乳腺癌前哨淋巴结冰冻切片假阴性分析  

Occult metastasis of sentinel lymph node in breast cancer:clinical and pathological analyses of fourteen cases

作　　者：杜红雁 雷莹 郭祎男 DU Hong-yan;LEI Ying;GUO Yi-nan(Department of Pathology,Northwest Women and Children’s Hospital,Xi'an 710061,China;Department of Breast Surgery,Northwest Women and Children’s Hospital,Xi'an 710061,China)

机构地区：[1]西北妇女儿童医院病理科,西安710061 [2]西北妇女儿童医院乳腺外科,西安710061

出　　处：《诊断病理学杂志》2021年第10期840-842,847,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨乳腺癌前哨淋巴结术中冰冻无明确转移,但冰余组织中查见转移癌的原因并分析其临床病理特征。方法2014-12—2020-01于西北妇女儿童医院甲乳科术前或术中明确为乳腺癌,且术中同时行腋窝前哨淋巴结活检术的病例共640例,选取其中前哨淋巴结冰冻切片未查见明确转移癌,但冰余组织中查见转移癌的病例,分析前哨淋巴结冰冻活检术诊断不足的原因。结果收集符合上述要求的病例共14例,其中宏转移1例,微转移11例,孤立肿瘤细胞2例。14例乳腺癌中浸润性导管癌12例,其中1例伴有神经内分泌分化,浸润性小叶癌1例,导管-小叶混合癌1例。结论术中冰冻评估前哨淋巴结癌转移的方法,由于转移癌的隐匿性和制片技术的时限性和局限性难以避免诊断不足的情况,影像学无明确提示作用。Objective To investigate the causes of metastasis in sentinel lymph node of breast cancer without definite metastasis and to analyze its clinicopathological features.Methods From November 2014 to January 2020,640 cases of axillary sentinel lymph node biopsy were carried out before or during operation in the Department of Breast Cancer,Northwest Women and Children’s Hospital.Sentinel lymph node frozen section was not found in 14 cases;however,metastatic carcinomas were found in remaining tissue from frozen sections.The reasons for the insufficient diagnosis in frozen sections of sentinel lymph node biopsy were analyzed.Results A total of 14 cases were collected,including macrometastasis on 1 case,micrometastasis in 11 cases,and isolated tumor cells in 2 cases.There were 12 cases of invasive ductal carcinoma in 14 cases of breast cance,including 1 case with neuroendocrine differentiation,1 case of invasive lobular carcinoma and 1 case of mixed ductal and lobular carcinoma.Conclusion The intraoperative frozen evaluation of sentinel lymph node metastasis is difficult to avoid the underdiagnosis due to the occult nature of metastatic carcinoma and the time and technique limitations.Imaging does not seem to have a significant role in diagnostic indication.

关 键 词：乳腺癌 前哨淋巴结 隐匿转移 冰冻切片 

分 类 号：R730.267[医药卫生—肿瘤]