HE、IHC和RT-PCR方法检测乳腺癌腋窝淋巴结转移的对照研究

A Comparative Study on Sensitivity of HE,IHC and RT-PCR in Detection of Breast Cancer Metastases in Axillary Lymph Nodes

目的 探讨检测乳腺癌腋窝淋巴结转移较敏感的方法。方法 应用常规HE染色法、细胞角蛋白19(CK19)作为单抗的免疫组化(IHC)SP染色及CK19 mRNA的逆转录聚合酶链反应(RT PCR)3 种方法检测20 例乳腺癌患者共239 个腋窝淋巴结的转移情况。结果 239 个腋窝淋巴结中,HE染色发现3 例患者7 个(2.9%,7/239)有癌转移,均位于level Ⅰ; IHC检测到7例患者13个(5.4%,13/239)有癌转移,其中11个位于level Ⅰ,2个位于level Ⅱ; RT PCR检测到14例患者52 个(21.8%,52/239)有癌转移,其中30 个位于level Ⅰ,22 个位于level Ⅱ。IHC和RT PCR检测证实,HE染色阳性的7 个淋巴结均有癌转移; IHC染色阳性的淋巴结均出现了PCR阳性扩增产物。HE、IHC及RT PCR 3 种检测方法对腋窝淋巴结微转移的检出率分别是0(0/232)、2.6%(6/232)及19.4%(45/232),P<0.05。结论 IHC及RT PCR是较HE检测淋巴结微转移更敏感的方法,而RT PCR较IHC更为敏感,能更准确地反映乳腺癌患者腋窝淋巴结的状况。

Objective To compare the sensitivity of HE,immunohistochemistry (IHC) and RT-PCR in detection of breast cancer metastases in axillary lymph nodes.Methods Twenty female patients with newly diagnosed and clinically node-negative breast cancers underwent modified radical mastectomy, including a complete axillary lymph node dissection. The ages of the patients ranged from 31 years to 65 years, and the diagnosis of breast cancer was approved by pathological finding. Two hundred and thirty-nine axillary lymph nodes were found in these 20 patients. Metastases in axillary lymph nodes were explored by HE, cytokeratin 19 IHC and RT-PCR for cytokeratin 19 respectively. Results Seven(2.9%) lymph nodes were found to have metastatic cancers by HE in 3 patients,all nodes were found in level Ⅰ. Metastatic cancers were found in 13 (5.4%) nodes by IHC in 7 patients,11 nodes in level Ⅰ and 2 nodes in level Ⅱ; and 52(21.8%) nodes were found to contain tumor cells by RT-PCR in 14 patients,30 nodes in level Ⅰ and 22 nodes in level Ⅱ. All of 7 histologically(HE) positive nodes were found to contain tumor cells by IHC and RT-PCR. Among 232 histologically(HE) negative nodes,6(2.6%) nodes were found to contain tumor cells by IHC,and 45(19.4%) nodes were found to contain tumor cells by RT-PCR, all 6 IHC positive nodes showed the expected 460-base pair products on gel electrophoresis ( P <0.05).Conclusion This study suggests that IHC and RT-PCR are more sensitive methods for the detection of micrometastases of breast cancer in lymph nodes than HE is,and RT-PCR is even better than IHC; the micrometastases of breast cancer in axillary lymph nodes could be detected accurately through these techniques.