乳腺癌局部淋巴结内隐匿性微小癌转移的免疫组化研究

An Immunohistochemical Study of Regional Lymph Nodes for Occult Tumor Micrometastases in Patients with Stage I Breast Carcinoma

１１２例女性乳腺癌病人手术切除１８４０枚淋巴结，常规病理检查无癌转移。现用连续切片，单克隆抗细胞角蛋白（ＡＥ１／ＡＥ３）、抗上皮细胞膜（ＥＭＡ）抗体及多克隆抗角蛋白抗体对肿瘤组织及所有淋巴结按ＬＳＡＢ法进行免疫染色。几种抗体均对肿瘤组织、淋巴结内微小癌灶及单个癌细胞呈现免疫染色阳性反应，尤以抗ＥＭＡ抗体反应最强。结果查出２７．７％（３１／１１２）病例及２．２７％（５０／１８４０）淋巴结内存在隐匿性微小癌转移。其中６１例病人经７年随访，显示有隐匿性微小癌转移病人肿瘤复发、远处扩散转移均较无癌转移病人高，而且术后时间短。作者对隐匿性微小癌的淋巴结内转移及其病理生物学与临床意义进行了讨论。

We re-examined 1840 regional lymph nodes which documental no tnmor cells by conventional histopathological examination from 112 female patients with stage I breast cancer using immunohistochemistry LSAB techniques.Monoclonal anticytokeratins(AE1/AE3),anti-EMA,and polyclonal anti-keratins antibodies were used as the primary reagents to identify tumor cells both in tumor tissues and lymph nodes.Over all, immunostaining positive tumor cells were found in 27.7% of lymph nodes of patients(31/112) and 2.27%(50/1840)of the dissected lymph nodes.Seven years postoperative follow-up observation revealed that the incidence of recurrence was high and the latent period of distant metastases was much shorter in patients with occult micrometastases than those without.