Department of Dermatology, Venerology and Allergology, Georg August University of Goettingen, Goettingen, Germany.
Mod Pathol. 2009 Dec;22(12):1622-7. doi: 10.1038/modpathol.2009.137. Epub 2009 Oct 2.
The optimal processing for the pathology of sentinel lymph nodes of patients with melanoma is still a matter of debate. We compared two protocols of sentinel lymph node processing, which were consecutively applied. For the first protocol, the sentinel lymph nodes were cut into 1-2 mm thick slices. From each slice, 12 microtome sections were stained (multiple slices protocol). For the second protocol, which is a modification of the recent European Organisation for Research and Treatment of Cancer protocol, the sentinel lymph nodes were bivalved. Five consecutive series of microtome sections, with gaps of 50 microm between them, were prepared from each cut surface (bivalving protocol). H&E and immunohistochemical staining were integral elements of both protocols. A total of 584 sentinel lymph nodes (1.8+/-0.9 per patient) were examined. The percentages of micrometastases (29 versus 27%) and of capsular naevi (13 versus 15%) detected were very similar for both protocols. As shown by multivariate logistic regression, Breslow thickness (P=0.003) and younger age (P=0.01) correlated with nodal metastasis. The type of histological preparation, ulceration and sex were not significant. The multiple slices protocol produced, on average, 4 paraffin blocks and 46 microtome sections per node. The bivalving protocol constantly produced 2 paraffin blocks and 42 microtome sections. For technical processing, the multiple slices protocol required, on average, 38 min per sentinel lymph node, whereas the bivalving protocol required 55 min. Both protocols yielded excellent detection rates with a similar amount of work being required on the part of the pathologist. Compared with the bivalving protocol, the multiple slices protocol was less labor intensive for the technical staff.
对于黑色素瘤患者前哨淋巴结的病理处理，哪种方法最优仍存在争议。我们比较了两种连续应用的前哨淋巴结处理方案。第一种方案是将前哨淋巴结切成 1-2mm 厚的切片，每一切片取 12 张切片进行染色（多切片方案）。第二种方案是对欧洲癌症研究与治疗组织最近的方案进行改良，将前哨淋巴结劈成两半，然后从每个切面制备 5 个连续的切片，切片之间的间隔为 50μm（劈裂方案）。两种方案均包含 H&E 染色和免疫组化染色。共检查了 584 个前哨淋巴结（每个患者 1.8+/-0.9 个）。两种方案检测到的微转移率（29%与 27%）和包膜痣（13%与 15%）非常相似。多变量逻辑回归显示，Breslow 厚度（P=0.003）和年龄较小（P=0.01）与淋巴结转移相关。组织学类型、溃疡和性别与淋巴结转移无显著相关性。多切片方案平均每个淋巴结制作 4 个石蜡块和 46 张切片，劈裂方案则始终制作 2 个石蜡块和 42 张切片。在技术处理方面，多切片方案平均每个前哨淋巴结需要 38 分钟，而劈裂方案需要 55 分钟。两种方案的检测率都很高，病理学家的工作量相似。与劈裂方案相比，多切片方案需要的技术人员工作量更少。
