乳腺癌内乳淋巴结活检的临床研究

背景与目的:内乳淋巴结(intemal mammary node,IMN)是乳腺癌重要的转移途径之一,其状况将影响乳腺癌患者的分期、治疗、预后及疗效评价,本研究旨在探讨内乳前哨淋巴结活检(intemal mammary sentinel node biopsy,IMSNB)和经肋间IMN第Ⅰ～Ⅳ肋间活检、以及IMN微转移灶检测在临床应用的意义.方法:在行常规乳腺癌切除术中,采用核素示踪法经肋间隙行IMSNB,然后对患侧第Ⅰ～Ⅳ肋间的IMN均行活检(经肋间隙,非扩大根治术),所有IMN均行常规单一切面HE染色病理检查,阴性病例的IMN采用多层切片加免疫组化的方法检测微转移.结果:全组38例病人中发现内乳前哨淋巴结(internal mammary sentinel node,IMSN)17例,占44.7%,均成功行IMSNB,其中4例IMSN常规病理阳性,1例IMSN发现微转移,2例发现孤立的肿瘤细胞群,10例为阴性,均与对应病例经第Ⅰ～Ⅳ肋间IMN活检的病理结果一致;无发现IMSN 21例,占55.3%,经第Ⅰ～Ⅳ肋间IMN活检,常规病理阳性5例,阴性16例,未发现微转移.结论:对发现IMSN者,IMSN能够准确评价IMN状况,但对无发现IMSN者,尤其是对IMN转移可能性大者,应经肋间隙行IMN第Ⅰ～Ⅳ肋间活检,以减少假阴性的发生;多层切片加免疫组化技术有助于IMN微转移灶的检出.

Internal mammary node biopsy in breast cancer

BACKGROUND & OBJECTIVE: Internal mammary node (IMN) is an important lymphatic metastasis pathway in breast cancer. Its status may affect the staging, treatment, prognosis, and outcome evaluation of breast cancer. This study was to discuss the significance of internal mammary sentinel node biopsy (IMSNB), IMN dissection via intercostal spaces, and IMN micro-metastasis detection in breast cancer. METHODS: A total of 38 consecutive patients with primary breast cancer received mastectomy in Cancer Center of Sun Yat-sen University from Dec. 2004 to May 2006. IMSNB was guided by radionuclide tracking method, followed by IMN dissection via the first to forth intercostal spaces. After routine pathologic examination for all the removed IMNs, the negative ones were submitted to further micro-metastasis detection by immunohistochemistry (IHC) combined with multilayer section technique. RESULTS: Of the 38 patients, 17 (44.7%) had internal mammary sentinel nodes (IMSNs). Of the 17 patients, 4 had IMSN metastasis detected by routine pathology, 1 had IMSN micro-metastasis, and 2 had isolated tumor cells in IMSNs, while the remaining 10 had no metastasis. The results of IMSNB were accordant to the results of IMN dissection. Of the 21 (55.3%) patients had no IMSN identified, 5 had IMN metastasis by routine pathology after IMN dissection, and 16 had no metastasis. CONCLUSIONS: When IMSNs are identified, they can predict the IMN status well. While for the patients had no IMSN identified, IMN dissection should be performed, especially for those more likely to have metastasis, to decrease the false negative rate. IHC combined with multilayer section technique tends to search out micro-metastasis.