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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 4 2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 4 2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 )、10 0 % (2 5 / 2 5 )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
Objective To evaluate the clinical value of radionuclide imaging and γ-ray detector (SLN) in the localization of sentinel lymph node (SLN), and to evaluate the correlation between HE staining and immunohistochemical analysis (IHC) in the detection of micrometastases in lymph nodes Role. Methods We conducted a prospective study of 42 breast cancer patients. Lymphoscintigraphy was performed after 99Tcm dextran injection around the tumor. Sentinel lymph nodes were resected with a hand-held γ-probe during operation, and axillary lymph nodes (ALNs) were completely removed. All resected lymph nodes were routinely HE stained. No metastasis was detected by HE staining of the sentinel lymph nodes followed by simultaneous HE staining and immunohistochemical analysis (IHC). Results In 42 breast cancer patients, sentinel lymph nodes were localized and resected in 39 patients. The sensitivity, specificity and accuracy of axillary lymph node status were 92 9% (13/14), 100% (25/25) and 97 4% (38/39), respectively, according to the pathological examination of sentinel lymph node. The combination of HE staining and immunohistochemical analysis revealed micrometastases in 3 sentinel lymph nodes (2 patients), whereas no micrometastases were found in the corresponding non-sentinel lymph nodes (NSLN). Conclusion Lymphoscintigraphy and γ-probe method can accurately locate sentinel lymph nodes in breast cancer. The combination of HE staining and immunohistochemical analysis can improve the detection rate of micrometastases in sentinel lymph node of breast cancer. Breast cancer sentinel lymph node biopsy can not only reflect the situation of axillary lymph nodes, but also for the staging and treatment of breast cancer has an important guiding significance