Hsieh P P, Ho W L, Yeh D C, Liu T J, Wu C C, Lin J H, Wang S J
Department of Pathology, Taichung Veterans General Hospital, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 2000 Oct;63(10):744-50.
Intraoperative lymphatic mapping and identification of the first draining lymph node (the sentinel lymph node) may allow some patients with breast cancer to avoid the morbidity of formal axillary clearance. The aim of this study was to determine the accuracy of sentinel lymph node (SLN) biopsy in predicting axillary nodal involvement.
From August, 1998 until July, 1999, 41 patients with clinically node-negative breast cancer underwent SLN biopsy that was immediately followed by axillary lymph node dissection. If the SLN section was found free of metastasis by routine hematoxylin and eosin staining (H&E), then an additional four sections of the SLN were cut and examined for the presence of tumor cells by H&E staining (three sections) and by cytokeratin immunohistochemical staining (IHC) (one section). If the SLN had metastatic cells and the other remaining nonsentinel axillary lymph nodes were free of metastases by routine H&E staining, then an additional three sections of the nonsentinel axillary lymph nodes were cut and examined for the presence of tumor cells by H&E staining.
The 41 patients had a mean of 2.2 sentinel (range, 1-7) and 14.6 nonsentinel (range, 5-32) lymph nodes excised per patient. Routine H&E staining identified 13 patients (31.7%) with SLN metastases and 28 patients (68.3%) with tumor-free SLNs. Applying IHC and the additional three sections stained with H&E to these tumor-free SLNs showed one additional patient with sentinel node metastasis. The conversion rate from being a sentinel node-negative patient to a sentinel node-positive patient was 3.6% (1/28). Overall, SLN metastases were detected in 14 (34.1%) of the 41 patients. The SLNs were negative in 27 patients (65.9%), two of whom had at least one positive nonsentinel lymph node each (7.4% "skip" metastasis). Biopsy of SLNs was 92.6% accurate in predicting the absence of nonsentinel nodal metastasis (p=0.001).
Our results suggest that formal axillary lymph node dissection may need only be performed in SLN-positive patients. Nonetheless, further experience and refinement are needed to perfect this technique.
术中淋巴管造影及识别首站引流淋巴结（前哨淋巴结）或许能使部分乳腺癌患者避免进行正规腋窝清扫术带来的并发症。本研究旨在确定前哨淋巴结活检在预测腋窝淋巴结受累情况方面的准确性。
从1998年8月至1999年7月，41例临床腋窝淋巴结阴性的乳腺癌患者接受了前哨淋巴结活检，随后立即进行腋窝淋巴结清扫术。若通过常规苏木精-伊红染色（H&E）发现前哨淋巴结切片无转移，则额外切取该前哨淋巴结的4个切片，通过H&E染色（3个切片）和细胞角蛋白免疫组化染色（IHC）（1个切片）检查是否存在肿瘤细胞。若前哨淋巴结有转移细胞，且其余非前哨腋窝淋巴结通过常规H&E染色无转移，则额外切取3个非前哨腋窝淋巴结切片，通过H&E染色检查是否存在肿瘤细胞。
41例患者平均每人切除2.2个前哨淋巴结（范围为1 - 7个）和14.6个非前哨淋巴结（范围为5 - 32个）。常规H&E染色发现13例患者（31.7%）前哨淋巴结有转移，28例患者（68.3%）前哨淋巴结无肿瘤。对这些前哨淋巴结无肿瘤的患者应用免疫组化及额外3个H&E染色切片检查，又发现1例前哨淋巴结转移患者。前哨淋巴结阴性患者转变为前哨淋巴结阳性患者的转化率为3.6%（1/28）。总体而言，41例患者中有14例（34.1%）检测到前哨淋巴结转移。27例患者（65.9%）的前哨淋巴结为阴性，其中2例患者各自至少有1个非前哨淋巴结阳性（“跳跃”转移率为7.4%）。前哨淋巴结活检在预测非前哨淋巴结无转移方面的准确率为92.6%（p = 0.001）。
我们的结果表明，或许仅需对前哨淋巴结阳性患者进行正规腋窝淋巴结清扫术。尽管如此，仍需要更多经验和改进来完善这项技术。
