Occult axillary node metastases in breast cancer: their detection and prognostic significance.
Occult axillary node metastases in breast cancer: their detection and prognostic significance.
复制标题
乳腺癌中的神秘腋窝淋巴结转移：它们的检测和预后意义。
DOI：
10.1038/bjc.1996.16
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发表时间：
1996-01
影响因子：
8.8
通讯作者：
Wright, R G
中科院分区：
文献类型：
--
作者：
McGuckin, M A;Cummings, M C;Walsh, M D;Hohn, B G;Bennett, I C;Wright, R G
虽然乳腺癌腋窝淋巴结转移的存在是一个关键的预后指标，并可能影响治疗决策，但使用标准组织病理学技术诊断为腋窝淋巴结阴性(ANN)的患者中，有相当大比例可能有隐匿性淋巴结转移(OM)。在208例ANN患者中，采用有限步切法(间隔4×100微米)和免疫组织化学染色(细胞角蛋白(MNF.116)和MUC1(BC2)抗体)相结合的方法检测OM。53例(25%)发现OMS，分步切片法和免疫组织化学检测均显著提高了OMS的检出率(P<；0.05)。BC2法(25%)优于MNF.116法(18%)和苏木精伊红(8%)法。51例患者仅使用第一和最深层面的切片和BC2染色即可发现OMS。OMS在小叶(38%)比导管癌(25%)更常见，在50岁以下的女性(41%)比老年女性(19%)更常见。单变量总体和无病生存分析显示，OM的存在、大小和数量以及肿瘤大小(仅限于无病)以及组织学和核分级对预后有意义(P>；0.05)。COX多因素比例风险回归分析显示，独立于其他预后因素，OMS的存在和增大与较差的无病生存率显著相关(P<；0.05)。然而，隐匿性转移的存在与总存活率之间并没有显着的独立关联(P=0.11)。这些发现对于选择ANN患者进行辅助治疗具有重要的意义。
Although the presence of axillary node metastases in breast cancer is a key prognostic indicator and may influence treatment decisions, a significant proportion of patients diagnosed as axillary node negative (ANN) using standard histopathological techniques may have occult nodal metastases (OMs). A combination of limited step-sectioning (4 x 100 microns intervals) and immunohistochemical staining (with cytokeratin (MNF.116) and MUC1 (BC2) antibodies) was used to detect OM in a retrospective series of 208 ANN patients. OMs were found in 53 patients (25%), and both step-sectioning and immunohistochemical detection significantly improved detection (P < 0.05). Detection using BC2 (25%) was superior to MNF.116 (18%) and haematoxylin and eosin (H&E) (8%). OMs were found in 51 patients using only the first and deepest sectioning levels and BC2 staining. OMs were more frequently found in lobular (38%) than ductal carcinoma (25%), and more frequently in women less than 50 years (41%) than in older women (19%). Univariate overall and disease-free survival analyses showed that the presence, size and number of OM had prognostic significance as did tumour size (disease-free only) and histological and nuclear grade (P > 0.05). Cox multivariate proportional hazard regression analyses showed that the presence and increasing size of OMs were significantly associated with poorer disease-free survival, independently of other prognostic factors (P < 0.05). However there was not a significant independent association of the presence of occult metastases with overall survival (P = 0.11). These findings have important implications with regard to selection of ANN patients for adjuvant therapy.