27：558-561, 2003

16）Yonemura Y, Endo Y, Hayashi I, et al：Proliferative activity of micrometastases in the lymph nodes of patients with gastric cancer. Br J Surg 94：731-736, 2007

17）Yanagita S, Natsugoe S, Uenosono Y, et al：Morphological distribution of metastatic foci in sentinel lymph nodes with gastric cancer. Ann Surg Oncol 15：770-776, 2008

18）Bos JL, Fearon ER, Hamilton SR, et al：Prevalence of ras gene mutations in human colorectal cancers. Nature 327：293-297, 1987

19）Forrester K, Almoguera C, Han K, et al：Detection of high incidence of K-ras oncogenes during human colon tumorigenesis. Nature 327：298-303, 1987

20）Andreyev HJ, Norman AR, Cunningham D, et al：Kirsten ras mutations in patients with colorectal cancer：the multicenter “RASCAL”study. J Natl Cancer Inst 90：675-684, 1998

21）Arigami T, Natsugoe S, Uenosono Y, et al：Lymphatic invasion using D2-40 monoclonal antibody and its relationship to lymph node micrometastasis in pN0 gastric cancer. Br J Cancer 93：688-693, 2005

22）Arigami T, Natsugoe S, Uenosono Y, et al：Evaluation of sentinel node concept in gastric cancer based on lymph node micrometastasis determined by reverse transcription-polymerase chain reaction. Ann Surg 243：341-347, 2006

23）Matsumoto M, Natsugoe S, Ishigami S, et al：Rapid immunohistochemical detection of lymph node micrometastasis during operation for upper gastrointestinal carcinoma. Br J Surg 90：563-566, 2003

24）Yanagita S, Natsugoe S, Uenosono Y, et al：The utility of rapid diagnosis of lymph node metastasis in gastric cancer using a multiplex real-time reverse transcription polymerase chain reaction assay. Oncology 77：205-211, 2009

25）Funasako Y, Uenosono Y, Hirata M, et al：Utility of the GeneSearch breast lymph node assay for the rapid evaluation of sentinel lymph nodes in breast cancer. Cancer 116：4450-4455, 2010