Chagpar Anees, Middleton Lavinia P, Sahin Aysegul A, Meric-Bernstam Funda, Kuerer Henry M, Feig Barry W, Ross Merrick I, Ames Frederick C, Singletary S Eva, Buchholz Thomas A, Valero Vincente, Hunt Kelly K
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2005 Apr 15;103(8):1581-6. doi: 10.1002/cncr.20934.
The ideal pathologic assessment of sentinel lymph nodes (SLNs) in patients with breast carcinoma remains controversial. The authors evaluated how detailed assessment of SLNs using immunohistochemistry (IHC) and serial sectioning would affect treatment decisions and outcomes in patients with breast carcinoma who had negative SLNs on standard hematoxylin and eosin staining.
The SLNs from patients who were treated between June 1998 and June, 1999 and who had negative lymph node status determined by hematoxylin and eosin staining (n = 84 patients) were evaluated further with serial sectioning and cytokeratin IHC. Patients were offered adjuvant therapy based on primary tumor factors.
The median patient age was 57 years, and the median tumor size was 1.2 cm. At a median follow-up of 40.2 months, 81 patients (96%) were alive with no evidence of disease, 1 patient was alive with disease, 1 patient had died of disease, and 1 patient had died of other causes. Fifteen patients (18%) had micrometastases identified on IHC. Of the total 84 patients, information regarding adjuvant therapy was not available for 5 patients. Of the remaining 79 patients, 10 patients (13%) were not offered adjuvant chemotherapy but had positive SLN status determined by IHC. SLN status based on IHC evaluation did not correlate with age (P = 0.077), tumor size (P = 0.717), grade (P = 0.148), estrogen receptor status (P = 1.000), or lymphovascular invasion (P = 0.274). Furthermore, IHC-detected positive SLN status did not correlate with distant metastasis (P = 0.372) or overall or distant metastasis-free survival (P = 0.543 and P = 0.540, respectively).
Although the finding of SLN micrometastases by IHC may change management in > 12% of patients, preliminary results suggested that such micrometastases do not affect outcomes significantly.
乳腺癌患者前哨淋巴结（SLN）的理想病理评估仍存在争议。作者评估了使用免疫组织化学（IHC）和连续切片对SLN进行详细评估如何影响标准苏木精和伊红染色下SLN为阴性的乳腺癌患者的治疗决策和预后。
对1998年6月至1999年6月接受治疗且苏木精和伊红染色确定淋巴结状态为阴性的患者（n = 84例）的SLN进行连续切片和细胞角蛋白IHC进一步评估。根据原发肿瘤因素为患者提供辅助治疗。
患者中位年龄为57岁，肿瘤中位大小为1.2 cm。中位随访40.2个月时，81例患者（96%）存活且无疾病证据，1例患者存活但有疾病，1例患者死于疾病，1例患者死于其他原因。15例患者（18%）经IHC检测发现有微转移。84例患者中，5例患者的辅助治疗信息不可用。其余79例患者中，10例患者（13%）未接受辅助化疗，但经IHC确定SLN状态为阳性。基于IHC评估的SLN状态与年龄（P = 0.077）、肿瘤大小（P = 0.717）、分级（P = 0.148）、雌激素受体状态（P = 1.000）或淋巴管浸润（P = 0.274）均无相关性。此外，IHC检测到的SLN阳性状态与远处转移（P = 0.372）或总无远处转移生存率（分别为P = 0.543和P = 0.540）均无相关性。
尽管通过IHC发现SLN微转移可能会改变超过12%患者的治疗方案，但初步结果表明此类微转移对预后无显著影响。
