术中快速免疫组化检测早期乳腺癌前哨淋巴结的临床价值

Application of rapid immunohistochemicat staining technique in sentinel lymph nodes for diagnosis of early breast cancer during operation

目的 探讨术中快速免疫组化检测乳腺癌前哨淋巴结（SLN）CK19、端粒酶表达的临床实用价值.方法 以蓝染法对66例乳腺癌患者施行SLN活检,62例获得成功,该62例患者的117枚SLN进行快速免疫组化检测,以CK19、端粒酶为检测指标,以术中冰冻切片、术后连续石蜡切片和常规免疫组化以及术后腋淋巴结连续石蜡切片为对照.结果 SLN活检成功率达93.93%,冰冻切片对SLN的阳性检出率最低,连续石蜡切片次之,快速免疫组化检测SLN阳性检出率明显高于冰冻切片（P = 0.002）,而快速免疫组化检测与常规免疫组化检测SLN阳性检出率的差异无统计学意义（P = 0.961）.快速免疫组化检测预测腋淋巴结转移准确率达96.55%,CK19与端粒酶的灵敏度分别为96.36%、96.83%,特异度均为100%.结论 正确使用蓝染法可获得较高的SLN活检成功率,SLN的快速免疫组化检测方法具有快速、及时、准确的优点,能在术中即时为术者提供检测结果,从而拟定个体化治疗方案,使早期乳腺癌患者免受腋淋巴结清扫之苦.

Objective To evaluate the significance of the rapid immunohistochemical （IHC） staining technique in detecting CK19 and telomerase in sentinel lymph nodes of breast cancer patients. Methods Blue staining method was used to detect the sentinel lymph node in 66 breast cancer patients form January 2008 to September 2009, Total 117 sentinel lymph nodes were obtained from 62 patients. Two primary antibodies （anti- CK19 and antitelomerase） were used for rapid immunohistochemical staining. The results of the rapid IHC were compared with those of frozen sections detection, routine HE staining and routine IHC method. Results The detection rate of sentinel lymph nodes with rapid IHC was 93.93% （62/66）, which was much higher than that of frozen sections detection （P = 0.002）. There was no significant differences in detection rate of lymph nodes between rapid IHC and routine IHC （P = 0.961）. The accuracy for detecting metastasis of sentinel lymph nodes with rapid IHC was 96.55%. The sensitivity of CK19 and telomerase for detecting positive lymph nodes was 96.36% and 96.83%, respectively, and the specificity was both 100.0%, Conclusion Rapid IHC staining technique is a reliable and precise procedure for detection of sentinel lymph nodes in early stage breast cancer, and can be helpful for surgeons to make quick clinical decision during operation.