乳腺癌前哨淋巴结微转移检测在根治术中的应用价值

Significance of Sentinel Lymph Node Micrometastasis Detection in Breast Cancer

目的：通过对腋淋巴结阴性乳腺癌行前哨淋巴结(sentinel lymph node， SLN）活检，可推测全腋窝淋巴结受累状况。对常规病理检查阴性的SLN再行连续切片检查，则能更准确查明微转移的有无，以更可靠地评价该项技术作为设计治疗方案依据的价值。方法：对本组52例采用染料法(1％ Patent Blue V)检出SLN，并对阴性的SLN再行连续切片，检查有无常规病理检查未能发现的微转移。结果：52例中检出SLN 44例(84．6％），检出率与肿瘤部位(P＜0．01）相关。常规病理检查见SLN(＋）13例，SLN(－）31例，此31例中有“跳跃转移”2例。总诊断符合率95．5％，假阴性率13．3％。对31例阴性SLN行连续切片检测微转移，在无“跳跃转移”的29例中又检出3例阳性，假阴性率降至11．1％。结论：SLN活检对评估全腋淋巴结受累状态有一定价值，可作为选择术式及术后治疗方案的参考。本组常规病理检查假阴性率为13．3％，与大多数研究结果相符，此为影响该项技术应用于临床的主要障碍。本研究采用连续切片检出常规法难以发现的微转移，减少了假阴性。若再结合免疫组化及RT－PCR技术，将能进一步提高SLN勘测技术的可靠性。

Objective： To detect the micrometastasis of pan－axillary lymph nodes by serial section of negative sentinel lymph node biopsy can be a more accurate reference for treatment． Methods： Blue dye (1％ Patented Blue) was used in 52 cases． Serial section of all the negative SLN was performed． Results： SLN was detected in 44 of 52 cases (84．6％)． The detected rate of SLN was associated with the site of tumor (P＜0．01)． The SLN was positive in 13 cases and negative in 31 cases by routine pathologic examination． The ″Jumping metastasis″ occurred in two of 31 SLN negative cases． The overall accordance rate was 95．5％ and false negative rate 13．3％． Serial section was performed in 31 SLN negative cases， and metastasis was found in 3 of 29 cases who had no ″Jumping metastasis″， and the false negative rate of the latter reduced to 11．1％． Conclusion： SLN biopsy is of some value to assess the axillary lymph node status in breast and can be regarded as a reference of treatment． Presence of false negative is the main problem of SLN biopsy． Serial section， immunohistochemistry and RT－PCR can increase the reliability of SLN biopsy．