Gimbergues P, Dauplat M M, Cayre A, Durando X, Le Bouedec G, Finat-Duclos F, Portefaix G, Kwiatkowski F, Dauplat J, Penault-Llorca F, Tchirkov A
Department of Surgery, Centre Jean Perrin, Clermont-Ferrand, France.
Eur J Surg Oncol. 2007 Feb;33(1):16-22. doi: 10.1016/j.ejso.2006.09.013. Epub 2006 Oct 27.
To evaluate the clinical significance of tumour metastases detected using real-time reverse transcription-PCR (RT-PCR) in sentinel lymph nodes (SLN) of breast cancer patients.
Sixty-seven patients with T1-T2 primary breast cancer were included in a prospective study. SLN were analysed for the presence of metastatic tumour cells using standard histopathology staining, immunochemistry (IHC) and multimarker real-time RT-PCR assay for mammaglobin (MMG), carcinoembryonic antigen (CEA) and cytokeratin-19 (CK19) mRNA expression. Correlations between molecular metastases and traditional clinicopathological prognostic factors, including St Gallen risk categories were studied.
Of the 67 patients, 15 (22.3%) had one or more pathology-positive SLN. Five (9.6%) pathology-negative SLN were positive by IHC and 19 (36.5%) by RT-PCR. Of note, RT-PCR analysis was also positive in all cases with pathology- or IHC-positive SLN. MMG was the most informative tumour marker in the panel. Molecularly detected metastases were significantly associated with intermediate St Gallen risk category (p=0.023).
Molecular staging of SLN using real-time RT-PCR for early breast cancer could serve as a useful complement to standard clinicopathological risk factors. Studies with long-term follow-up are necessary to define the impact of molecular metastases on disease free survival and overall survival.
评估实时逆转录聚合酶链反应（RT-PCR）检测乳腺癌患者前哨淋巴结（SLN）中肿瘤转移的临床意义。
67例T1-T2期原发性乳腺癌患者纳入一项前瞻性研究。采用标准组织病理学染色、免疫化学（IHC）以及针对乳珠蛋白（MMG）、癌胚抗原（CEA）和细胞角蛋白-19（CK19）mRNA表达的多标志物实时RT-PCR检测分析SLN中转移性肿瘤细胞的存在情况。研究分子转移与传统临床病理预后因素之间的相关性，包括圣加仑风险分类。
67例患者中，15例（22.3%）有一个或多个病理阳性的SLN。5例（9.6%）病理阴性的SLN经IHC检测为阳性，19例（36.5%）经RT-PCR检测为阳性。值得注意的是，在所有病理或IHC阳性的SLN病例中，RT-PCR分析也呈阳性。MMG是该检测组中信息量最大的肿瘤标志物。分子检测到的转移与圣加仑中度风险分类显著相关（p=0.023）。
采用实时RT-PCR对早期乳腺癌的SLN进行分子分期可作为标准临床病理风险因素的有益补充。需要进行长期随访研究以确定分子转移对无病生存期和总生存期的影响。
