乳腺癌前哨淋巴结及骨髓中微转移的联合检测

目的：探讨乳腺癌患者联合进行前哨淋巴结（SLN）及骨髓微转移检测的可行性及临床价值。方法：^99mTc-SC作为示踪剂，进行前哨淋巴结活检，使用流式细胞仪检测前哨淋巴结中的微转移，并使用EMA和CK19的免疫组化染色，对腋窝淋巴结常规检查阴性的乳腺癌患者进行骨髓微转移的检测。结果：13例腋窝淋巴结常规HE检查阴性的患者中，流式细胞仪发现6例患者前哨林巴结中存在微转移（46．2％），SLN微转移的发生率与肿块大小相关（P＝0．027）。在腋窝淋巴结常规HE检查阴性的20例乳腺癌患者中，9例患者的骨髓中存在EMA或CK阳性的细胞（45％），骨髓微小转移与肿瘤ER（P＝0．045），OR（0＝0．010）的状态相关。10例同时进行骨髓及SLN微转移检测的患者，4例pN0(i )，4例pM0(i )，2例pN0(i )Mo(i )。结论：骨髓及淋巴结中的微转移可能与患者预后差相关。

Combined Detection for Micrometastasis in Sentinel Lymph Node and in Bone Marrow in Patients with Breast Cancer

To evaluate the feasibility of combined detection for micrometastasis in sentinel lymph node(SLN) and in bone marrow, and its clinical significance. Sentinel lymph node biopsy was performed with the injection of 99mTc_SC. Flow cytometry was used to detect micrometastasis. We also detected disseminated tumor cells in bone marrow with immunocytochemical staining of EMA and CK19 in lymph node negative patients. Six out of 13 patients(46.2%) with negative lymph node were found to have micrometastasis in SLN, which was significantly correlated with tumor size(P=0.027). With the immunocytochemical staining of EMA and CK19 for bone marrow smear, we detected micrometastasis in nine out of 20 (45%) breast cancer patients, which was significantly correlated with ER, PR status. Among 10 patients combined detected,4 patients were pNo(i+), 4 patents were pMo(i+), and 2 patients were pNo(i+)Mo(i+). [Conclusion] Micrometastasis in SLN and bone marrow maybe correlate with worse prognosis.