Mannell Aylwyn, Wium Brunton, Thatcher Charles
Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
S Afr J Surg. 2014 Aug 8;52(3):75-8. doi: 10.7196/sajs.1954.
Background. In breast cancer, sentinel lymph node biopsy (SLNB) is widely used to assess the axilla when the nodes appear normal on palpation and ultrasonography. When the sentinel lymph nodes (SLNs) are negative, no further dissection is required. Surgical dissection or radiotherapy of the axilla is indicated for macrometastases, as well as adjuvant therapy for macrometastases and micrometastasic spread.Aim. To determine the accuracy of scrape cytology (SC) for intraoperative examination of the SLNs.Methods. SLNB was performed in 100 patients with early breast cancer in whom the axillary nodes appeared normal on clinical examination and ultrasonography. None of the patients with negative SLNs or SLNs with micrometastases only (N1mic, 0.2 - 2 mm) had further axillary dissection. Patients with SLNs containing macrometastases (N1, >2 mm) underwent axillary lymph node dissection. The results of intraoperative cytology were compared with the histopathological findings on examination of serial paraffin-embedded sections of the SLNs.Results. Intraoperative SC identified SLN metastases in 20 patients: 17 had macrometastases and 3 micrometastases. Histopathological examination of the SLNs found macrometastases in 18 patients and micrometastases in 6. SC had a sensitivity of 94% and specificity of 100% for the detection of macrometastases. For micrometastatic spread, the sensitivity and specificity were 50% and 100%, respectively.Conclusion. SC is a rapid, sensitive technique for detection of macrometastases in the SLNs of women with breast cancer. The overall accuracy in identification of any metastatic spread (N1mic, N1) to the SLNs was 85%, rising to 94% in SLNs with macrometastases.
背景。在乳腺癌中，当触诊和超声检查显示腋窝淋巴结正常时，前哨淋巴结活检（SLNB）被广泛用于评估腋窝情况。当前哨淋巴结（SLN）为阴性时，无需进一步清扫。腋窝的手术清扫或放疗适用于存在大转移灶的情况，以及针对大转移灶和微转移扩散的辅助治疗。
目的。确定刮片细胞学检查（SC）用于术中检测SLN的准确性。
方法。对100例临床检查和超声检查显示腋窝淋巴结正常的早期乳腺癌患者进行SLNB。SLN为阴性或仅存在微转移（N1mic，0.2 - 2毫米）的患者均未进行进一步的腋窝清扫。SLN含有大转移灶（N1，>2毫米）的患者接受腋窝淋巴结清扫。将术中细胞学检查结果与SLN系列石蜡包埋切片的组织病理学检查结果进行比较。
结果。术中SC在20例患者中检测到SLN转移：17例为大转移灶，3例为微转移灶。SLN的组织病理学检查发现18例患者存在大转移灶，6例存在微转移灶。SC检测大转移灶的敏感性为94%，特异性为100%。对于微转移扩散，敏感性和特异性分别为50%和100%。
结论。SC是一种快速、敏感的技术，可用于检测乳腺癌女性SLN中的大转移灶。识别SLN任何转移扩散（N1mic，N1）的总体准确率为85%，在存在大转移灶的SLN中升至94%。
