J.Jpn. Surg. Soc.. 102(6): 449-452, 2001

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Feature topic

SIGNIFICANCE OF DETECTION OF MICROMETASTASES IN REGIONAL LYMPH NODES IN CANCER PATIENTS USING RT－PCR

Lymph node metastasis is the most important predictor of prognosis, and lymph node dissection is indispensable in achieving curative resection. However, even in patients who undergo curative resection, 20-30% experience relapse, which may be due to micrometastases that are undetectable by conventional histologic methods. Recently, more specific and sensitive genetic methods, including the reverse-transcriptase polymerase chain reaction (RT-PCR), have been introduced to detect micrometastases. We review the literature to evaluate the significance of detecting micrometastases in lymph nodes by RT-PCR. Since the first study by Smith in 1991, many authors have reported molecular diagnoses in the lymph nodes, blood, and bone marrow in patients with various types of cancer using markers such as CEA and cytokeratins. Many researchers have found RT-PCR to be more sensitive than conventional histological methods in detecting lymph node metastases. Molecular diagnosis will become a powerful tool for predicting prognosis and determining who should receive postoperative adjuvant chemotherapy. However, reports on the relationship between molecular diagnosis and prognosis are still few. It will be important to clarify this relationship in large-scale clinical trials to evaluate the significance of detecting micrometastases in the lymph nodes.

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