An immunohistochemical study of occult micro-metastases in regional lymph nodes of 94 patients with stage I non-small cell lung carcinoma
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In the study, 739 regional lymph nodes from 94 patients with stage I non- small cell lung carcinoma ( NSCLC ) were studied by immunohistochemical techniques. These lymph nodes contained no metastatic tumor as assessed by conventional histopathology were recut. A series of consecutive sections from the original blocks were immunostained with poly- and monoclonal antibodies to cytokeratins, carcinoembryonic antigen (CEA), and human milk fat globulin membrane antigen (HMFG-2). Single tumor cells or small clusters of tumor cells, not visible on routine examination, were readily detected. The actual number of lymph nodes that contained occult tumor cells was 123 (16.6%) from 53 patients (56.4%). The majority of 102 immunostained positive nodes were distributed in the hilar (29%) and peribronchial (25%) regions. Our data indicate that (1) a series of consecutive sections and immunohistochemistry may greatly increase the diagnostic yield of occult micrometastases in lymph nodes; (2) the high incidence of occult metastases in NSCLC may be of importance in relation to their rapid dissemination and high death rate; (3) the high frequency of occult nodal metastases in NSCLC raises questions in regard to our presently used criteria for staging, prognosis and treatment of ostensibly stage I disease; and (4) perhaps dissections of hilar and peribronchial nodes will have an importantly clinical significance in prevention of wide dissemination of tumor cells.
Key wordsNon- small cell lung cancer Occult micrometastases Immunohistochemistry
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