Thomsen Jørn Bo, Christensen Rikke Kølby, Sørensen Jens Ahm, Krogdahl Annelise
Department of Plastic Surgery, Odense Uinversity Hospital, Odense C, Denmark.
J Oral Pathol Med. 2007 Aug;36(7):425-9. doi: 10.1111/j.1600-0714.2007.00538.x.
Extended histopathologic work-up has increased the detection of micrometastasis in sentinel lymph nodes in malignant melanoma and breast cancer. The aim of this study was to examine if (A) step-sectioning of the central 1000 microM at 250 microM levels with immunostaining were accurate when compared with (B) step-sectioning and immunostaining of the entire sentinel lymph node at 250 microM levels.
Forty patients with T1/T2 cN0 oral cancer were enrolled. Three patients were excluded. In one patient no sentinel lymph node was identified. The remaining two had unidentified sentinel lymph nodes due to lymphoscintigraphic and surgical sampling error. The central 1000 microM of 147 sentinel lymph nodes were step-sectioned in 250-microm intervals and stained with hematoxylin and eosin and CK-KL1. All lymph nodes were recorded as negative or positive for macrometastases or micrometastases. After inclusion of the last patient the residual tissue of the lymph nodes was totally step-sectioned at 250-microm intervals and re-classified. The tumor deposits were divided into macrometastases and micrometastases and ITC.
Method (A) upstaged 17 lymph nodes and 11 patients compared with method (B), which upstaged 22 lymph nodes and 11 patients. Seven of the patients with positive lymph nodes did not change stage. However, four lymph nodes changed from micrometastases to macrometastases. One patient changed from a micrometastasis to four micrometastases. One pN2c patient with bilateral micrometastases did not change stage, but an additional ipsilateral lymph node with a micrometastasis was identified.
Larger tumor deposits and more metastases are identified by more extensive sectioning of the sentinel lymph nodes. None of the patients was false-negative due to histopathologic sampling error, but the results indicate that central step-sectioning of the central 1000 microM cannot completely be relied upon for accurate staging of the patients.
扩大的组织病理学检查提高了恶性黑色素瘤和乳腺癌前哨淋巴结微转移的检出率。本研究的目的是检验：（A）将中央1000微米以250微米间隔进行阶梯状切片并免疫染色，与（B）将整个前哨淋巴结以250微米间隔进行阶梯状切片并免疫染色相比，是否准确。
纳入40例T1/T2 cN0期口腔癌患者。排除3例患者。1例患者未发现前哨淋巴结。另外2例因淋巴闪烁显像和手术取样误差未找到前哨淋巴结。对147个前哨淋巴结的中央1000微米以250微米间隔进行阶梯状切片，并用苏木精-伊红染色和CK-KL1染色。所有淋巴结均记录为有无大转移或微转移。纳入最后1例患者后，将淋巴结的剩余组织以250微米间隔进行完全阶梯状切片并重新分类。肿瘤沉积物分为大转移、微转移和孤立肿瘤细胞。
与方法（B）相比，方法（A）使17个淋巴结和11例患者分期上调，方法（B）使22个淋巴结和11例患者分期上调。7例淋巴结阳性患者分期未改变。然而，4个淋巴结从微转移变为大转移。1例患者从1个微转移变为4个微转移。1例pN2c期双侧微转移患者分期未改变，但发现另外1个同侧微转移淋巴结。
对前哨淋巴结进行更广泛的切片可发现更大的肿瘤沉积物和更多转移灶。没有患者因组织病理学取样误差出现假阴性，但结果表明，对中央1000微米进行中央阶梯状切片不能完全依赖于准确的患者分期。
