术中分层冷冻切片在乳腺癌前哨淋巴结活检中的诊断价值  

Diagnostic value of intraoperative frozen section in sentinel lymph node biopsy of breast cancer

作　　者：黄自明[1] 王蓉[1] 郑媛[1] 卢文亮[1] 陈波[1] 魏刚[1] 高丹[1] 薛明兴[1] 叶春梅[1] Zi-ming Huang;Rong Wang;Yuan Zheng;Wen-liang Lu;Bo Chen;Gang Wei;Dan Gao;Ming-xing Xue;Chun-mei Ye(Department of Breast and Thyroid Surgery, Hubei Maternal and Child Health Care Hospital,Wuhan, Hubei 430070, China)

机构地区：[1]湖北省妇幼保健院甲乳外科,湖北武汉430070

出　　处：《中国现代医学杂志》2017年第28期56-60,共5页China Journal of Modern Medicine

基　　金：湖北省自然科学基金(No:2013CFB047)

摘　　要：目的探讨术中应用不同分层冷冻切片检测前哨淋巴结(SLN)的方法在乳腺癌手术治疗中的应用价值。方法 67例乳腺癌患者术中行亚甲蓝示踪并成功行前哨淋巴结活检(SLNB),SLN均行术中冷冻切片HE染色,依次记录单层切片组、3层切片组及6层切片组冷冻病理结果,术后SLN常规HE染色石蜡切片为确诊SLN转移的标准。不同切片方法冷冻病理诊断结果与石蜡切片HE染色结果进行比较分析。结果 67例患者常规石蜡切片结果中19例SLN阳性,3例为SLNB假阴性,假阴性率为13.6%(3/22)。不同切片方法冷冻病理结果与SLN石蜡切片HE染色结果比较:单层切片的敏感性为21.1%(4/19)、符合率为73.1%(49/67)、特异性为100%(45/45);3层切片的敏感性为31.6%(6/19)、符合率为76.1%(51/67)、特异性为97.8%(44/45);6层切片的敏感性为84.2%(16/19)、符合率为91.1%(61/67)、特异性为95.6%(43/45)。敏感性和符合率,6层切片组与3层切片组、单层切片组分别比较,差异有统计学意义(P<0.05),6层切片组高于3层切片组、单层切片组。而单层切片组与3层切片组比较,差异无统计学意义(P>0.05)。结论 SLN术中冷冻病理检查诊断SLN转移可靠而快速,多层切片方法可以提高SLN微小转移灶的检出率,6层切片组冷冻病理检查结果与术后石蜡切片结果接近。Objective To investigate the clinical value of method of detecting sentinel lymph node(SLN)bydifferent frozen sections in the surgical treatment of breast cancer.Methods Sixty-seven breast cancer patientswere given methylene blue and successfully underwent sentinel lymph node biopsy.Intraoperative frozen sectionsof SLN were made and HE staining was performed.The pathological results of single slice,3slice and6slice wererecorded.Postoperative routine HE staining of SLN paraffin sections was performed and considered as the standardof the diagnosis of SLN metastasis.Results of pathological diagnosis of different frozen sections were comparedwith the results of paraffin sections.Results The routine paraffin section results of the67patients revealed positiveSLN in19cases,false negative SLN in3cases,the false negative rate was13.6%(3/22).Comparison of the resultsof different slicing methods of frozen sections with paraffin sections of SLN showed the sensitivity of single slicewas21.1%(4/19),the coincidence rate was73.1%(49/67),the specificity was100%(45/45);the sensitivity of3slicewas31.6%(6/19),the coincidence rate was76.1%(51/67),the specificity was97.8%(44/45);the sensitivity of6slice was84.2%(16/19),the coincidence rate was91.1%(61/67),the specificity was95.6%(43/45).The sensitivityand coincidence rates of the6slice were significantly higher than those of3slice and single slice,the differenceswere significant(P<0.05).The difference between the single slice group and the3slice group were not significant(P>0.05).Conclusions SLN intraoperative frozen pathological diagnosis is a reliable and fast method for diagnosisof SLN metastais.Multilayer section method can improve the detection rate of SLN metastasis,the results of6layerfrozen section is close to postoperative pathological results of paraffin section.

关 键 词：乳腺肿瘤 前哨淋巴结 冷冻切片 病理诊断 

分 类 号：R737.9[医药卫生—肿瘤]