乳癌高强度聚焦超声治疗后腋窝引流淋巴结的免疫病理形态学观察

Effect of High Intensity Focused Ultrasound Therapy on Axillary Tumor Draining lymph Nodes of Breast Cancer Patients

目的 通过观察乳癌患者肿瘤同侧腋窝引流淋巴结微结构免疫病理形态学的改变 ,分析乳癌病人高强度聚焦超声 (HIFU)治疗后局部引流淋巴结的免疫反应特点 ,进一步揭释HIFU治疗对肿瘤病人抗肿瘤免疫机能的影响。方法 48例女性乳癌病人被分为HIFU治疗组 (HIFU组 ,2 3例 )和常规外科手术组 (对照组 ,2 5例 )。HIFU组在接受HIFU治疗后 7～ 14天进行外科常规乳癌改良根治术 ,对照组仅行乳癌改良根治术。术中收集肿瘤同侧腋窝引流淋巴结。制备 4μm组织切片 ,常规HE染色 ,按照Cottieer等提出的淋巴结免疫形态学参数标准判断 :窦组织细胞反应 (SH )、副皮质区淋巴细胞增生 (PHCL)、皮质区淋巴滤泡增生 (FHCA)。根据DiGiorgio等提出的淋巴结免疫反应分级方法 ,以细胞免疫反应为主型 (CR)、体液免疫反应为主型 (HR)、混合免疫反应增强型 (CR +HR)、无反应型 (R0 )对病人淋巴结免疫状况进行分类统计记录 ,并采用对数似然比检验对两组病人的淋巴结免疫反应状况进行统计学比较。结果 HIFU治疗后乳癌病人腋窝引流淋巴结免疫反应发生率提高 ,反应强度增强 ,呈混合高等级免疫反应。两组比较 ,淋巴结免疫反应状况存在显著差异 (P <0 .0 5 )。结论 HIFU治疗激发机体免疫反应 ,有利于机体抗肿瘤免疫功能的增强。

Objective To observe the morhpologic changes of axillarfy tumor draining lymph nodes in breast cancer patients and to explore the changes of breast cancer patient's anti-cancer immune function.Methods A total of 48 female patients with breast cancer were pathologically diagnosed with needle biopsy.Among them,23 patients underwent HIFU treatment for one or two weeks before modified radical mastectomy(HIFU group).The others were only treated by modified radical mastectomy without any intervention(control group).After operation,the speciemens of the axillary lymph nodes were collected,fixed in 10% neutral formalin,embedded in paraffin,and cut into 0.4 μm-thick slices,then stained by H&E.The immunomorhpologic patterns were histologically studied according to the systems presented by Cottieer etc.and Di Giorgio etc.The differences between the two groups were analyzed by Fisher exact test.Results The immunomorphological patterns in the axillary lymph node of the breast cancer patients in HIFU group mostly showed mixtured high-grade cellular and humeral response.This was significatly different from the control group(P<0.05).Conclusions HIFU therapy on breast cancer patients can activated the host anti-cancer immune response.