乳腺癌前哨淋巴结转移检测方法的研究

目的探讨乳腺癌前哨淋巴结(SLN)活检的可行性、准确性以及比较几种方法对SLN转移灶检出率的差异。方法对86例乳腺癌患者用亚甲蓝示踪行SLN活检,获取的SLN分别进行常规HE染色、连续病理切片、免疫组化测定CK19和MUCI粘蛋白、RT-PCR法测定CK19和MUCI粘蛋白,比较4种方法对SLN转移灶的检出率。结果86例乳腺癌患者中,80例检出SLN,检出率93.0%,共切除151枚SLN。SLN常规HE染色法预测腋窝淋巴结转移状态敏感性94.74%(36/38),准确率97.50%(78/80),假阴性率5.26%(2/38)。常规HE染色诊断检出率46.36%;连续切片诊断检出率54.30%;免疫组化检测检出率56.29%;RT-PCR法CK19、MUCI粘蛋白联合检测检出率73.50%。结论SLN活检可有效判断乳腺癌腋淋巴结转移状态,RT-PCR法检测乳腺癌SLN转移最敏感。

Detection methods of sentinel lymph node metastases in breast cancer

Objective To evaluate the feasibility and accuracy of different methods in detection of sentinel lymph nodes (SLNs) metastases in breast cancer. Methods Eighty-six patients with breast cancer were recruited in the study. Injection of methylene blue and biopsy was applied to detect SLNs. The SLNs were examined with HE staining, serial section, immunohistochemical staining for CK19 and MUCI and RT-PCR determination of CK19 and MUCI mRNA. The detection rates of SLN metastases were compared among those methods. Results One hundred and fifty one SLNs were identified in 80 cases with a detection rate of 93.0%,. The sensitivity was 94.74%(36/38), accuracy rate was 97.50%(78/80)and false negative rate of 5.26% (2/38) by HE staining. The detection rate of HE staining, serial section, immunohistochemistry and RT-PCR was 46.36%, 54.30%, 56.29% and 73.50%, respectively. Conclusion SLN detection can predict the axillary metastasis in patients with breast cancer. Among above 4 methods RT-PCR for CK19 and MUCI has the best sensitivity to identify metastases of SLNs.