乳腺癌前哨淋巴结的定位活检和免疫组织化学检测

目的　对应用HE染色和不同角蛋白免疫组化染色检测乳腺癌前哨淋巴结 (sentinellymphnode ,SLN)转移进行评价。方法　 71例女性乳腺癌患者 ,腋窝均未扪及肿大腋淋巴结 ,分别采用染料、核素及联合应用染料与核素的方法进行淋巴示踪 ,其中 6 0例找到SLN ,切除SLN后行腋淋巴结切除术。对SLN和其它腋淋巴结的病理组织学特点进行分析比较 ,并对SLN分别以抗CKAE1/AE3 、抗CK7、抗CK2 0 用Envision法进行免疫组化染色。结果　在腋淋巴结阳性病人中SLN的转移率为 72 % ( 2 6 / 36 ) ,非SLN的转移率为 16 % ( 39/ 2 4 8) (P <0 .0 0 1)。对SLN进行角蛋白免疫组化染色 ,可使 5 .0 %的病人的病理分期提高。应用抗CK7、抗CK2 0 、抗CKAE1/AE3 染色的灵敏度分别为 10 0 %、3.9%、10 0 % ,特异度分别为 10 0 %、10 0 %、10 0 % ,阳性预测值分别为10 0 %、10 0 %、10 0 % ,阴性预测值分别为 10 0 %、74 .5 %、10 0 %。结论　抗CK7和抗CKAE1/AE3 用于检测乳腺癌前哨淋巴结肿瘤转移是敏感的指标 ,而抗CK2 0 对乳腺癌上皮细胞的敏感度差 ,不宜用于乳腺癌微转移的检测。对SLN应用免疫组化染色 ,可提高病理分期的准确性。

Biopsy and Immunohistochemical Characters of Sentinel Lymph Nodes in Patients with Breast Cancer

Purpose To evaluate H.E. stain and immunohistochemical stain with different cytokeratine(CK) to examine the sentinel lymph node(SLN) metastasis in breast cancer. Methods 71 female breast cancer patients with no palmed axillary lymph node underwent SLN localization using blue dye,technetium labeled sulfur colloid or combination of them.SLN was found in 60 cases.Axillary dissection was done after SLN had been removed.The pathologic characters of SLNs and other axillary nodes were analyzed.SLNs were stained with immunohistochemical method by anti CK AE1/AE3 ,anti CK 7,anti CK 20 . Results The metastasis rate of SLN is 72%(26/36) and that of non SLN is 16%(39/248) in patients with positive axillary node(s) ( P <0.001).Tumor stage of 3 patients was raised related to cytokeratine immunohistochemical stain.Sensitivity of anti CK 7,anti CK 20 ,anti CK AE1/AE3 is 100%,3.9%,100%. Specificity is 100%,100%,100%.Positive predictive value is 100%,100%,100%. Negative predictive value is 100%,74.5%,100%. Conclusions anti CK AE1/AE3 and anti CK 7 can examine the metastasis of SLN sensitively.The sensitivity of anti CK 20 is poor. Immunohistochemical stain of SLN can increase the accuracy of pathologic stage of breast cancer.