乳腺癌前哨淋巴结术中快速冷冻切片的临床意义研究

目的研究乳腺癌前哨淋巴结术中快速冷冻切片对腋窝淋巴结状态的预测价值及其临床意义。方法用美兰作为示踪剂对2006～2011年合肥市第二人民医院165例临床分期为T1～2 N0M0乳腺癌患者进行前哨淋巴结活检,所有患者均同时进行腋窝淋巴结清扫。术中前哨淋巴结冷冻切片,并与石蜡切片及免疫组化CK19检测作比较。结果 165例患者中有160例找到前哨淋巴结,活检成功率97.0%(160/165)。前哨淋巴结数量是1～4枚,平均1.4枚。腋窝淋巴结6～22枚,平均每例12.3枚。160例活检成功的患者中,41例冷冻快速切片报告有癌转移,其中27例(65.9%)患者腋窝淋巴结有转移。119例冷冻快速切片报告为阴性患者中,术后免疫组化CK19证实3例(2.5%)有微小转移(1 mm),其中有2例发现有腋窝淋巴结转移,组织学类型均为浸润性微乳头状癌。前哨淋巴结术中快速冷冻切片报告的准确性为98.1%(157/160),敏感性95.3%(41/44),特异度为100%(116/116)。结论前哨淋巴结术中快速冷冻切片有较高的准确性,对腋窝淋巴结状态有很好预测价值,浸润性微乳头状癌患者易出现前哨淋巴结假阴性,免疫组化染色可提高准确性。

Clinical significances for frozen sections of sentinel lymph no in breast cancer

Objective To discuss the predictive value of froze sections of sentinel lymph node(SLN) for axillary lymph node(ALN) status and clinical significances in breast cancer.Methods 165 breast cancer patients were enrolled in the second people’s hospital of Hefei during 2006 to 2011 years(T1-2N0M0).Sentinel lymph node biopsy(SLNB) were performed using methylene blue injected at the primary breast cancer site followed by a complete axillary lymph node dissection(ALND).SLN was examined by frozen sections intraoperatively.All of the axillary lymph nodes were evaluated with HE and immunohistochemical stains for CK19.Results In total,160 patients were(97.0%) successfully identified by SLN biopsy.The mean number of SLNs removed and axillary lymph node wer 1.4(range,1-4) and12.3(range,6-22),respectively.Among the 160 patients,metastasis in SLNs were revealed by frozen-section histology in 41 patients,and 27(65.9%) patients with metastasis in ALN.119 patients had negative SLNs revealed by frozen-section histology,and 3 of them were confirmed with metastasis using immunohistochemical stains for CK19 with diameter less than 1mm.Two patients were also with metastasis in ALN,and both of them were invasive micropapillary carcinoma.The precision of SLN examination by using frozen sections intraoperatively was 98.1%(157/160),the sensitivity was95.3%(41/44),and the spectivity was 100%(116/116).Conclusion Frozen sections of SLN can accurately predict ALN status in most of breast cancer patients.False negative is decreased by using immunohistochemical staining.