【摘要】 目的探讨各种检测方法对乳腺癌前哨淋巴结(SLN)转移灶的检出效率,以及转移灶类型与临床病理特征的关系。方法收集2015年12月至2017年6月139例乳腺癌SLN活检病例,比较术中冰冻HE连续切片、印片细胞学、术后石蜡HE切片及CK19免疫组化染色对SLN的检出效率,分析SLN转移灶与乳腺癌临床病理特征的关系。结果 139例患者中,发现宏转移36例、微转移(MM) 10例和孤立肿瘤细胞簇(ITC) 11例。术中冰冻病理显示假阴性11例,包括宏转移1例、MM 3例及ITC 7例,假阴性率为19. 3%(11/57)。术中冰冻HE连续切片显示宏转移检出率高(35例),检出MM 7例、ITC 4例;细胞印片检出宏转移29例,MM和ITC均显示阴性;术后石蜡HE切片仅显示3例ITC,另8例ITC在CK19免疫组化染色中检出。年龄、肿瘤部位、SLN总数、病理类型、组织学分级、激素受体状态、HER-2状态、是否三阴性乳腺癌及Ki-67指数与SLN转移灶无关(P> 0. 05);而肿瘤大小和脉管癌栓与SLN转移灶有关(P <0. 05)。结论冰冻HE连续切片辅助印片细胞学可以提高术中乳腺癌SLN转移灶的检出效率,免疫组化染色提高了术后ITC的检出效率。原发病灶> 2 cm、脉管癌栓阳性提示乳腺癌SLN出现转移的风险升高。更多还原

【Abstract】 Objective To explore the detection efficiency of sentinel lymph node( SLN) metastases of breast cancer by various detection methods,and the relationship between SLN metastasis and clinicopathological characteristics. Methods From December2015 to June 2017,139 cases of breast cancer patients with sentinel lymph node( SLN) biopsy specimens were collected. The detection efficiency of intraoperative frozen HE serial section,imprint cytology and postoperative paraffin HE sections and CK19 immunohistochemical stain was compared. The relationship of SLN metastasis with clinicopathological characteristics of breast cancer was analyzed. Results In 139 cases of breast cancer patients,macrometastasis was found in 36 cases,micrometastasis( MM) in 10 cases and isolated tumor cell( ITC) in 11 cases. There were 11 false negative cases of frozen pathology during operation,including 1 case of macrometastasis,3 cases of MM and 7 cases of ITC. The false negative rate was 19. 3%( 11/57). Frozen HE serial sections showed high detection rate of macrometastasis( 35 cases),7 cases of MM and 4 cases of ITC. 29 cases of macrometastasis were detected by imprint cytology,and MM and ITC were negative. Postoperative paraffin HE sections showed only 3 cases of ITC,and 8 cases of ITC were detected by CK19 immunohistochemical staining. Age,tumor location,number of SLN,pathological type,histological grade,hormone receptor state,HER-2 state,triple negative breast cancer and Ki-67 index were not related to SLN metastasis,but related to tumor size and vascular cancer embolus( P < 0. 05). Conclusion Intraoperative frozen HE serial sections with the addition of imprint cytology can improve the detection efficiency of SLN metastasis in breast cancer during surgery,and immunohistochemistry can improve the detection efficiency of ITC after operation. Primary lesion over 2 cm and positive intravascular thrombus suggest increased risk of SLN metastasis in breast cancer.更多还原