Head and Neck Oncology Service, Mazumdar Shaw Cancer Center, Bangalore, India.
Head Neck. 2010 Nov;32(11):1437-43. doi: 10.1002/hed.21345.
The objective of this study was to determine the relative efficacy of different methods of pathologic evaluation of sentinel lymph nodes.
In this prospective study, sentinel nodes were evaluated for occult metastasis using frozen section, imprint-cytology, hematoxylin-eosin staining, serial step sectioning (SSS) with hematoxylin-eosin, and immunohistochemistry (IHC). Metastases were classified into macrometastasis (>2.0 mm), micrometastasis (0.2 mm-2.0 mm), isolated tumor cells (<0.2 mm).
Occult metastasis was detected in 20 of 80 patients. Frozen section and imprint cytology identified metastasis in 10 of 20 patients, hematoxylin-eosin stain in 13 patients; SSS upstaged the disease in a further 7 patients (9%). Frozen section detected macrometastasis in 7 of 8 cases but failed to detect smaller metastases (missed micrometastasis in 4 of 7 and isolated tumor cells in 5 of 5). SSS upstaged the disease by 10%, and sensitivity and negative predictive value of SSS with hematoxylin-eosin stain were 90% and 97%, respectively.
Frozen section and imprint cytology are not effective in identifying occult metastasis. IHC and SSS are required to identify micrometastasis and isolated tumor cells.
本研究旨在确定评估前哨淋巴结的不同方法的相对疗效。
在这项前瞻性研究中，使用冷冻切片、印片细胞学、苏木精-伊红染色、苏木精-伊红连续切片（SSS）和免疫组织化学（IHC）评估前哨淋巴结是否存在隐匿性转移。将转移灶分为大转移灶（>2.0mm）、微转移灶（0.2mm-2.0mm）、孤立肿瘤细胞（<0.2mm）。
在 80 例患者中，有 20 例发现隐匿性转移。冷冻切片和印片细胞学在 20 例患者中的 10 例中发现转移，苏木精-伊红染色在 13 例中发现转移；SSS 在另外 7 例患者中进一步分期疾病（9%）。冷冻切片在 8 例中检测到大转移灶，但未能检测到较小的转移灶（在 7 例中的 4 例中漏诊微转移灶，在 5 例中的 5 例中漏诊孤立肿瘤细胞）。SSS 分期提高了 10%，苏木精-伊红染色的 SSS 的敏感性和阴性预测值分别为 90%和 97%。
冷冻切片和印片细胞学不能有效识别隐匿性转移。需要免疫组织化学和 SSS 来识别微转移灶和孤立肿瘤细胞。
