连续切片联合免疫组化染色在临床Ⅰ、Ⅱ期乳腺癌前哨淋巴结隐性转移检测中的应用  

Application of serial sections and immunohistochemical staining in detection of occult metastases in sentinel lymph node of stage I II breast cancer

作　　者：张春丽[1] 刘珺[2] 杨敏[2] 张根花[2] 

机构地区：[1]浙江省中医院病理科,杭州310006 [2]浙江省立同德医院

出　　处：《浙江医学》2012年第12期986-989,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科研基金项目（2009A033）

摘　　要：目的 探讨连续切片联合免疫组化染色在临床Ⅰ、Ⅱ期乳腺癌前哨淋巴结（SLN）隐性转移检测中的应用.方法 对43例临床Ⅰ、Ⅱ期乳腺癌患者行SLN亚甲蓝示踪法活检,行SLN活检和腋窝淋巴结清扫,对常规HE染色病理诊断阴性的SLN以100μm间距行连续切片后HE（SS HE）及CK19、SBEM、EpCAM免疫标记染色（SS HE＋IHC）,确定检测隐性转移的最佳间距及最佳免疫标记.结果 检出SLN者39例（72枚）,每例患者1～4枚,平均1.8枚;检出非SLN 694枚,每例患者10～19枚,平均17.8枚.最大剖面HE染色阳性12例（27.9%）,其中2例为微转移,CK19、SBEM、EpCAM阳性17例（39.5%）;最大剖面HE阴性者通过SS HE检出隐性转移5例,其中微转移3例.SLN阴性的55枚淋巴结SS HE检出隐性转移5枚（9.0%）,间距为100、200、300、400、500μm时SS HE＋IHC隐性淋巴结转移的检出率分别为9.0%、7.3%、7.3%、3.6%、3.6%,间距200、300μm与400、500μm的差异有统计学意义（P＜0.05）.结论 应用连续切片结合免疫组化染色可以提高0.2～2mm的微转移检测率,从而提高临床分期准确率,对后期治疗具有重要的指导意义.Objective To evaluate the application of serial sections and immunohistochemical staining for breast sentinel lymph node （SLN） biopsy in detection of occult metastases of breast cancer. Methods Forty three patients with stage I , II breast cancer underwent SLN methylene blue tracer biopsy, outpost of the lymph node biopsy （of SLNB） and axillary lymph node dissection （of ALND）. Negative SLN diagnosed by conventional HE staining were sliced with 100 μm space for serial sections, then HE（SS HE） and CK19, small breast epithelial mucin（SBEM）, EpCAM immune labeling staining （SS＋IHC） were applied to determine the optimal spacing for detecting occult metastases and the best immune markers. Results Thirty nine SLN cases were successfully detected in 43 patients with a success rate of 90.7%; among them 12 cases were positive in the largest section of HE staining of 72 SLN, including 2 cases of micrometastasis with a positive rate of 27.9%; the rates of 17 CK19, SBEM, EpCAM positive cases increased to 39.5%; 5 cases were detected to have occult metastases in the negative largest section of HE by the SS HE, including 3 cases of micrometastasis. The spacing were 100, 200, 300,400 and 500 tJ m in 55 negative conventional HE staining SLN, the rates of occult metastases detected by SS HE and IHC were 9.0%, 7.3%, 7.3%, 3.6% and 3.6%. There was no significant difference in the rates of occult metastases detection when comparing the spacing of 200,300 p m with the spacing of 100tJm （P 〉0.05）, and when comparing to, the spacing of 400μm, 500μm there was significant difference （P〈0.05）. Conclusion The application of serial section and IHC can increase the rate of 0.2-2mm micrometastasis detection and improve the accuracy of clinical staging and the guidance for post-treatment.

关 键 词：乳腺癌 前哨淋巴结 微转移 乳腺小粘蛋白 

分 类 号：R737.9[医药卫生—肿瘤]