目的评价核素淋巴显像和γ线探测仪(γ探针法)定位前哨淋巴结(SLN)的临床价值,并评价HE染色和免疫组织化学分析(IHC)联合应用对淋巴结中微转移灶检出的作用.方法我们对42名乳腺癌患者进行了前瞻性的研究.在肿瘤周围注射99Tcm-右旋糖酐之后,进行核素淋巴显像.在术中用手持γ探针对前哨淋巴结进行定位切除,同时完整地切除腋窝淋巴结(ALN).所有切除的淋巴结都先进行常规的HE染色.对经过前哨淋巴结HE染色没有发现有转移的患者,再同时进行HE染色和免疫组织化学分析(IHC).结果在42名乳腺癌患者中,定位并切除了39名患者的前哨淋巴结.根据前哨淋巴结的病理检查判断腋窝淋巴结状况,其灵敏度、特异性及准确性分别为92.9%(13/14)、 100%(25/25)和97.4%(38/39).HE染色和免疫组织化学分析相结合发现了3个前哨淋巴结(2名患者)中有微转移灶,而在相应的非前哨淋巴结(NSLN)中则没有发现微转移灶.结论核素淋巴显像和γ探针法能准确地定位乳腺癌的前哨淋巴结.HE染色和免疫组织化学分析相结合可以提高乳腺癌前哨淋巴结中微转移灶的检出率.乳腺癌前哨淋巴结的病理检查不仅能反应腋窝淋巴结的情况,而且对乳腺癌的分期与治疗有着重要的指导意义.%Objectives To determine the clinical value of sentinel lymph node (SLN) detection by lymphoscintigraphy and gamma ray detecting probe (GDP) and to assess the value of hematoxylin and eosin (H&E) staining combined with immunohistochemistry (IHC) analysis for detecting micrometastasis in lymph nodes (LNs).Methods Forty-two patients with breast cancer were included in this study. 99 Tcm-dextran was injected peritumourally. Lymphoscintigraphy images were obtained in anterior and lateral views. SLNs were removed with the aid of GDP during surgery. A standard axillary lymph nodes (ALNs) dissection was performed. All lymph nodes were first analyzed by HE staining. When all of the SLNs in a patient were negative, the ALNs were subjected to additional HE staining combined with IHC analysis.Results SLNs were successfully detected and removed in 39 (92.9%) of the 42 patients. The sensitivity, specificity and accuracy of SLN biopsy were 92.9% (13 in 14), 100% (25 in 25) and 97.4% (38 in 39) respectively. Additional HE staining combined with IHC analysis of the ALNs detected micrometastasis in 3 SLNs (2 cases), but there were no positives in the non-sentinal lymph nodes (NSLNs).Conclusions This study suggests that lymphoscintigraphy and GDP may be used to detect SLN. Additional HE staining combined with IHC analysis of the ALNs may help predict micrometastasis. Biopsy of SLN may be an accurate method for staging breast cancer.
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