乳腺癌前哨淋巴结冰冻切片检查优化方案探讨

A rational scheme for frozen sections of sentinel lymph node

目的:探讨乳腺癌术中诊断前哨淋巴结(sentinel lymph node,SLN)转移的最佳病理学方法。方法:收集204例乳腺癌患者,并进行淋巴结定位,前哨淋巴结活检、术中病理诊断。102例(A法)患者的前哨淋巴结均二等分后再进行连续切片,另外102例(B法)患者的前哨淋巴结先切成1mm-1.5mm厚的薄片,置于冷冻托头上,用水溶胶包埋;再从各个组织切面进行印片细胞检查,然后进行连续切片检查。以前哨淋巴结转移的术后诊断作为金标准。结果:A组28(27%)例、B组42(40%)例检出前哨淋巴结转移(P=0.05)。前哨淋巴结转移灶平均大小:A组5.5mm、B组3.3mm(P<0.05)。结论:B法能检出更多、更小的转移灶,并且需时少,花费人力少。而A法许多微小转移性不能检出。

Objective： To explore the best intraoperative pathologic method of diagnosing sentinel lymph node （SLN） metastasis in patients with breast cancer. Methods： Total of 204 samples of patients with breast cancer were collected. Then Lymph node location, SLN biopsy and intraoperative pathologic diagnosis were conducted. In group A, all 102 SLN samples were further halved,and cut into serial sections（ method A）. In group B ,SLN samples were cut into slices with thickness of 1 to 1.5 mm, put on the apparatus and embedded in hydrosol, then cut into serial sections after imprint cytoscopy （method B）. The results of postoperative diagnosis were set as Gold Standard. Results： Twenty eighty samples （27%） of Group A and 42 samples （40%） of Group B were detected to have SLN metastases（ P = 0.05） ,and the average size of the SLN metastases was 5.5 mm for Group A and 3.3 mm for Group B,respectively（P 〈 0.05）. Conclusion ： Method B is more efficient than method A in finding more and smaller metastasis, and eco- nomical in time and manpower. Many minute metastases can not be detected in method A.