印片细胞学联合冷冻切片术中诊断乳腺癌前哨淋巴结的研究  

Combination of frozen section and touch imprint cytology for the intraoperative diagnosis of sentinel lymph node in breast cancer

作　　者：杨耿侠[1] 王永胜[1] 陆作为[1] 穆殿斌[1] 王爱兰[1] 仲伟霞[1] 

机构地区：[1]山东省肿瘤医院乳腺病中心,济南250117

出　　处：《肿瘤研究与临床》2008年第12期809-811,819,共4页Cancer Research and Clinic

摘　　要：目的对乳腺癌前哨淋巴结活组织检查（SLNB）术中诊断常用的方法印片细胞学（TIC）及冷冻切片（FS）术中联合应用的价值进行评估。方法150例患者的400枚前哨淋巴结（SLN），将其中352枚SLN沿长轴对分，两切面分别印片，行术中TIC及FS诊断，其余48枚较小的SLN仅行FS诊断，结果与术后病理进行比较。结果55例患者的89枚SLN为阳性。TIC及FS特异度均为100％。按SLN数目统计，TIC和FS术中诊断的敏感度分别为71．9％（64／89）和83．1％（74／89）（P〉0．05）；两者联合诊断的敏感度为96．6％（86／89），显著高于FS和TIC单独诊断的敏感度（均P〈0．001）。按患者数目统计，TIC及FS术中诊断的敏感度分别为80．0％（44／55）及81．8％（45／55）（P〉0．05），两者联合诊断的敏感度为94．5％（52／55），显著高于FS和TIC单独诊断的敏感度（均P〈0．001）。结论联合应用FS及TIC进行SLN术中诊断具有较高的敏感度和特异度，能够满足临床需求，可以有效地避免二次手术。Objective Frozen section （FS） and touch imprint cytology （TIC） were common methods for intraoperative evaluation of sentinel lymph node （SLN） biopsy in breast cancer, with low sensitivity when used separately. The purpose of this study was to evaluate the value of combination of these two techniques. Methods This study included 400 sentinel nodes from 150 patients with breast cancer. 352 sentinel nodes were bisected along the long axis. Each sectioned surface of SLN was imprinted onto the surface of a slide and was analyzed by cytologist; meanwhile SLN were analyzed with intraoperative FS. The other 48 SLN were only analyzed with intraoperative FS due to their small size. Results of intraoperative FS and TIC were compared with final pathology. Results Eighty-nine positive SLN from 55 patients were identified by final pathology. The specificity of FS and TIC were both 100 %. According to the number of SLN, the sensitivity of TIC and FS was 71.9 % （64/89） and 83.1% （74/89）, respectively （P 〉0.05）. The sensitivity of TIC compared with FS was 96.6 % （86/89）, significantly higher than that of TIC and FS separately （both P 〈0.001）. According to the number of patients, the sensitivities of TIC and FS were 80.0 % （44/55） and 81.8 % （45/55）, respectively （P 〉 0.05）. The sensitivity of TIC compared with FS was 94.5 % （52/55）, significantly higher than that of TIC and FS separately （both P 〈0.001）. Conclusion Combination of FS and TIC for the intraoperative diagnosis of SLN biopsy in breast cancer was reliable, with high sensitivity and specificity, and could avoid the second axillary operation efficiently.

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 细胞学制备技术 冷冻切片 

分 类 号：R737[医药卫生—肿瘤]