Microstaging of breast cancer patients using cytokeratin staining of the sentinel lymph node
Microstaging of breast cancer patients using cytokeratin staining of the sentinel lymph node
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DOI：
10.1007/s10434-999-0095-3
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发表时间：
1999-01-01
影响因子：
3.7
通讯作者：
Cox, CE
中科院分区：
文献类型：
--
作者：
Schreiber, RH;Pendas, S;Cox, CE
背景：前哨淋巴结（SLN）定位是一种有效而准确的腋窝淋巴结转移评估方法。细胞角蛋白（CK）免疫组织化学（IHC）染色发现了以前常规苏木精和伊红（H&E）染色未发现的微转移性疾病。本研究的目的是确定被抢戏或微戏的患者数量，即仅通过联合淋巴作图和CK - IHC检测到微转移性疾病的患者数量。方法：210例新诊断的乳腺癌患者在术中使用生命蓝染料和技术标记的硫胶体联合进行淋巴作图。切除的前哨淋巴结通过印迹细胞学、标准H&E组织学和CK免疫组化染色进行粗略检查。仅CK阳性的sln经组织学检查证实为恶性。结果：210例乳腺癌患者381例sln行CK免疫组化染色。210例患者中有47例（22.4%）淋巴结阳性。47例患者中有30例（63.8%）同时存在H&E和ck阳性sln，另有17例（36.2%）仅存在ck阳性sln。180例H&E染色阴性的患者中有17例（9.4%）被SLN恶性细胞的CK MC染色所取代。肿瘤大小与淋巴结阳性患者总数的比较显示，30例T0和T1淋巴结阳性患者中有16例（53.5%），39例淋巴结中有22例（56.4%）被CK IHC染色抢镜。T2和T3患者淋巴结细胞角蛋白分析较少被抢镜。17例淋巴结阳性患者中仅有1例（5.9%）被抢镜，34例T2和T3肿瘤患者中仅有7例（20.6%）被抢镜。结论：CK - IHC染色将9.4%的sln患者从i期转移到II期。在肿瘤大小小于2cm的患者中有明显的前期影响。这种微分期转移或超前分期可能是I期乳腺癌治疗失败的重要原因。使用更灵敏的检测方法对sln进行微分期可能有助于确定浸润性乳腺癌患者亚组，这些患者将受益于全身辅助治疗，同时使无病患者亚组免受毒性辅助化疗的额外风险。
Background: Sentinel lymph Rode (SLN) mapping is an effective and accurate method of axillary nodal evaluation for metastatic disease. Cytokeratin (CK) immunohistochemical (IHC) staining of the SLN has found micrometastatic disease previously undetected by routine hematoxylin and eosin (H&E) stains. The purpose of this study is to determine the number of patients who were upstaged or microstaged, i.e., detected to have micrometastatic disease only by combined lymphatic mapping with CK IHC,Methods: Two hundred and ten patients with newly diagnosed breast cancer underwent intraoperative lymphatic mapping using a combination of vital blue dye and technetium-labeled sulfur colloid. The excised sentinel lymph nodes were examined grossly, by imprint cytology, by standard H&E histology, and by IHC stains for CK. SLNs that were only CK positive were confirmed to be malignant by histologic examination.Results: CK IHC staining was performed on 381 SLNs in 210 breast cancer patients. Forty-seven of 210 patients (22.4%) had positive nodes. Thirty of these 47 patients (63.8%) had both H&E- and CK-positive SLNs, and an additional 17 of the 47 positive patients (36.2%) had only CK-positive SLNs. Seventeen of the 180 patients (9.4%) who were negative on H&E staining were upstaged by CK MC staining of malignant cells in the SLN. Comparison of tumor size with the total number of node-positive patients demonstrated that 16 of 30 node-positive T0 and T1 patients (53.5%) and 22 of 39 nodes (56.4%) were upstaged by CK IHC staining. T2 and T3 patients were less frequently upstaged by cytokeratin analysis of lymph nodes. Only one of 17 node-positive patients (5.9%) and seven of 34 nodes (20.6%) in patients with T2 and T3 tumors were upstaged.Conclusion: CK IHC staining of SLNs shifted 9.4% of patients from stage I. to stage II. There was a significant upstaging influence noted in patients with tumor sizes under 2 cm. This microstaging shift or upstaging may account for the significant proportion of stage I breast cancer treatment failures. Microstaging of the SLNs using more sensitive assays may help identify a subgroup of patients with invasive breast cancer who would benefit from systemic adjuvant treatment, while sparing a disease-free subset of patients the additional risks of toxic adjuvant chemotherapy.