Lockett M A, Metcalf J S, Baron P L, O'Brien P H, Elliott B M, Robison J G, Cole D J
Department of Surgery (Section of Surgical Oncology), Hollings Cancer Center, Medical University of South Carolina, Charleston 29425, USA.
Am Surg. 1998 Jun;64(6):539-43; discussion 543-4.
Pathologic examination of axillary lymph nodes (ALNs) may miss micrometastases in 30 per cent of breast cancer patients. We have developed a multimarker reverse transcriptase-polymerase chain reaction (RT-PCR)-based screening method that detects histopathologically positive ALNs with a 5 per cent false-negative rate. The purpose of this study was to compare this RT-PCR methodology with histopathology with regard to sensitivity and cost. Pathologically negative ALNs from 35 breast cancer patients were re-evaluated by a single pathologist in a blinded fashion using serial sectioning with immunohistochemical staining. Histopathologic results were then compared with those of RT-PCR. Cost analysis was performed based on standard charges for these methods. RT-PCR identified micrometastases in 14 of 35 pathologically negative nodes. Serial sectioning and immunohistochemical staining identified micrometastases in two cases, with RT-PCR positive for one of these. The charge per specimen for performing routine histopathologic examination was $380, serial sectioning and immunohistochemical staining $787, and RT-PCR $125. RT-PCR appears to be more sensitive at detecting ALN micrometastasis than histopathologic examination even with serial sectioning and immunohistochemical staining. If micrometastatic breast cancer detected by RT-PCR proves to be clinically relevant, it could be a more effective screening methodology with significant cost savings as compared to currently available pathologic examinations.
腋窝淋巴结（ALNs）的病理检查可能会使30%的乳腺癌患者漏诊微转移。我们开发了一种基于多标记逆转录酶 - 聚合酶链反应（RT-PCR）的筛查方法，该方法检测组织病理学检查呈阳性的ALNs时假阴性率为5%。本研究的目的是比较这种RT-PCR方法与组织病理学在敏感性和成本方面的差异。对35例乳腺癌患者病理检查为阴性的ALNs，由一名病理学家采用连续切片免疫组化染色的方法进行盲法重新评估。然后将组织病理学结果与RT-PCR结果进行比较。基于这些方法的标准收费进行成本分析。RT-PCR在35个病理检查阴性的淋巴结中检测到14个存在微转移。连续切片免疫组化染色检测到2例存在微转移，其中1例RT-PCR呈阳性。进行常规组织病理学检查每个标本收费380美元，连续切片免疫组化染色收费787美元，RT-PCR收费125美元。即使采用连续切片免疫组化染色，RT-PCR在检测ALN微转移方面似乎比组织病理学检查更敏感。如果RT-PCR检测到的微转移乳腺癌被证明具有临床相关性，那么与目前可用的病理检查相比，它可能是一种更有效的筛查方法，且能显著节省成本。
