乳腺癌患者非前哨淋巴结转移的预测因素

Predictors of Metastasis in Nonsentinel Lymph Nodes in Breast Cancer Patients

目的:探讨乳腺癌患者非前哨淋巴结转移的预测因素。方法:用同位素法示踪前哨淋巴结(sentinel lymph node,SLN),除常规HE染色外,对前哨淋巴结还进行间隔连续切片和免疫组化染色。回顾性分析了1999年5月～2008年7月间前哨淋巴结活检中存在转移的108例患者,以研究非前哨淋巴结转移与各种临床病理因素的关系。结果:SLN活检的成功率为96%,灵敏度为92%,特异度为100%,假阴性率为8%,假阳性率为0,准确率为96.6%。当原发肿瘤>2cm或者脉管受侵时或者前哨淋巴结转移灶最大径>2mm,非SLN的转移率分别为66.7%(54/81),84.1%(37/44)和87.3%(55/63)。如果原发肿瘤>2cm且脉管受侵,或者原发肿瘤>2cm且前哨淋巴结转移灶最大径>2mm,或者脉管受侵且前哨淋巴结转移灶最大径>2mm,非SLN的转移率分别为85.7%(18/21),93.8%(15/16)和94.7%(18/19)。如果原发肿瘤>2cm,脉管受侵且前哨淋巴结转移灶最大径>2mm,则全部14例非SLN都有转移。结论:非前哨淋巴结是否转移与原发肿瘤大小、前哨淋巴结转移灶最大径和脉管是否受侵有关,患者具有的不良因素越多,则非前哨淋巴结发生转移的可能性越大。

Objective： To investigate the predictive factors of metastasis in non-sentinel lymph nodes （SLNs） in breast cancer patients. Methods： We identified SLNs by isotope. Besides routine H＆E staining, serial section and immunohistochemistry were employed. Between May 1999 and July 2008, 108 patients had positive SLNs verified by SLN biopsy. We reviewed the records of all these patients to explore the correlation between metastasis in non-SLNs and clinicopathologic features in these patients. Results： The successful rate of SLN biopsy was 96.0%, the sensitivity was 92.0%, the specificity was 100.0%, the false negative rate was 8.0%, the false positive rate was 0%, and the accuracy rate was 96.6%. The rate of metastasis in non-SLNs was 66.7% （54/81） in patients with a primary tumor size 〉2 cm, 84.1% （37/44） in patients with the presence of lymphovascular invasion, and 87.3% （55/63） in patients with the size of the largest SLN metastasis〉2 mm. The 14 .patients with a primary tumor size〉2mm, lymphovascular invasion and the size of the largest SLN metastasis〉2mm presented with a metastatic rate of 100% in non-SLNs. Conclusion： The metastasis to non-SLNs from breast cancer is correlated with primary tumor size, size of the largest SLN metastasis, and presence of lymphovascular invasion.