King Tari A, Ganaraj Archana, Fey Jane V, Tan Lee K, Hudis Clifford, Norton Larry, Cody Hiram S, Borgen Patrick I
Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Cancer. 2004 Sep 1;101(5):926-33. doi: 10.1002/cncr.20517.
The incidence of immunohistochemistry (IHC)-detected epithelial cell displacement in sentinel lymph node (SLN) biopsy is unknown. In the current study, we address this question by examining the pattern of SLN involvement in patients undergoing prophylactic mastectomy (PM) at Memorial Sloan-Kettering Cancer Center (New York, NY).
Between January 1999 and January 2003, 5275 patients underwent SLN biopsy. Unilateral or bilateral PM with SLN biopsy was performed in 143 (2.7%) patients, representing 163 PM cases.
Occult carcinoma was identified in 13 of 163 (8.0%) PM specimens. Two patients with occult invasive carcinoma had positive SLNs (hematoxylin and eosin). In the remaining 150 PM cases without occult carcinoma (130 patients), 89% underwent IHC analysis of the SLNs. Of these 130 patients, 43 (33%) had one or more prior biopsies in their "cancer-free" breast, a median of 43 days (range, 3-314 days) before PM. A total of 310 SLNs were examined by IHC (mean, 2.3 lymph nodes per PM case). Only 1 of 130 (0.8%) patients without occult carcinoma had an IHC-positive SLN. This patient had Stage IIIC carcinoma of the contralateral breast. IHC-positive SLNs were not identified in any of the 43 patients with a history of prior biopsy. Therefore, only 1 IHC-positive SLN was detected in 310 (0.3%) lymph nodes examined.
IHC-positive cells in SLNs are rare in the absence of cancer and are not the result of previous breast instrumentation. Although the prognostic significance of IHC-positive cells remains controversial, the current study suggests that they are not random events.
前哨淋巴结（SLN）活检中免疫组化（IHC）检测到的上皮细胞移位发生率尚不清楚。在本研究中，我们通过研究纽约纪念斯隆凯特琳癌症中心接受预防性乳房切除术（PM）患者的SLN受累模式来解决这个问题。
1999年1月至2003年1月期间，5275例患者接受了SLN活检。143例（2.7%）患者进行了单侧或双侧PM并同时进行了SLN活检，共163例PM病例。
163例PM标本中有13例（8.0%）发现隐匿性癌。2例隐匿性浸润性癌患者的SLN呈阳性（苏木精和伊红染色）。在其余150例无隐匿性癌的PM病例（130例患者）中，89%对SLN进行了IHC分析。在这130例患者中，43例（33%）在其“无癌”乳房中曾有过一次或多次活检，在PM前的中位时间为43天（范围3 - 314天）。共对310个SLN进行了IHC检查（平均每个PM病例2.3个淋巴结）。130例无隐匿性癌的患者中只有1例（0.8%）的SLN为IHC阳性。该患者对侧乳房为IIIC期癌。43例有既往活检史的患者中未发现IHC阳性的SLN。因此，在检查的310个淋巴结中仅检测到1个IHC阳性的SLN（0.3%）。
在无癌症的情况下，SLN中IHC阳性细胞很少见，且不是先前乳房检查的结果。尽管IHC阳性细胞的预后意义仍存在争议，但本研究表明它们并非随机事件。
