印片细胞学联合快速免疫组化检测在乳腺癌前哨淋巴结活检术中诊断的应用

Application of touch imprint cytology plus rapid immunohistochemistry staining in the intraoperative assessments of breast cancer sentinel lymph nodes(SLNs)

目的:探讨乳腺癌前哨淋巴结活检(SLNB)术中,印片细胞学(TIC)与快速免疫组化(RIHC)联合应用诊断乳腺癌前哨淋巴结(SLN)转移的价值。方法:选择89例乳腺癌患者,共281枚SLN,在SLNB中行TIC和(或)RIHC检测。RIHC检查以广谱细胞角蛋白19(pan-cytokeratin 19,pan-CK19)为指标。以术后石蜡切片诊断为对照,分析单独TIC和TIC联合RIHC诊断乳腺癌SLN转移的阳性检出率、敏感度、准确率、假阴性率。结果:TIC诊断乳腺癌SLN转移的阳性检出率为25.8%(23/89),TIC联合RIHC诊断乳腺癌SLN转移的阳性检出率为36.0%(32/89),差异有统计学意义(P<0.05)。TIC及RIHC诊断乳腺癌SLN转移的特异度均为100.0%。单独TIC检查诊断乳腺癌SLN转移的敏感度为69.7%(23/33),TIC联合RIHC检查的敏感度为97.0%(32/33),差异有统计学意义(P<0.001)。单独TIC检查诊断乳腺癌SLN转移的假阴性率为30.3%(10/33),TIC联合RIHC检查的假阴性率为3.0%(1/33),差异有统计学意义(P<0.001)。结论:乳腺癌SLNB中联合应用TIC和RIHC检查能提高乳腺癌SLN转移的检出率、敏感度和准确率。

Objective：To investigate the clinical values of touch imprint cytology（TIC）plus rapid immunohistochemistry staining（RIHC）in the intraoperative assessments of breast cancer sentinel lymph nodes（SLNs）.Methods：A total of 281 SLNs from89patients of breast cancer were examined in this study.All those SLNs were evaluated with intraoperative touch imprint cytology and rapid immunohistochemistry staining.The RIHC indicator was pan-cytokeratin 19（pan-CK 19）.The two intraoperative methods are compared the results of SLNs metastases by postoperative routine pathological examination.Results：The detection rate of SLNs with TIC was 25.8%（23/89）;the detection rate with touch imprint cytology plus rapid immunohistochemistry staining technique was 36.0%（32/89）,which was much higher than touch imprint cytology（P〈0.05）.The specificity was both100.0%.The sensitivity of TIC and TIC plus RIHC for detecting positive lymph node was 69.7%（23/33）and 97.0%（32/33）,respectively.The sensitivity of TIC plus RIHC was significantly higher than that of TIC（P〈0.001）.The false negative rate of SLNs with TIC was 30.3%（10/33）;the false negative rate with TIC plus RIHC was 3.0%（1/33）,which was lower than TIC（P〈0.001）.Conclusions：Touch imprint cytology plus rapid immunohistochemistry staining can provide a reliable and precise result for the intraoperative assessment of breast cancer SLNs.