乳腺癌前哨淋巴结微转移的检测

Detection of Sentinel Lymph Node Micrometastases in Breast Cancer

目的探讨检测乳腺癌前哨淋巴结(SLN)微转移的有效手段。方法以99mTc标记的硫胶体作为前哨淋巴结示踪剂,使用γ探测仪进行前哨淋巴结定位,对41例临床腋淋巴结阴性的乳腺癌患者实施前哨淋巴结活检(SLNB)。收集常规病理检查无转移的SLN行多层次连续切片,分别行H-E染色和细胞角蛋白免疫组织化学染色。结果39例乳腺癌检出SLN,SLN检出成功率为95.1%(39/41例)。在常规病理学检查SLN无转移的20例中,连续切片H-E染色发现4例SLN微转移,免疫组织化学染色发现7例SLN微小转移癌。连续切片免疫组织化学染色对SLN微转移的检出率高于常规病理学检查(P<0.05)。结论连续切片免疫组织化学染色是检测乳腺癌前哨淋巴结微转移的有效方法,可提高SLNB的准确性。

Objective To investigate the optimal methods of detecting micrometastases in sentinel lymph node（SLN） in breast cancer. Methods Forty-one patients with clinically node-negative breast cancer underwent sentinel lymph node biopsy（SLNB） procedure using ^99mTc-labeled sulfur colloid. Series sections were made at multiple levels in these SLNs, H-E staining and cytokeratin immunohistochemical detection was performed respectively. Results SLN was successfully identified in 39 （95.1%） of the 41 cases. No SLN metastasis was found in 20 cases after routine pathological examination. But occult metastases were found in 4 cases by H-E staining on series sections, and in 7 cases using immunohistochemical staining protocol. The accuracy of immunohistochemical staining was much more higher than that of routine pathological examination（P〈0.05）. Conclusions Cytokeratin immunohistochemistry on series sections is a reliable method for detection of sentinel lymph node micrometastases in breast cancer.