术中分层冷冻切片在乳腺癌前哨淋巴结活检中的诊断价值

摘要

Objective To investigate the clinical value of method of detecting sentinel lymph node (SLN) by different frozen sections in the surgical treatment of breast cancer. Methods Sixty-seven breast cancer patients were given methylene blue and successfully underwent sentinel lymph node biopsy. Intraoperative frozen sections of SLN were made and hE staining was performed. The pathological results of single slice, 3 slice and 6 slice were recorded. postoperative routine hE staining of SLN paraffin sections was performed and considered as the standard of the diagnosis of SLN metastasis. Results of pathological diagnosis of different frozen sections were compared with the results of paraffin sections. Results The routine paraffin section results of the 67 patients revealed positive SLN in 19 cases, false negative SLN in 3 cases, the false negative rate was 13.6% (3/22). Comparison of the results of different slicing methods of frozen sections with paraffin sections of SLN showed the sensitivity of single slice was 21.1% (4/19), the coincidence rate was 73.1% (49/67), the specificity was 100% (45/45); the sensitivity of 3 slice was 31.6% (6/19), the coincidence rate was 76.1% (51/67), the specificity was 97.8% (44/45); the sensitivity of 6 slice was 84.2% (16/19), the coincidence rate was 91.1% (61/67), the specificity was 95.6% (43/45). The sensitivity and coincidence rates of the 6 slice were significantly higher than those of 3 slice and single slice, the differences were significant (P < 0.05). The difference between the single slice group and the 3 slice group were not significant (P > 0.05). Conclusions SLN intraoperative frozen pathological diagnosis is a reliable and fast method for diagnosis of SLN metastais. Multilayer section method can improve the detection rate of SLN metastasis, the results of 6 layer frozen section is close to postoperative pathological results of paraffin section.%目的 探讨术中应用不同分层冷冻切片检测前哨淋巴结(SLN)的方法 在乳腺癌手术治疗中的应用价值.方法67例乳腺癌患者术中行亚甲蓝示踪并成功行前哨淋巴结活检(SLNB),SLN均行术中冷冻切片HE染色,依次记录单层切片组、3层切片组及6层切片组冷冻病理结果 ,术后SLN常规HE染色石蜡切片为确诊SLN转移的标准.不同切片方法冷冻病理诊断结果与石蜡切片HE染色结果进行比较分析.结果67例患者常规石蜡切片结果中19例SLN阳性,3例为SLNB假阴性,假阴性率为13.6%(3/22).不同切片方法冷冻病理结果与SLN石蜡切片HE染色结果比较:单层切片的敏感性为21.1%(4/19)、符合率为73.1%(49/67)、特异性为100%(45/45);3层切片的敏感性为31.6%(6/19)、符合率为76.1%(51/67)、特异性为97.8%(44/45);6层切片的敏感性为84.2%(16/19)、符合率为91.1%(61/67)、特异性为95.6%(43/45).敏感性和符合率,6层切片组与3层切片组、单层切片组分别比较,差异有统计学意义(P<0.05),6层切片组高于3层切片组、单层切片组.而单层切片组与3层切片组比较,差异无统计学意义(P>0.05).结论 SLN术中冷冻病理检查诊断SLN转移可靠而快速,多层切片方法可以提高SLN微小转移灶的检出率,6层切片组冷冻病理检查结果与术后石蜡切片结果接近.