IMB联合SEM检测乳腺癌患者骨髓微转移的临床意义

Detecting micrometastasis in bone marrow of breast cancer patients by immunomagnetic-bead combined with scanning electron microscope

目的:探讨免疫磁珠(immunomagnetic beads,IMB)联合扫描电镜(scanning electron microscope,SEM)检测乳腺癌患者骨髓微转移(bone marrow micrometastasis,BMM)的临床意义。方法:采用IMB富集联合SEM鉴定的方法检测106例乳腺癌患者骨髓有核细胞中上皮来源细胞的阳性发生率,分析其与原发肿瘤大小、临床分期、腋淋巴结转移、病理组织学分级、雌孕激素受体蛋白(ER、PR)表达及术后1年远端转移发生情况等常用病理学观测指标的关系。结果:106例乳腺癌骨髓标本中,37例检测到肿瘤细胞,骨髓微转移阳性率为34.9%;乳腺癌BMM阳性率与原发肿瘤大小正相关(P<0.05);临床分期越晚,出现BMM的概率也越高(P<0.01);BMM不仅与腋淋巴结是否转移有关(P<0.05),且随淋巴结转移数目增加,BMM阳性率亦增高(P<0.05);此外,乳腺癌BMM阳性率还与病理组织学分级正相关(P<0.05);与ER、PR蛋白在肿瘤组织中的表达负相关(P<0.05);与术后1年内患者是否发生远端转移正相关(P<0.05)。结论:IMB联合SEM检测骨髓微转移是具有潜在应用价值的乳腺癌早期诊断方法和预后指标。

Objective： To study the method and clinical significance of detecting micrometastasis in bone marrow of breast cancer patients with an immunomagnetic bead （IMB） combined with laser scanning electron microscope （SEM）. Methods： The method of IMB to enrich the cells combined with SEM was used to detect the positive incidence rate of the cells derived from the epithelium in bone marrow karyocytes of 106 breast cancer patients. The relationship between the rate and the size of the tumor, clinical stage, the metastasis in axillary lymph nodes, grade of pathology, the expression of ER and PR in tumor tissue and distant metastasis occurring 1 year after operation was analyzed. Results：Thirty-seven of the 106 bone marrow specimens from breast cancer patients had tumor cells. The positive rate of bone marrow micrometastasis （BMM） was 34.9%. The positive rate of breast cancer BMM was positively correlated with the size of the tumor （P 〈 0.05 ）. The later the clinical stage, the higher the positive BMM detection rate（P 〈 0.01 ）. BMM was not only related to the metastasis of axillary lymph nodes （P 〉 0.05）, but its positive rate also increased with the the number of metastatic axillary lymph nodes （ P 〈 0.05 ）. Breast cancer BMM was correlated positively with the histopathological grade （ P 〈 0.05 ）, negatively with the expression of ER and PR in tumor tissue （P 〈 O. 05） and positively correlated with the distant metastasis 1 year after operation （P 〈 0.05）. Conclusion： IMB combined with SEM for detecting micromctastasis in bone marrow is a method potentially applicable to early diagnosis and prognosis of breast cancer.