Paish E C, Green A R, Rakha E A, Macmillan R D, Maddison J R, Ellis I O
Breast Cancer Pathology Research Group, Department of Histopathology, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
J Clin Pathol. 2009 Jul;62(7):617-23. doi: 10.1136/jcp.2009.065219. Epub 2009 Mar 19.
A better understanding of the biology of nodal metastatic disease is of indisputable value. Three-dimensional (3D) serial section alignment and reconstruction techniques can be used for visualisation of nodal metastasis and could provide better understanding of disease growth patterns.
19 tumour-involved sentinel nodes (SLNs) from breast cancer patients were serially sectioned, immunohistochemically stained, and digitally scanned. Digital image alignment and voxel-based rendering was used to construct informative 3D visual representations of metastatic tumour distribution within involved nodes.
The 3D reconstruction technique was successful and informative. The reconstructions of all 19 SLNs enabled the metastatic tumour cells to be viewed infiltrating normal SLN tissue from all angles. Metastases were present at the afferent lymphatic pole in 17/19 cases, confined to the afferent pole only in 7 cases, located at the efferent pole in 12/19 cases, and efferent pole only in just 2 cases. Finally, this study made the novel observation that metastatic growth occurs in three distinct patterns: sinusoidal, nodular and diffuse.
This methodology provides improved understanding of metastatic disease development and potentially could be used to develop strategies to improve techniques for its routine detection. Further studies are required in order to evaluate the prognostic and biological significance of the growth patterns identified.
更好地了解淋巴结转移疾病的生物学特性具有无可争议的价值。三维（3D）连续切片对齐和重建技术可用于可视化淋巴结转移，并能更好地理解疾病的生长模式。
对19例乳腺癌患者的肿瘤累及前哨淋巴结（SLN）进行连续切片、免疫组化染色和数字扫描。利用数字图像对齐和基于体素的渲染技术，构建受累淋巴结内转移瘤分布的信息丰富的3D视觉表现。
3D重建技术成功且信息丰富。所有19个SLN的重建都能从各个角度观察到转移瘤细胞浸润正常SLN组织的情况。17/19例患者的转移灶位于输入淋巴管极，仅7例局限于输入极，12/19例位于输出极，仅2例位于输出极。最后，本研究有一个新发现，即转移生长以三种不同模式发生：窦状、结节状和弥漫性。
该方法能更好地理解转移疾病的发展，潜在地可用于制定策略以改进其常规检测技术。为了评估所确定的生长模式的预后和生物学意义，还需要进一步研究。
