乳腺癌前哨淋巴结术中分子诊断的价值  

Value of intraoperative GeneSearch^TM BLN assay to detect breast cancer metastases in sentinel lymphnodes

作　　者：孙晓[1] 王永胜[1] 宋现让[2] 仲伟霞[3] 穆殿斌[3] 周长春[2] 魏丽丽[2] 李冬梅[2] 

机构地区：[1]山东省肿瘤医院乳腺病中心,济南250117 [2]山东省肿瘤医院乳腺病中心中心实验室,济南250117 [3]山东省肿瘤医院乳腺病中心病理科,济南250117

出　　处：《中华肿瘤杂志》2011年第2期138-141,共4页Chinese Journal of Oncology

基　　金：中国抗癌协会乳腺癌专业委员会CBCSG-OOIA子项目

摘　　要：目的评价乳腺癌前哨淋巴结（SLN）术中分子诊断的价值。方法选择90例患者行前哨淋巴结活枪术。术中获得的SLN均年直于长轴切割为1．5～3mm组织块，所有组织块均术中行印片细胞学检测，奇数组织块术中行GeneSearch^TM乳腺淋巴结检测，偶数组织块术中快速冰冻病理榆测并且术后行逐层切片病理检测。将BLN检测结果旧病理检测做比较。结果经过10例的学习曲线，BLN检测可以在35min内完成，乳腺球蛋门、角蛋白-19的循环阈值与转移灶大小呈明显的负相关性（Spearman相天系数分别为0．67和0．71）。BLN检测的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为95.6％、93．3％、96．7％、93．3％和96．7％，其敏感性优于快速冰冻病理（P=0．07），鼹著优于印片细胞学（P=0．04）。相对于微转移灶的检测，BLN检测的敏感性显著优于快速冰冻病理及印片细胞学（P=0．03）。结论BLN检测快速，易于操作，具有较高的准确性，其敏感性优于快速病理和印片细胞学，适合在中国进行推广。Objective To evaluate the value of GeneSearchTM BLN assay as an intraoperative diagnostic method of sentinel lymph node metastases in breast cancer patients. Methods Ninety consecutive patients were involved in this study. SLNs were intraoperatively identified and dissected, and then sectioned vertically to the long axis into multiple blocks. The odd blocks were tested by BLN assay and even ones prepared for frozen sectioning （ FS ） , while all blocks were evaluated by touch imprint cytology （TIC）. Post-operatively, residual tissues of the even blocks were assessed by histopathologic examination （4-6 μm thick serial sectioning permanent H＆E slides were performed every 150 μm and one block made 6 slides）. Results BLN assay could be performed within less than 35 rain after learning curve of 10 cases. A correlation was found between cycle time values of mamruaglobin or cytokeratin-19 and size of metastases, with Spearman correlation coefficients of 0.67 and 0.71, respectively. The accuracy, sensitivity, specificity, positive predict value （PPV） and negative predict value （NPV） of the assay were 95. 6% , 93.3% , 96.7% , 93.3% and 96.7% , While FS had tile sensitivity, specificity, PPV, NPV of 76.7% , 100%, 100% , 89.6% , and TIC of 73.3% , 100% , 100% , 88.2% , respectively. The sensitivity of the assay was higher than that of FS （P =0.07）, and was significantly higher than that of FS （P =0.04）. When assessing patients with micro-metastases, the assay had a sensitivity of 85.7% , which was significantly higher than that of FS and TIC （P = 0.03）. Conclusion GeneSearchTM BLN Assay can replace FS and TIC for the intraoperative assessment of SLN.

关 键 词：乳腺肿瘤 前哨淋巴结 分子诊断技术 

分 类 号：R737.9[医药卫生—肿瘤]