连续切片检测乳腺癌前哨淋巴结隐性转移研究

Study on detection of occult metastases in sentinel lymph node of breast cancer by serial section

目的探讨更为合理的乳腺癌前哨淋巴结(sentinel lymph node,SLN)隐性转移(occult metastases)的病理检测办法。方法对245例常规病理诊断阴性的569枚SLN以100仙m间距行连续切片(serial section,SS)后HE染色(sS-HE),确定检测隐性转移的最佳间距。结果 245例患者通过sS—HE检测出隐性转移36例(14.7%),其中大体转移6例,微转移22例,孤立肿瘤细胞8例。569枚SLN中,SS-HE检出隐性转移39枚(6.9%),间距100一、200一、300一、400一和500"m ss-HE隐性淋巴结转移的检出率分别为6.9%、6.3%、5.1%、3.7%、3.5%,间距200¨m SLN隐性转移检出率与间距100 p.m相比差异无统计学意义(JD>O.05)。研究发现浸润性小叶癌隐性转移的检出率(52.O%)显著高于浸润性导管癌(13.9%,.p=0.000),而与病理分期、受体状况以及HER-2表达无关(均Jp>O.05)。结论ss.HE对于SLN隐性转移的检f9llI具有显著优势;200 txm为SS-HE的最佳检测间距;浸润性小叶癌SLN隐性转移的检出率显著高于浸润性导管癌。

Objective To explore a more rational pathological method for the detection of occult metastases in sentinel lymph nodes （SLNs）. Methods Two hundred and fourty-five breast cancer women were included. 569 SLNs of the 245 patients which were identified negative by standard hematoxylin and eosin （HE） staining examination. All SLNs were serial section （SS） every 100 I^m interval and HE stain examination was performed to find out the optimal interval for the detection of occult metastases. Results In the 245 SLNs negative patients, 36 cases were upstaged in node status by using SS-HE method, therefore the positive detecting rate was increased by 14.7%. The occult metastases included macrometastases in 6, MMs in 22, and ITCs in 8 cases. In all the 569 originally negative SLNs, 39 （6.9%） SLNs were positive. The detection rate of occult metastases at 100-, 200-, 300-, 400-, 500 μm intervals was 6.9%, 6.3%, 5.1%, 3.7% and 3.5%, respectively, and no significant differences were found between 100 μm and 200p.rn intervals （ P 〉 0.05 ）. Furthermore, occult metastases were also found to be positively correlated with histopathology. The variance was significant in the detection of rate occult metastases between invasive lobular carcinoma and invasive ductal carcinoma （P = 0. 000）, but no significant correlations were found among pathologic stage, ER, PR, and HER-2 status （all P 〉 0.05 ）. Conduslons SS could significantly increase the detection rate of occult metastases in negative SLNs with routinely histological exam. The detection rates of metastases were significantly higher in patients with invasive lobular carcinoma than those with invasive ductal carcinoma. The optimal interval for the detection of occult metastases in SLN was 200 μm by SS-HE.