Shang Jiuyan, Zhao Meng, Deng Huiyan, Liu Chang, Cai Lijing, Liu Yueping
Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Gland Surg. 2022 Oct;11(10):1628-1638. doi: 10.21037/gs-22-485.
Currently, assessment of sentinel lymph node (SLN) requires cytology, hematoxylin-eosin (HE), and immunohistochemistry (IHC). However, routine pathological slides still suffer from certain sampling errors and have time limitations. This study sought to investigate the sensitivity and specificity of SLN detection by reverse transcription-polymerase chain reaction (RT-PCR), which quantifies the expression of mammaglobin and cytokeratin-19 genes to determine SLN status.
The RT-PCR detection of cycles threshold (CT) values has a direct relationship with the lymph node metastasis. This study prospectively collected 256 sentinel lymph nodes from 150 patients diagnosed with breast cancer between August and November 2017. In the detection of metastases in lymph nodes, molecular markers can be verified at the cell-level and tissue-level of tumor cells. In this study, IHC results were used as the gold standard for judging sentinel lymph node status.
(I) According to the established cell models, as the lymph nodes in tumor cells increase, RT-PCR CT values decrease. (II) 83 lymph nodes were first collected, and the interpretation criteria for the molecular detection results were determined based on the IHC results. (III) The statistical analysis showed that the sensitivity of the RT-PCR was 80.49% and the specificity was 91.55%. The positive predictive and negative predictive values were 64.71% and 96.06%, respectively. There was no significant difference between RT-PCR detection and IHC detection (P=0.076). Statistical chi-square analysis also showed that the difference between intraoperative freezing and immunohistochemistry was statistically significant (P=0.000). There was a statistically significant difference between intraoperative freezing and RT-PCR detection (P=0.000). RT-PCR detection is more sensitive than intraoperative frozen detection, and is closer to the results of immunohistochemistry.
RT-PCR had objective and rapid output advantages, and was proven to be true and reliable. RT-PCR detection can not only rapidly assess sentinel lymph node status in breast cancer patients during surgery, but its accuracy is also close to that of IHC. Correctly determine whether to perform axillary lymph node dissection and improve the survival rate of patients.
目前，前哨淋巴结（SLN）评估需要细胞学、苏木精-伊红（HE）染色及免疫组织化学（IHC）检查。然而，常规病理切片仍存在一定抽样误差且有时间限制。本研究旨在探讨逆转录-聚合酶链反应（RT-PCR）检测SLN的敏感性和特异性，该方法通过定量乳腺珠蛋白和细胞角蛋白-19基因的表达来确定SLN状态。
RT-PCR检测的循环阈值（CT）值与淋巴结转移有直接关系。本研究前瞻性收集了2017年8月至11月间150例确诊为乳腺癌患者的256枚前哨淋巴结。在检测淋巴结转移时，分子标志物可在肿瘤细胞的细胞水平和组织水平得到验证。本研究中，IHC结果被用作判断前哨淋巴结状态的金标准。
（I）根据建立的细胞模型，随着肿瘤细胞中淋巴结数量增加，RT-PCR的CT值降低。（II）首先收集83枚淋巴结，并根据IHC结果确定分子检测结果的判读标准。（III）统计分析显示，RT-PCR的敏感性为80.49%，特异性为91.55%。阳性预测值和阴性预测值分别为64.71%和96.06%。RT-PCR检测与IHC检测之间无显著差异（P = 0.076）。统计学卡方分析还显示，术中冰冻与免疫组织化学之间的差异具有统计学意义（P = 0.000）。术中冰冻与RT-PCR检测之间存在统计学显著差异（P = 0.000）。RT-PCR检测比术中冰冻检测更敏感，且更接近免疫组织化学结果。
RT-PCR具有客观、快速出结果的优势，且被证明真实可靠。RT-PCR检测不仅能在手术中快速评估乳腺癌患者前哨淋巴结状态，其准确性也接近IHC。正确决定是否进行腋窝淋巴结清扫并提高患者生存率。
