免疫组织化学和RT-PCR法检测乳腺癌骨髓和前哨淋巴结微小转移的临床研究  

Detection of micrometastases in bone marrow and sentinel lymph node of breast cancer patients by immunohistochemistry and RT-PCR

作　　者：赵佳[1] 刘晓安[1] 王水[1] 刘力嘉[1] 

机构地区：[1]南京医科大学第一附属医院普外,江苏南京210029

出　　处：《现代肿瘤医学》2006年第7期813-816,共4页Journal of Modern Oncology

基　　金：江苏省卫生厅重大科研资助项目135工程[No.(2001)31]

摘　　要：目的探讨免疫组织化学(IHC)和RT-PCR法检测乳腺癌骨髓和前哨淋巴结(SLN)微小转移的灵敏度及临床意义。方法留取乳腺癌改良根治术腋窝淋巴结HE染色证实阴性的病人的胸骨骨髓血和SLN,分别采用IHC和RT-PCR方法检测其微小转移情况。结果62例中,骨髓样本RT-PCR检测15例阳性表达,其中9例IHC检测也为阳性,二者结果有较好一致性(kappa=0.6945),检出率有统计学差异(P=0.0412);SLN样本RT-PCR法有13例KT19mRNA表达,其中7例IHC检出KT19阳性细胞,二者结果一致性较好(kappa=0.6483),检出率有统计学差异(P=0.0412);骨髓和SLN同时表达KT19mRNA仅3例,无显著相关(P=0.796);原发肿瘤大小和骨髓KT19mRNA表达率有关联(P=0.003)。结论常规检查未发现远处和腋窝淋巴结转移,骨髓和SLN可检出微小转移,RT-PCR较IHC更灵敏,肿瘤大小与骨髓微小转移有关联。由于骨髓和腋窝淋巴结微小转移不一定同步出现,选用灵敏方法对不同组织同时进行检测可能更具临床价值。Objective： To study the value of immunohistochemistry （ IHC ） and RT - PCR in the detection of micrometastases in bone marrow and sentinel lymph node （SLN） samples from breast cancer patients. Methods：Micrometastases were detected by IHC and RT - PCR in both bone marrow and SLN from 62 breast cancer patients whose axil- lary lymph nodes were negative for HE - stain. Results： Comparing different methods in detection of 62 bone marrow , 15 were RT - PCR positive and 9 were IHC positive. Agreement of the results between PT - PCR and IHC was good （kappa = 0.6945 ）and there was significant difference in detective rate between these two methods statistically（P =0.0412）. In SLN samples,13 were RT- PCR positive, while 7 were IHC positive. Agreement between PT PCR and IHC was good（kappa =0.6483） and significant difference was also found in detective rate between these two methods（P =0. 0412）. Three of 62 paired bone marrow and SLN samples were detected both positive by RT- PCR, which indicated that bone marrow micrometastases did not always accompany SLN micrometastases （P = 0.796）. In addition, a correlation was showed statistically between KT19mRNA expression in bone marrow and primary tumor size（P =0.003）. Conclusion： Micrometastases can be detected in bone marrow and SLN from patients who have no distant metastases by regular examination and no axillary lymph node metastases by HE - staining. RT - PCR is more sensitive than IHC in detecting micrometastases. Because the bone marrow micrometastases and axillary nodes micrometastses are not present simultaneously, combining test of multiple indicators will be more accurate and effective.

关 键 词：骨髓 前哨淋巴结 微小转移 乳腺肿瘤 免疫组织化学 RT—PCR 

分 类 号：R737.9[医药卫生—肿瘤]