目的

探讨术中冰冻切片联合快速免疫组织化学检测对乳腺癌前哨淋巴结(SLN)微转移的诊断价值,分析SLN 微转移与临床各因素的关系。

方法

对43 例乳腺癌患者行前哨淋巴结活检(SLNB),切除SLN 送快速病理学检查。 以100 μm 为间隔,进行连续切片(SS),并做冰冻切片HE 染色及快速免疫组织化学染色检测SLN 微转移[检测广谱细胞角蛋白(pan-CK)及上皮膜抗原(EMA)的表达];采用χ² 检验或连续性校正χ² 检验对定性资料进行统计学分析。

结果

43 例乳腺癌患者成功行SLNB,共检出SLN 100 枚。 4 例冰冻切片HE 染色查见癌转移,39 例HE 染色阴性者继续行快速免疫组织化学染色检出微转移者6 例。 冰冻切片检测SLN 癌转移率为9.3%(4/43),冰冻切片联合术中快速免疫组织化学染色检测SLN 癌转移率为23.3%(10/43)。 两者的灵敏度、特异度、总符合率和假阴性率分别为36.4%/90.9%、100%/100%、83.7%/97.7%、63.6%/9.1%。 SLN 微转移与月经状态、肿瘤分期、组织学类型、肿瘤位置、激素受体状态及人表皮生长因子受体2(HER-2)状态无明显关系(P＞0.05)。

结论

术中冰冻切片联合快速免疫组织化学染色法提高了SLN 微转移的检出率,减少了假阴性率,且安全、快速、花费少,值得在临床推广使用。

Objective

To investigate the diagnostic value of intraoperative frozen sections plus rapid immunohistochemistry staining in detecting sentinel lymph nodes(SLNs)micrometastases of breast cancer, and analyse the relation between SLNs micrometastases and clinical factors.

Methods

Forty-three breast cancer patients underwent sentinel lymph node biopsy (SLNB). The intraoperatively resected SLNs were sent for rapid pathological examination. Serial sections at a 100 μm interval, HE staining of frozen sections and rapid immunohistochemistry staining were done to detect SLNs micrometastases and test the expressions of pan-cytokerain(pan-CK) and epithelial membrane antigen (EMA). Chisquare test or correction chi-square test was used for statistical analysis.

Results

SLNB was successful for the 43 breast cancer patients. A total of 100 SLNs were detected. Four cases were detected with cancer metastases by HE staining of frozen sections. Thirty-nine cases with negative HE staining were continuously detected with rapid immunohistochemistry staining examination, of them 6 were detected with micrometastases. The detection rate of SLNs metastases was 9.3%(4/43)by HE staining of frozen sections, but was 23.3%(10/43) by frozen sections plus intraoperative rapid immunohistochemistry staining. The sensitivity,specificity, coincidence rate and false negative rate for HE staining of frozen sections and frozen sections plus intraoperative rapid immunohistochemistry staining were 36.4% and 90.9%, 100% and 100%, 83.7% and 97.7%, and 63.6% and 9.1%, respectively. There was no significant correlation between the SLNs micrometastases and menstrual status, tumor stage, histological type, tumor location, hormone receptor status and HER-2 status(P＞0.05).

Conclusion

Intraoperative frozen sections plus rapid immunohistochemistry staining can increase the detection rate of SLNs micrometastases and reduce the false negative rate. It is safe, rapid, and low-costly. We recommend this method in clinical application.