病理大切片技术在新辅助化疗后乳腺癌手术标本中的应用及其推广价值

Application of large section technique of breast on the research of shrinkage model of breast cancer treated with neoadjuvant chemotherapy and its promotion value

目的:通过在新辅助化疗后乳腺癌的手术标本中应用病理大切片技术,探讨乳腺癌的肿瘤退缩模式及该技术的推广价值。方法:21例粗针穿刺明确为乳腺癌的女性患者,分别行2～4个周期新辅助化疗后行改良根治或标准根治术,术后行全乳取材,制作病理大切片,并作细致观察。结果:进一步完善的病理大切片技术制片效果良好,适用于普通病理科,新辅助化疗后临床完全缓解占28.6%(6/21),病理完全缓解占9.5%(2/21)。6例临床完全缓解病例中2例病理完全缓解,1例仅残留2 mm癌灶,3例肿瘤呈筛状缩小,未达到病理缓解。21例乳腺癌标本中3例肿瘤呈向心性缩小且周围无残留,18例肿瘤范围没有缩小,而呈卫星灶式的分布,癌细胞密度呈不同程度减小。结论:全乳病理大切片取材能更加全面观察残留肿瘤情况,明确残留肿瘤范围,更大可能发现微小残留癌灶,对于预后评估及后续治疗方案的制定有其优势;这一技术同样适用于其他脏器,有推广价值。

Objective：Via the application of pathological large section technique on the surgical specimen of breast cancer treated with neoadjuvant chemotherapy to explore the shrinkage model of breast cancer and its promotion value.Methods：Twenty-one cases of breast cancer confirmed by the core-needle aspiration were administered with 2～4 cycles of neoadjuvant chemotherapy followed by modified or standard radical mastectomy.After the operation,the whole mammary glands were sampled and made into the pathological large section in order to observe and evaluate the residual tumor focus at great length.Results：The further improvoment of pathological large section technique was good in the section effect and suitable to the ordinary department of pathology.The ratio of clinical complete response and pathological complete remission was 28.6%（6/21） and 9.5%（2/21） respectively.Of 6 cases of clinical com-plete response,there were 2 cases of pathological complete remission,1 residual cancer focus with 2 mm and 3 tumors showing the sieve-like shrinkage didn＇t reach the pathological remission.3 cases of 21 breast cancers＇ specimen showed the concentric shrink-age without any peripheral cancer residue and 18 cases of tumor didn＇t show any shrinkage but the distribution of the satellite lesions type and the cell density of tumor decreased at the variable degrees.Conclusion： The whole mammary sampling with pathological large section technique can observe the condition of residual tumor more comprehensive,confirm the range of residue tumor and find the small residue foci of cancer more likely,which has some advantages of evaluating the prognosis and of instituting the follow-up treatment.This technique can be applied on the other organs likewise and has its promotion value.