| Objective:To investigate the clinical diagnosis values of SLNs micrometastases by using frozen sections(FS) plus rapid immunohistochemistry staining,and providing a new way for diagnosis methods of the SLNs metastases in breast cancer.The study also analyzes the relationship between SLNs micrometastases and menstrual status,tumor stage,histological type,tumor location,estrogen receptor(ER) status,progesterone receptor(PR) status and human epidermal growth factor receptor-2 (HER-2) status,to further explore SLNs micrometastases influencing the prognosis of patients with breast cancer.Methods:51 patients of breast cancer from December 2009 to December 2010 in the thyroid and breast surgery department of Jinan Military General Hospital have undergone sentinel lymph node biopsy(SLNB),All the patients are in line with SLNB conditions that 2010 clinical guidelines for breast cancer.To positioning SLNs by use of methylene blue plus nuclide(99mTc-Dx) during intraoperative period,the removable SLNs are sent immediately to accept rapid pathological examination. The SLNs are divided into two parts by long axis,one part is undergone intraoperative frozen sections, which are serially sectioned three levels at a 100μm interval,each level is cut three slices,and the thickness of each slice is 5μm;one slice of each level is firstly stained by hematoxylin-eosin(H-E) to detect the status of SLNs metastases. If the H-E staining is positive, then a patient has undergone the axillary lymph node dissection(ALND) surgery.If the H-E staining is negative,the others slices of each level will stained by intraoperative rapid immunohistochemistry staining to detect the status of SLNs metastases, the immunohistochemistry detecting indicators are pan-cytokeratin(pan-CK) and epithelial membrane antigen(EMA).By the same,if SLNs are positive,ALND is done;if SLNs are nagative, then choosing the suitable surgery by the every patient's status.The other part of SLNs is undergone postoperative routine pathological examination by use of paraffin imbedding, the intervals,number,thickness of slices and the methods of examination are the same as the frozen sections.The two intraoperative methods which diagnose sensitivity﹑specificity﹑coincidence rate and false negative rate of SLNs metastases are compared respectively,the results of SLNs metastases by postoperative routine pathological examination and intraoperative pathological examination are analyzed,the correlations between SLNs micrometastases and menstrual status,tumor stage,histological type,tumor location,hormone receptor status and HER-2 status are also analyzed.The Statistical methods are used chi-square test.Results:51 patients of breast cancer are succeeded in SLNB, and examined 120 SLNs. The coincidence rate of SLNs which are localized by methylene blue plus nuclide method is 96.1%,and the successful rate is 100%.The number of SLNs in each patient is 1 to 5,and the average is 2.All of SLNs are located in the lateral group of axillary nodes, but SLNs are not found in the internal mammary lymph nodes. The total number of axillary lymph nodes is 643, each patient is 10 to 22, and the average is 13;The total number of internal mammary lymph nodes is 76,each patient is 0 to 11,and the average is 1.4 cases are detected metastases by H-E staining in frozen sections,47 cases with negative H-E staining are detected 8 micrometastases cases by continue to process rapid immunohistochemistry staining. SLNs metastases rate are 7.8%(4/51)by H-E staining in frozen sections,but 23.5% ( 12/51 ) are detected by frozen sections plus intraoperative rapid immunohistochemistry staining. Both of the sensitivity﹑specificity﹑coincidence rate and false negative rate are 30.8%vs92.3%,100%vs100%,82.4%vs98.0%,69.2%vs7.7%,respectively.Rapid immunohistochemistry staining shows a good learning curve for the operating time, the average time is 31 minutes.SLNs metastases rate are 25.5%(13/51) are detected by the examination of postoperative routine paraffin sections,and this method is much better than the frozen sections H-E staining and frozen sections plus intraoperative rapid immunohistochemistry staining(χ2=6.21,P<0.05).There are no significant correlations between the SLNs micrometastases and menstrual status,tumor stage,histological type,tumor location,hormone receptor status and HER-2 status(P>0.05). Conclusion:1. Though the intraoperative frozen sections H-E staining is used widely in clinical practice, but the detection of SLNs metastases rate is low, and there is also low sensitivity,high false negative rate.2.By comparing to using the frozen sections H-E staining alone, frozen sections plus rapid immunohistochemistry staining can significantly increase the SLNs micrometastases rate and reduce the false negative rate.3.There is no significant correlation between the SLNs micrometastases and menstrual status,tumor stage,histological type,tumor location,hormone receptor status and HER-2 status.4.Intraoperative frozen sections plus rapid immunohistochemistry staining can quickly and accurately detect SLNs micrometastases in breast cancer. |
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