早期乳腺癌前哨淋巴结转移39例病理学研究

Metastases in the sentinel lymph nodes of patients with early stage breast carcinoma

目的 探讨提高早期乳腺癌前哨淋巴结活检阳性率的方法。方法 回顾性分析 39例早期乳腺癌前哨淋巴结定位活检病例。对 2 8例阴性前哨淋巴结及所属非前哨淋巴结 ,在原组织蜡块平面 10 0 μm深处切片 2张 ,1张HE染色 ,1张免疫组化染色 ;于 2 0 0 μm深处切片 1张 ,行HE染色。 结果 39例中前哨淋巴结转移率是非前哨淋巴结的 4 3倍 ;多层切片、HE染色及免疫组化染色检测 2 8例 6 7枚阴性前哨淋巴结和 4 2 4枚非前哨淋巴结 ,2例 (2枚 )发现有转移 ,与单切面HE染色法相比 ,敏感性提高 7 1% ;前哨淋巴结假阴性率由 8 3%降为 7 1%。结论 前哨淋巴结是乳腺癌最早发生也是最易发生转移的淋巴结 。

Objective To investigate metastases in the sentinel lymph nodes (SLN) of patients with early stage breast cancer Methods Original pathology material was re examined from 39 patients enrolled on a validation study of sentinel lymph node Paraffin embeded tissue blocks of sentinel and nonsentinel lymph nodes(NSLN) were obtained from 28 lymph node negative patients Additional sections at 100 and 200?μm deeper from the original cutting surface were examined for the presence of occult metastatic carcinma Both routine histology (HE) and cytokeratin immunohistochemical(IHC)staining were employed Results The likelihood of matastases in SLN was 4 3(19 0/4 4)times higher that in that of NSLN In the 28 patients who had sentinel lymph nodes, 67 SLNs and 424 NSLNs were examined by multiple sections and IHC Only 2 additional tumor positive SLNs were indentified for a conversion rate of 7 1% Multiple section and IHC stains on SLNs would reduce the false negative rate of SLN from 8 3% to 7 1% Conclusions The sentinel lymph node is indeed the axillary node to harbor most likely metastatic breast carcinoma IHC analysis or serial sectioning of SLN can improve the sensitivity of this staging technique