目的

探讨更为合理的乳腺癌前哨淋巴结（sentinel lymph node，SLN）微转移（micrometastasis，MMs）的病理检测方法和临床意义。

方法

对50例常规病理证实阴性的109枚SLN以100 μm间距行多层切片（step section，SS），给予HE染色及广谱细胞角蛋白单抗AE1/AE3免疫组化（immunohistochemical，IHC）检测，比较不同的检测方法。

结果

50 例SLN通过SS-HE法和联合IHC法检测分别检出新的转移灶13 例和17 例，阳性检出率分别提高26%和34% ；联合IHC新增SLN阳性检出4 例，提高检出率8% （ P﹥0.05）；全部1166 层切片中，SS病理检测出阳性层面57 层（4.9% ），联合IHC新增阳性层面28层（2.4% ）（ P﹤0.05）；按100、200、300、400、500 μm不同间距进行SS对MMs的检出率分别是26% 、20% 、20% 、16% 、14% ；联合IHC 不同间距对MMs 的检出率分别是34% 、32% 、30% 、32% 、30% 。

结论

SS检测对于微小病灶的检出具有显著优势，联合IHC显著提高阳性层数的检出，但对SLN检出率的提高的差异无统计学意义。 按100、200、300、400、500 μm不同间距进行SS对MMs的检出率无统计学差异。

Objective

To explore a more rational pathological detection method for micrometastasis of sentinel lymph nodes （ SLNs） and its clinical significance.

Methods

Fifty women with breast cancer were included.109 SLNs of the 50 patients were identified negative by standard hematoxylin and eosin （HE） staining examination carried out on initial levels.All SLNs were step sectioned （SS） atl00μm interval and for each level both HE stain examination and immunohistochemical detection with AE1/AE3 were performed.Then different detection methods were analyzed.

Results

In the 50 negative SLN patients， 13 and 17 cases were upstaged in node status by using SS-HE method and combined IHC method separately， therefore the positive detecting rate was increased by 26% and 34% ， respectively.Four cases were upstaged in node status via using SS combined with IHC method， the positive detecting rate was increased by 8% （P﹥0.05）.In all 1166 slides， 57 slides （4.9% ） were abnormal by SS， and 28 （2.4% ） slides were abnormal by SS combined with IHC （ P﹤0.05）.The rate of detection of MMs in 100-， 200-， 300-，400-， and 500 μm intervals was 26% ，20% ， 20% ， 16% ， and 14% by SS with HE stain respectively， and 34% ， 32% ， 30% ， 32% ， and 30% by the method of SS combined with IHC.

Conclusions

SS could significantly increase the detection of occult tumor deposits in negative SLN with routinely histological exam； IHC could increase the detection of abnormal slides； SS in different intervals does not add significance.