术中冰冻切片联合快速免疫组织化学染色检测乳腺癌前哨淋巴结微转移的临床研究  

Clinical research of intraoperative frozen sections plus rapid immunohistochemistry staining in detection of sentinel lymph node micrometastasis of breast cancer

作　　者：席晨辉[1] 庄大勇[1] 郑鲁明[1] 周鹏[1] 段松建[1] 柳晓建[1] 贺青卿[1] 

机构地区：[1]济南军区总医院甲状腺乳腺外科,济南250031

出　　处：《中华乳腺病杂志（电子版）》2011年第4期10-15,共6页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：中国博士后科学基金资助(20080431408)

摘　　要：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100μm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SLN100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 mierometastases and test the expressions of pan- cytokerain（pan-CK） and epithelial membrane antigen （EMA）. Chi-square 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 were36. 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 immtmohistoehenfistry 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 appl

关 键 词：乳腺肿瘤 前哨淋巴结活检 免疫组织化学 微转移 

分 类 号：R737.9[医药卫生—肿瘤]