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目的探讨更为合理的乳腺癌前哨淋巴结(sentinel lymph node,SLN)微转移(micrometastasis,MMs)的病理检测方法和临床意义。方法对50例常规病理证实阴性的109枚SLN以100μm间距行多层切片(step section,SS),给予HE染色及广谱细胞角蛋白单抗AE1/AE3免疫组化(immunohisto-chemical,IHC)检测,比较不同的检测方法。结果 50例SLN通过SS-HE法和联合IHC法检测分别检出新的转移灶13例和17例,阳性检出率分别提高26%和34%;联合IHC新增SLN阳性检出4例,提高检出率8%(P>0.05);全部1166层切片中,SS病理检测出阳性层面57层(4.9%),联合IHC新增阳性层面28层(2.4%)(P<0.05);按100、200、300、400、500μm不同间距进行SS对MMs的检出率分别是26%、20%、20%、16%、14%;联合IHC不同间距对MMs的检出率分别是34%、32%、30%、32%、30%。结论 SS检测对于微小病灶的检出具有显著优势,联合IHC显著提高阳性层数的检出,但对SLN检出率的提高的差异无统计学意义。按100、200、300、400、500μm不同间距进行SS对MMs的检出率无统计学差异。
Objective To investigate the more reasonable method and clinical significance of pathological detection of sentinel lymph node (SLN) micrometastasis (MMs) in breast cancer. Methods Fifty-nine SLNs with negative histopathology were examined by HE staining and immunocytochemistry (immunhisto-chemical (IHC)) of the cytokeratin monoclonal antibody (AE1 / AE3) Detection, comparison of different detection methods. Results In 50 cases of SLN, 13 new cases and 17 cases of new metastases were detected by SS-HE method and combined IHC method respectively. The positive detection rate of SLN was increased by 26% and 34% respectively. In addition, (P> 0.05). In all the 1166-slice sections, 57 (4.9%) were positive for SS and 28 (2.4%) for positive IHC The detection rates of SS to MMs with different pitches of 100, 200, 300, 400 and 500μm were 26%, 20%, 20%, 16% and 14%, respectively. The detection rates of MMs with different intervals of IHC were 34% , 32%, 30%, 32%, 30%. Conclusion SS detection has obvious advantages for the detection of small lesions, combined with IHC significantly increased the detection of positive layers, but there was no significant difference in the detection rate of SLN. There was no significant difference in the detection rate of SS to MMs at different distances of 100, 200, 300, 400 and 500μm.