一步核酸扩增和快速直接免疫组化在乳腺癌前哨淋巴结术中的诊断价值  

Diagnostic value of one-step nucleic acid amplification technique and rapid direct immunohistochemistry in sentinel lymph nodes of breast cancer

作　　者：尹明英 李珀 胡鹏然 杨宇石 黄瑾瑾 徐澍[1] YIN Mingying;LI Po;HU Pengran;YANG Yushi;HUANG Jinjin;XU Shu(Department of Pathology,Guizhou Medical University,Guizhou Guiyang 550000,China;Department of Pathology,Affiliated Hospital of Guizhou Medical University,Guizhou Guiyang 550000,China)

机构地区：[1]贵州医科大学病理学教研室,贵州贵阳550000 [2]贵州医科大学附属医院病理科,贵州贵阳550000

出　　处：《现代肿瘤医学》2024年第12期2218-2223,共6页Journal of Modern Oncology

基　　金：贵州省科技计划项目(编号:黔科合成果-LC[2023]030)。

摘　　要：目的:探讨一步核酸扩增(one-step nucleic acid amplification,OSNA)检测技术及快速直接免疫组织化学(rapid direct immunohistochemistry,RDIHC)染色技术在乳腺癌前哨淋巴结(sentinel lymph node,SLN)术中的诊断价值。方法:应用多聚辣根过氧化物酶直接标记的抗体CK和CK19对乳腺癌前哨淋巴结冷冻切片进行RDIHC染色,OSNA检测淋巴结CK19 mRNA表达量,以术后石蜡诊断为金标准,对常规冷冻切片(frozen section,FS)、OSNA及联合RDIHC的冷冻切片(FS+RDIHC)进行评价及比较。结果:67例206枚淋巴结的结果分析,FS+RDIHC准确率(100%)显著高于FS(97.09%,P<0.05)。67例的整体诊断中FS与FS+RDIHC在准确率、特异度、灵敏度、假阴性率以及延迟诊断率无显著差异。对同时进行FS、RDIHC以及OSNA检测的结果分析,OSNA准确率(95.45%)与FS准确率(94.32%)显著低于FS+RDIHC(100%,P<0.05);FS延迟诊断率(4.55%)显著高于OSNA(0)和FS+RDIHC(0,P<0.05)。结论:FS联合RDIHC染色技术可以提高乳腺癌SLN术中诊断准确性,RDIHC染色流程耗时10 min,是检测乳腺癌SLN状态的最佳联合检测方式;OSNA具有高准确率及高灵敏度,OSNA检测流程耗时30~40 min,可以应用于SLN术中诊断。Objective:To investigate the diagnostic value of one-step nucleic acid amplification(OSNA)technique and rapid direct immunohistochemistry(RDIHC)in sentinel lymph node(SLN)of breast cancer.Methods:The antibodies CK and CK19 directly labeled by poly horseradish peroxidase were used to perform RDIHC staining on frozen sections of breast cancer sentinel lymph nodes.At the same time,CK19 mRNA expression in lymph nodes was detected by OSNA.In addition,the post-operative paraffin diagnosis was taken as the gold standard to evaluate and compare the conventional frozen sections(FS),OSNA,and frozen sections(FS+RDIHC).Results:According to the analysis of 67 cases with 206 lymph nodes,the FS+RDIHC accuracy rate(100%)was significantly higher than FS(97.09%,P<0.05).There was no significant difference in accuracy,specificity,sensitivity,false negative rate,and delayed diagnosis rate between FS and FS+RDIHC in the overall diagnosis of 67 cases.As shown by the analysis results of simultaneous FS,RDIHC,and OSNA tests,the OSNA accuracy rate(95.45%)and FS accuracy(94.32%)were significantly lower than FS+RDIHC(100%,P<0.05).The FS delayed diagnosis rate(4.55%)was significantly higher than OSNA(0)and FS+RDIHC(0,P<0.05).Conclusion:FS combined with RDIHC staining technology is conductive to improving the accuracy of diagnosis during SLN surgery for breast cancer.The RDIHC staining procedure takes 10 minutes and is the best joint detection method for detecting breast cancer SLN status.OSNA has high accuracy and high sensitivity.Moreover,the OSNA test process takes 30 to 40 minutes,and can be applied to intraoperative diagnosis of SLN.

关 键 词：乳腺肿瘤 前哨淋巴结 快速直接免疫组化 一步核酸扩增技术 

分 类 号：R737.9[医药卫生—肿瘤]