Newman Erika L, Kahn Amina, Diehl Kathleen M, Cimmino Vincent M, Kleer Celina A, Chang Alfred E, Newman Lisa A, Sabel Michael S
Department of Surgery, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan 48109, USA.
Breast J. 2006 Jan-Feb;12(1):53-7. doi: 10.1111/j.1075-122X.2006.00179.x.
More detailed examination of the sentinel lymph node (SLN) in breast cancer has raised concerns about the clinical significance of micrometastases, specifically isolated tumor cells detected only through immunohistochemical (IHC) staining. It has been suggested that these cells do not carry the same biologic implications as true metastatic foci and may represent artifact. A retrospective institutional review board-approved review was conducted on clinically node-negative breast cancer patients who underwent SLN biopsy (SLNB) between 1997 and 2003. Retrospective analysis of tumor characteristics and the method of the initial diagnostic biopsy were correlated with the presence and nature of metastatic disease in the SLN. Of 537 SLNBs, 123 (23%) were hematoxylin-eosin (H&E) positive. SLN positivity strongly correlated with tumor size (p<0.001) and tumor grade (p=0.025), but not with the method of biopsy (needle versus excisional biopsy). Prior to July 2002, we routinely evaluated H&E-negative SLNs with IHC (n=381). Of the 291 H&E-negative patients, 26 had IHC-only detected micrometastases (9%). The likelihood of detecting IHC-only metastases did not correlate with tumor size or grade, but was significantly higher in patients undergoing excisional biopsy than core needle biopsy. While the method of biopsy has no demonstrable effect on the likelihood of finding metastases in the SLN by routine serial sectioning and H&E staining, it may significantly impact the likelihood of finding micrometastases by IHC. IHC should not be used routinely in the evaluation of the SLN and caution should be used when basing treatment decisions (completion axillary lymph node dissection or adjuvant therapy) on IHC-only detected micrometastases.
对乳腺癌前哨淋巴结（SLN）进行更详细的检查引发了人们对微转移临床意义的关注，特别是仅通过免疫组织化学（IHC）染色检测到的孤立肿瘤细胞。有人认为这些细胞与真正的转移灶没有相同的生物学意义，可能是人为现象。对1997年至2003年间接受前哨淋巴结活检（SLNB）的临床淋巴结阴性乳腺癌患者进行了一项经机构审查委员会批准的回顾性研究。对肿瘤特征和初始诊断活检方法进行回顾性分析，并与前哨淋巴结转移疾病的存在和性质相关联。在537例前哨淋巴结活检中，123例（23%）苏木精-伊红（H&E）染色呈阳性。前哨淋巴结阳性与肿瘤大小（p<0.001）和肿瘤分级（p=0.025）密切相关，但与活检方法（针吸活检与切除活检）无关。在2002年7月之前，我们常规用免疫组织化学方法评估H&E染色阴性的前哨淋巴结（n=381）。在291例H&E染色阴性的患者中，26例（9%）仅通过免疫组织化学检测到微转移。仅通过免疫组织化学检测到转移的可能性与肿瘤大小或分级无关，但在接受切除活检的患者中明显高于粗针活检患者。虽然活检方法对通过常规连续切片和H&E染色在前哨淋巴结中发现转移的可能性没有明显影响，但它可能会显著影响通过免疫组织化学发现微转移的可能性。免疫组织化学不应常规用于前哨淋巴结的评估，在基于仅通过免疫组织化学检测到的微转移做出治疗决策（腋窝淋巴结清扫或辅助治疗）时应谨慎。
