Cohen Cynthia, Alazraki Naomi, Styblo Toncred, Waldrop Sandra M, Grant Sandra F, Larsen Travis
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Appl Immunohistochem Mol Morphol. 2002 Dec;10(4):296-303. doi: 10.1097/00129039-200212000-00002.
Sentinel lymph node sampling has become an alternative to axillary lymph node dissection to provide prognostic and treatment information in breast cancer patients. The role of immunohistochemistry has yet to be established. A total of 241 sentinel lymph nodes (in 270 slides) from 91 patients with invasive carcinoma (73 ductal, 9 lobular, 8 mixed lobular/ductal, 1 NOS) were studied for presence of macrometastases (> 0.2 cm), identified in hematoxylin and eosin sections, and occult metastases (micrometastases [< or = 0.2 cm], clusters of cells, isolated carcinoma cells), identified only by immunohistochemistry. Intraoperative touch preparations, frozen sections, seven hematoxylin and eosin levels (L1-L7), and two AE1-3 cytokeratin immunohistochemistries (L1, L4-5) of the entire bisected or trisected sentinel lymph node were examined. Thirty-one (34%) patients had 50 positive sentinel lymph nodes. Twenty-six (33%) sentinel lymph nodes had metastatic carcinoma (11 macrometastases, 11 micrometastases, 3 clusters of cells, 1 isolated carcinoma cells) by touch preparations, frozen sections, and one hematoxylin and eosin (L1). Thirty-eight (43%) were positive by AE1-3 immunohistochemistry (L1) (11 macrometastases, 8 micrometastases, 13 clusters of cells, 6 isolated carcinoma cells), significantly more than by touch preparations, frozen sections, hematoxylin and eosin L1, or hematoxylin and eosin L2-7. Cytokeratin immunostain on L4-5 demonstrated 31 (34%) positive sentinel lymph nodes, a similar frequency to cytokeratin immunostain on L1. Size of sentinel lymph node metastasis did not correlate with size, histologic grade, or type of primary breast carcinoma. AE1-3 (L1) immunohistochemistry is highly sensitive in delineating sentinel lymph node metastasis, especially clusters of cells and isolated carcinoma cells. The prognostic significance of clusters of cells and isolated carcinoma cells and the value of AE1-3 immunohistochemistry on frozen sections need to be determined.
前哨淋巴结取样已成为腋窝淋巴结清扫术的替代方法,用于为乳腺癌患者提供预后和治疗信息。免疫组织化学的作用尚未确立。对91例浸润性癌患者(73例导管癌、9例小叶癌、8例小叶/导管混合癌、1例未特指类型)的241个前哨淋巴结(载于270张切片)进行研究,以检测苏木精-伊红切片中确定的大转移灶(>0.2 cm)以及仅通过免疫组织化学确定的隐匿转移灶(微转移灶[≤0.2 cm]、细胞簇、孤立癌细胞)。对整个二分或三分的前哨淋巴结进行术中触摸涂片、冰冻切片、七个苏木精-伊红水平(L1-L7)以及两种AE1-3细胞角蛋白免疫组织化学检测(L1、L4-5)。31例(34%)患者有50个前哨淋巴结阳性。通过触摸涂片、冰冻切片以及一个苏木精-伊红水平(L1),26个(33%)前哨淋巴结有转移癌(11个大转移灶、11个微转移灶、3个细胞簇、1个孤立癌细胞)。38个(43%)通过AE1-3免疫组织化学(L1)呈阳性(11个大转移灶、8个微转移灶、13个细胞簇、6个孤立癌细胞),显著多于通过触摸涂片、冰冻切片、苏木精-伊红L1或苏木精-伊红L2-7检测出的阳性数。L4-5水平的细胞角蛋白免疫染色显示31个(34%)前哨淋巴结阳性,与L1水平的细胞角蛋白免疫染色频率相似。前哨淋巴结转移灶的大小与原发性乳腺癌的大小、组织学分级或类型无关。AE1-3(L1)免疫组织化学在确定前哨淋巴结转移方面高度敏感,尤其是细胞簇和孤立癌细胞。细胞簇和孤立癌细胞的预后意义以及冰冻切片上AE1-3免疫组织化学的价值有待确定。