The Study Of Sentinel Lymph Node Biopsy And Micrometastasis Detection Of Breast Cancer

Part 1The study of sentinel lymph node biopsy of breast cancerBackground and ObjectBreast cancer is one of the main malignant tumor in women,and its incidence is increasing year by year. Nowadays, it has become the first malignant tumor in some domestic cities.In 1984, Radical Mastectomy was invented by Halsted. This operation had been the one and only method in later several decades.As the biological behavior of breast cancer was understand more clearly, the single operation method had been gradually replaced by comprehensive therapy. Surgery is becoming small.Surgery methods for invasive breast cancer include Radical Mastectomy, Modified Radical Mastectomy, Breast Conserving Surgery(BCS),but all of them are required axillary lymph node dissection(ALND) in order to understand the situation of lymph nodes, to determine the prognosis of diseases,to direct adjuvant therapy.In recent years, sentinel lymph node biopsy(SLNB) is an important progress in the breast surgery field. The sentinel lymph node(SLN) is the first lymph node of lymph fluid draining for the primartumor, and then metastasizes to distal lymph nodes. If the SLN has no tumor metastasis, there is no metastasis in other lymph nodes. In breast cancer, if the SLN is negative, ALND should not be carried out, and then the quality of life of patients can be improve.This article aims to study SLNB in breast cancer by dye methods, and to explore clinical factors that affect the success rate of SLNB. ALND were avoided in Some patients whose SLN were negative in this study.MethodsSince March 2007, 78 patients with early breast cancer were detected SLNB using methylene blue in the First Affiliated Hospital Zhengzhou University. 67 cases were taken conventional ALND surgery, and ALND were avoided in 11 patients.26 cases were examined using dynamic contrastenhanced magnetic resonance imaging(MRI) united with diffusion-weighted imaging scans.Results72 cases were successfully detected sentinel lymph nodes in 78 patients, the detection rate is 92.31%(72/78). 156 SLNs were found in the study, 2.20 SLNs on average. Nearly 80% of 72 cases detected 1 or 2 SLNs. With the practice experience accumulating, the detection rate is increasing.39 SLNs were positive using frozen section method, and 117 negative. 39 SLNs were confirmed true positive by routine pathological,112 true negative,5 false-negative,respectively. No false positive case.False-negative rate of frozen section method was 11.37%, false-positive rate was 0%. Success rate and false-negative rate of SLNB were unrelated to the patient's age, tumor size, the quadrant where the tumor, the pathological type of tumor (P> 0.05).17 cases of 26 that adopt MRI examination were founded axillary lymph node imaging,and all the 17 cases were detected SLN successfully. It is suggested that internal mammary lymph nodes were metastasis in 2 cases,and SLNs was not found in these 2 case. MRI has the sensitivity of 57.14%,specificity of 94.74% and 84.62% of accuracy in determining the benign and malignant lymph nodes.11 patients that avoiding ALND were followed up for 6 to 23 months, with a median follow-up period was 11 months, no recurrence was found in ipsilateral axillary.Conclusions 1.Dye-guided SLND can accurately predict axillary lymph node status;2.Success rate and false-negative rate of SLNB were unrelated to the patient's age,tumor size, the quadrant where the tumor, the pathological type of tumor.3.Negative cases of SLNB could have been avoided ALND. In the earlyperiod,substitute job can be carried out in mucinous adenocarcinoma, ductalcarcinoma with micro-invasive, the elderly and other special cases;4.Preoperative MRI will help to determine lymph node status,to guide SLNB.Part 2The study of micrometastasis detection in sentinel lymph node ofbreast cancerBackground and objectThe purpose of sentinel lymph node biopsy(SLNB) in breast cancer is to find SLN-negative patients,and axillary lymph node dissection(ALND) should not be carried out, and then the quality of life of patients can be improve. So,to determine the sentinel lymph node status accurately is the key of success. It is difficult to detect micrometastasis of SLN by frozen section method.This study was designed to lower rate of false-negative through the multi-interval slice and immunohistochemical(IHC) methods.MethodsTo detect the micrometastasis of negative SLN that confirmed by frozen section through immunohistochemical staining.51 cases,117 lymph nodes were detected. Cytokeratinl9(CK19) united with human tumor-associated mucin (MUC1) were checked to be IHC factors.26 cases of the whole group were confirmed lymph node metastasis, we detected ER, PR and C-erbB-2 by IHC in primary tumors and metastatic lymph nodes.Results51 cases,117 lymph nodes were detected.ll cases (21.57%) and 15(12.82%) SLNs were found micrometastasis. 2 cases that negative by frozen section were detected micrometastasis by IHC. So,false negative rate dropped to 11.37 percent from 6.82 percent. When using a single staining method, as the additional level ncreasing, the number of micro-metastasis detection were increasing too. Detection rate of united different factors was higher than the detection of a single factor, micrometastasis were related with clinical staging and C-erbB-2 expression.26 cases of the whole group were confirmed lymph node metastasis, we detected ER, PR and C-erbB-2 by IHC in primary tumors and metastatic lymph nodes.Positive expression rate of of ER, PR, C-erbB-2 in primary breast cancer were 69.23%, 65.38% and 42.31%,respectively;In axillary lymph node were 65.38 %, 57.69% and 19.23%,.respectively. The expressions of ER, PR had higher relevance between primary breast cancer and positive lymph node, the Correlation Coefficient were 0.920 and 0.786,respectively.but the expression of C-erbB-2 were just lower correlation (r=0.498).Conclusions1.CK19 United with MUC1 immunohistochemical staining is a sensitive method thatdetect micrometastasis of SLNs.2.SLNB Micrometastasis associated with tumor clinical staging, and C-erbB-2expression.3. In the clinical application,it's a great significance to detect micrometastases of SLN in the SLNB to replace ALND.4. When the primary breast tumor is (cTx) impossible to obtain, the ER,PR status of metastatic lymph nodes can be used for endocrine therapy,but the C-erbB-2 status of metastatic lymph nodes can not used be for targeted therapy.