乳腺癌前哨淋巴结活检及其微转移检测临床意义.docVIP

乳腺癌前哨淋巴结活检及其微转移检测临床意义 　 作者：庄亚强， 莫军扬， 任占平， 梁志东 【摘要】 【目的】 探讨美蓝法示踪和定位行乳腺癌前哨淋巴结活检（SLNB）的可行性及其临床意义，并探索常规病理检查（HE染色）、免疫组化染色（IHC染色）及逆转录聚合酶链反应（RT-PCR）技术对判断前哨淋巴结（SLN）微转移灶的价值。【方法】 66例乳腺癌患者，用美蓝示踪行SLNB，对SLN及腋窝淋巴结（ALN）进行HE染色；随机选取40例SLN进一步行细胞角蛋白19（CK19）的IHC染色及RT-PCR检测；比较3种方法对SLN微转移灶检出的敏感性、准确率及假阴性率的差异。【结果】 66例中，美蓝示踪成功检出63例，检出率达95.5%。IHC与RT-PCR比较无差异，而与HE比较差异有显著性。【结论】 美蓝法SLNB也有很高的检出率，由于常规病理检查对微转移的诊断率低，结合IHC及RT-PCR检测能则有效判断乳腺癌腋淋巴结转移状态，提高SLN中微转移的检出率，降低假阴性率。 【关键词】 前哨淋巴结活检； 免疫组织化学； RT-PCR； CK19； 乳腺癌 Clinical Value of Sentinel Lymph Node Biopsy and Detection of Micrometastasis in Abstract:【Objective】 To investigate the possibility that methylene blue being used on sentinel lymph node biopsy (SLNB) in breast cancer and the value of hematoxylin and eosin staining (HE staining), immunohistochemistry (IHC) and RT-PCR in judging micrometastasis in sentinel lymph node (SLN).【Methods】 Sixty-six patients with breast cancer were injected methylene blue to detect the axillary SLN. The SLN and axillary lymph node were examined with HE staining. Random 40 cases were evaluated with IHC examination of cytokine 19 (CK 19) and RT-PCR. The accuracy, sensitivity, and false-negative ratio of HE staining, IHC examination and RT-PCR were compared to see if they had any discrepancy. 【Result】 SLN were successfully identified in 63 (95.5%) of 66 patients. IHC had no discrepancy compared with RT-PCR in the accuracy, sensitivity, and false-negative ratio, but it had obvious discrepancy with HE staining.【Conclusion】 Methylene blue can be used on the SLNB in breast cancer successfully. Since the sensitivity of HE staining was low, combined examination of IHC and RT-PCR would evaluate the micrometastasis more effectively, raise the efficiency of estimate of metastasis in SLN, and reduce the false-negative ratio. Key words: sentinel lymph node biopsy; immunohistochemistry; RT-PCR; cytokine 19; breast cancer 目前的研究证实，对腋窝淋巴结转移阴性的乳腺癌患者行腋窝淋巴结清扫（ALND）， 并不能提高其总体生存率和延长无病生存期[1]，其术后的并发症也一直是临床外科治疗的一大难题。近年来，通过前哨淋巴结活检（sentine