Detection of lymph node micrometastasis in pancreatic head carcinoma

Objective To detect the lymph node micrometastasis in resected pancreatic head carcinoma, to investigate the role of lymphatic micrometastasis in clinical staging and predicting prognosis of the pancreatic head carcinoma. Methods Pancreaticoduodenectomy with extended lymph nodes dissection were performed in 20 patients with pancreatic head carcinoma. All the lymph nodes were taken out by operating microscope method and metastasis was diagnosed by routine histological examination with hematoxylin and eosin staining, and the presence of lymph node micrometastasis was examined by immunohistochemisty. Results A total of 677 lymph nodes were found in the 20 eases, routine histological examination revealed metastasis occurred in 87 lymph nodes in 13 cases. Of the 590 negative lymph nodes by routine histological examination, 57 lymph nodes in 3 cases were diagnosed as having micrometastasis by immunohistochemisty. With the combination of routine histological examination and immunohistochemisty, the percent of patients with positive lymph nodes increased from 65% (13/20) to 80% (16/20), the detection rate of metastasis lymph node increased from 12.9% (87/677) to 21.3% (144/677) with significant difference (P <0.05). The detection of lymph node micrometastasis changed the staging of Ⅱ A to Ⅱ B in 3 patients. Tumor metastasis and recurrence rate of patients with lymph nodes micrometastasis within one year after operation was 75%, while it was 25% of patients without lymph nodes micrometastasis. Conclusions The detection of lymph node mierometastasis metastasis was helpful in the determination of clinical staging and predication of prognosis. Key words: Pancreatic neoplasms;  Lymphatic metastasis;  Cytokeratin;  Micrometastasis