[术中GeneSearch(TM) BLN检测法在检测前哨淋巴结中乳腺癌转移灶的价值]

[Value of intraoperative GeneSearch(TM) BLN assay to detect breast cancer metastases in sentinel lymph nodes].

作者信息

Sun Xiao, Wang Yong-sheng, Song Xian-rang, Zhong Wei-xia, Mu Dian-bin, Zhou Chang-chun, Wei Li-li, Li Dong-mei

机构信息

Shandong Cancer Hospital, Jinan 250117, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2011 Feb;33(2):138-41.

PMID:21575485

Abstract

OBJECTIVE

To evaluate the value of GeneSearch(TM) BLN assay as an intraoperative diagnostic method of sentinel lymph node metastases in breast cancer patients.

METHODS

Ninety consecutive patients were involved in this study. SLNs were intraoperatively identified and dissected, and then sectioned vertically to the long axis into multiple blocks. The odd blocks were tested by BLN assay and even ones prepared for frozen sectioning (FS), while all blocks were evaluated by touch imprint cytology (TIC). Post-operatively, residual tissues of the even blocks were assessed by histopathologic examination (4 - 6 µm thick serial sectioning permanent H&E slides were performed every 150 µm and one block made 6 slides).

RESULTS

BLN assay could be performed within less than 35 min after learning curve of 10 cases. A correlation was found between cycle time values of mammaglobin or cytokeratin-19 and size of metastases, with Spearman correlation coefficients of 0.67 and 0.71, respectively. The accuracy, sensitivity, specificity, positive predict value (PPV) and negative predict value (NPV) of the assay were 95.6%, 93.3%, 96.7%, 93.3% and 96.7%, While FS had the sensitivity, specificity, PPV, NPV of 76.7%, 100%, 100%, 89.6%, and TIC of 73.3%, 100%, 100%, 88.2%, respectively. The sensitivity of the assay was higher than that of FS (P = 0.07), and was significantly higher than that of FS (P = 0.04). When assessing patients with micro-metastases, the assay had a sensitivity of 85.7%, which was significantly higher than that of FS and TIC (P = 0.03).

CONCLUSION

GeneSearch(TM) BLN Assay can replace FS and TIC for the intraoperative assessment of SLN.

摘要

目的

评估GeneSearch™ BLN检测作为乳腺癌患者前哨淋巴结转移术中诊断方法的价值。

方法

90例连续患者纳入本研究。术中识别并切除前哨淋巴结，然后沿长轴垂直切成多个组织块。奇数组织块采用BLN检测，偶数组织块用于冷冻切片（FS），同时所有组织块均采用印片细胞学检查（TIC）。术后，对偶数组织块的残留组织进行组织病理学检查（每150μm制作4 - 6μm厚的连续切片永久苏木精-伊红染色玻片，每个组织块制作6张玻片）。

结果

经过10例的学习曲线后，BLN检测可在35分钟内完成。发现乳腺珠蛋白或细胞角蛋白-19的循环时间值与转移灶大小之间存在相关性，Spearman相关系数分别为0.67和0.71。该检测的准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为95.6%、93.3%、96.7%、93.3%和96.7%，而FS的敏感性、特异性、PPV、NPV分别为76.7%、100%、100%、89.6%，TIC的敏感性、特异性、PPV、NPV分别为73.3%、100%、100%、88.2%。该检测的敏感性高于FS（P = 0.07），且显著高于FS（P = 0.04）。在评估微转移患者时，该检测的敏感性为85.7%，显著高于FS和TIC（P = 0.03）。