Branagan G, Hughes D, Jeffrey M, Crane-Robinson C, Perry P M
Department of Surgery, Queen Alexandra Hospital, Cosham, Portsmouth, UK.
Br J Surg. 2002 Jan;89(1):86-9. doi: 10.1046/j.0007-1323.2001.01970.x.
Sentinel node biopsy affords the opportunity of focused examination of lymph nodes, including the use of the reverse transcriptase-polymerase chain reaction (RT-PCR). The mammaglobin gene is expressed by breast cancers but has not been detected in histologically normal lymph nodes. This study compared mammaglobin RT-PCR with routine histology in the sentinel and non-sentinel nodes of patients with breast cancer.
Patients with breast cancer underwent tumour excision, sentinel node biopsy and axillary dissection. All nodes were bisected and half of each node was sent for routine histological examination. The other half underwent RNA extraction and mammaglobin RT-PCR.
Sentinel node biopsy was successful in 50 (96 per cent) of 52 patients. Mammaglobin expression was detected in nine (8 per cent) of 119 histologically negative sentinel nodes (Clopper-Pearson 95 per cent confidence interval (c.i.) 4 to 14 per cent) and in 13 (5 per cent) of 247 histologically negative non-sentinel nodes (95 per cent c.i. 3 to 9 per cent). Mammaglobin expression was detected in four (13 per cent) of 31 patients with histologically negative sentinel nodes (95 per cent c.i. 4 to 30 per cent) and in six (14 per cent) of 44 patients with histologically negative non-sentinel nodes (95 per cent c.i. 5 to 27 per cent). The false-negative rate for sentinel node biopsy was zero using histology results and 10 per cent using RT-PCR.
RT-PCR screening of axillary nodes for mammaglobin expression increased the detection of breast cancer metastases compared with routine histology.
前哨淋巴结活检为淋巴结的重点检查提供了机会，包括使用逆转录酶-聚合酶链反应（RT-PCR）。乳腺珠蛋白基因在乳腺癌中表达，但在组织学正常的淋巴结中未被检测到。本研究比较了乳腺癌患者前哨淋巴结和非前哨淋巴结中乳腺珠蛋白RT-PCR与常规组织学检查的结果。
乳腺癌患者接受肿瘤切除、前哨淋巴结活检和腋窝清扫。所有淋巴结均一分为二，每个淋巴结的一半送去进行常规组织学检查。另一半进行RNA提取和乳腺珠蛋白RT-PCR检测。
52例患者中有50例（96%）前哨淋巴结活检成功。在119个组织学检查阴性的前哨淋巴结中有9个（8%）检测到乳腺珠蛋白表达（克洛珀-皮尔逊95%置信区间（c.i.）为4%至14%），在247个组织学检查阴性的非前哨淋巴结中有13个（5%）检测到乳腺珠蛋白表达（95% c.i.为3%至9%）。在31例组织学检查阴性的前哨淋巴结患者中有4例（13%）检测到乳腺珠蛋白表达（95% c.i.为4%至30%），在44例组织学检查阴性的非前哨淋巴结患者中有6例（14%）检测到乳腺珠蛋白表达（95% c.i.为5%至27%）。以前哨淋巴结活检的组织学结果计算假阴性率为零，以RT-PCR结果计算为10%。
与常规组织学检查相比，通过RT-PCR检测腋窝淋巴结中的乳腺珠蛋白表达可增加乳腺癌转移灶的检出率。
