乳腺癌前哨淋巴结微转移的研究

The study of micrometastases in sentinel lymph nodes of breast cancer

目的提高乳腺癌前哨淋巴结(SLN)病理诊断的准确性,为手术彻底切除肿瘤提供依据。方法应用亚甲蓝生物染色的方法确定60例Ⅰ、Ⅱ期乳腺癌SLN并活检,44(73.3%)例SLN取材成功。每一枚SLN均进行冰冻病理切片、石蜡病理和角蛋白Keratin19(CK19)逆转录聚合酶链反应(RT PCR)检测。结果44例SLN冰冻病理切片、石蜡病理切片和CK19诊断的灵敏度和特异度分别是77.8%和100.0%、88.9%和100.0%、100.0%和82.9%,诊断符合率分别为95.5%、97.7%和86.4%,诊断指数分别为0.778、0.889和0.829。结论CK19检测可进一步提高乳腺癌SLN微转移的检出率,提高SLN活检的准确性。但CK19检测与冰冻病理病理检查联合应用可提高诊断的准确率和临床的可操作性。

Objective ： To detect tumor mlcrometastases in sentinel lymph nodes（SLN） of breast carcinoma so as to obtain more reliable information about SLN biopsy and its clinical sianificance.Methods：In 60 breast cancer patients,methylene blue was used to locate the SLNs. SLN was successfully Tdentified in 44 of the 60 cases. Beside the routine patholoaical examination,expression of CK19 mRNA was detected by using reverse transcripase-polymerase chain reaction （RT-PCR） in every SLN in 44 cases in whose SLN was successfully identified. Results： The sensitivity and the distinctivity of ice slide biopsy,paraffin slide biopsy and expression of CK-19 were 77. 896 and 100. 0%,88. 9% and 100. 0%,100.0% and 82.9% respeotively. The ooinoidencity was 95. 5%,97. 7% and 86.4% respeotively and the diaanosis index was 0. 778,0. 889 and 0. 829 respeotively. Conclusion：The CK19 RT-PCR method is more sensitive than routine pathological method for deteotion of micrometastases in SLN. This new method is of value in differentlating breast cancer patients at risk for miorometastases from those with neaative SLN by routine patholoaical.