乳腺癌前哨淋巴结微转移分子检测及其临床意义

Molecular detection and its clinical significance of micrometastasis of SLNs in breast cancers

目的探讨乳腺癌前哨淋巴结(SLN)定位和SLN微转移检测的临床意义。方法对66例乳腺癌患者行术前Y探测仪SLN定位,用RTPCR法检测SLN中CK19mRNA的表达。同时与常规病检法比较其检测敏感性。并比较转移组、微转移组、无转移组患者的临床病理资料。结果SLN定位成功率为97%,RTPCR法与常规病检法转移的检出率相比较差异有统计学意义(P<0.05)。在常规病检阴性的38例淋巴结中,RTPCR法检出8例有微转移。同时乳腺癌转移组与微转移组患者在肿物大小与淋巴管浸润上有相似性,而同无转移组差异有统计学意义(P<0.05)。结论RTPCR法较常规病理检查更为敏感,通过SLN定位和RTPCR的联合使用,可明显提高乳腺癌SLN微转移的检出率。同时也证明RTPCR法是可靠的,SLN微转移有可能作为肿瘤预后的指标。

Purpose To investigate the clinical significance of locating sentinel lymph nodes(SLN) and detecting the sentinel lymph node micrometastasis in breast cancers. Methods In 66 breast cancer cases,the SLN was identified by r-counter and located,furthermore RT-PCR was used to examined the expression of CK19 mRNA of SLN. The sensitivity of the method of RT-PCR was compared with that of the routine pathologic examination. At the same time,various clinic pathologic parameters were contrasted among metastasis negative group,micro-metastasis group and metastasis group. Results The SLN was successfully identified in 66 of 68 cases (97%) ,the detection of metastasis rate of SLN had significant difference between RT-PCR and the routine pathologic examination(P<0.05). 8 of 38 metastasis negative patients detected by the routine pathology were CK19 gene positive detected by RT-PCR method. The micro-metastasis group was similar with the metastasis group in tumor size and lymphatic vessel invasion,which was significantly(P<0.05) different with that of metastasis negative group. Conclusions The RT-PCR is more sensitive than the routine pathological method for the detection of micrometastasis. The combinated utilization of locating SLN and RT-PCR can greatly improve the efficiency of micrometastasis in SLNs. The results detected by RT-PCR are reliable. Micrometastasis in SLN is possible a prognostic indicator.