乳腺癌患者腋窝前哨淋巴结微转移及孤立癌细胞的评价

Are there other axillary lymph node metastasis than positive sentinel lymph nodes containing micrometnstuses and isolated tumor cells in patients with breast cancer

目的评价连续切片及免疫组化技术在乳腺癌前哨淋巴结（SLN）转移诊断中的价值，探讨微转移和孤立癌细胞的临床意义。方法对80例腋窝淋巴结阴性的乳腺癌患者，用^99mTc—SC和异硫蓝联合法进行前哨淋巴结活检（SLNB），对所有SLN和非SLN进行常规HE染色及免疫组织化学分析。结果78例（97．5％）成功检出SLN，其中76．5％的SLN同位素和染料检查均为阳性。32例（41％）SLN转移阳性，其中13例（40．6％）为微转移。共有14例（43．8％）患者SLN是惟一阳性的淋巴结。SLN预测腋窝状态的敏感性、特异性和准确性分别为96．9％，100％和98．7％。SLN转移的患者，其SLN之外的转移率明显高于仅有微转移的患者（78．9％vs．23．1％）。结论连续切片及免疫组化技术是乳腺癌SLN转移诊断的敏感方法。仅有SLN微转移患者的SLN之外的腋窝淋巴结转移率低，但其预后意义及对手术方案的影响尚待进一步研究。

Objective The purpose of this study was to assess the value of serial sectioning and immunohistocbemistry （IHC） for the diagnosis of sentinel lymph node （SLNs） metastases in patients with breast cancer, and to evaluate the significance of micrometastases and isolated tumor cells （ITCs） in the SLNs. Methods Eighty patients with clinically node-negative breast cancer underwent SLN biopsy with both ^99mTc-labeled sulfur colloid and isosulfan blue dye for SLN identification. All SLNs and non-SLNs were evaluated with standard H＆E stain and IHC analysis. Results SLNs were successfully identified in 78 of 80 patients（97.5% ） , the isotope/blue dye concordance rate was 76. 5% for all SLNs. Thirty two patients （41%） had histologically positive SLNs, and 13（40. 6% ） of these patients had SLNs with micrometastatic disease. In 14 （43.8%） of these patients, the SLNs were the only nodes involved. The sensitivity, specificity and accuracy of SLN biopsy in predicting axillary node status were 96. 9% , 100% and 98.7% , respectively. Patients with positive SLNs metastasis bad a markedly higher proportion of non-SLNs metastases compared with those with only micrometastasis in the SLNs （78.9% vs 23. 1% ）. Conclusions Serial sectioning and IHC are sensitive methods for detecting breast cancer metastases in SLNs. The incidence of non-SLNs metastases is rather low in patients with SLNs that contain only micrometastatic loci and ITCs. The prognostic significance and effect on surgical management of these occult disease have yet to be determined.