前哨淋巴结微转移分子检测对保乳治疗的 预后判断价值
Detection of Sentinel Lymph Node Micrometastases in Breast2conservation Therapy of Breast Cancer and Its Prognostic Signif icance
-
摘要: 目的 探讨乳腺癌前哨淋巴结(SLN) 定位活检及微转移检测对保乳治疗的预后判断价值。方法 对83 例临床考虑保乳患者于术前3～4 h 在肿瘤处皮下或瘤床内注射入99m Tc2DX, 术中用γ探测仪定位并切除SLN, 再行象限切除+ 腋淋巴结清扫(ALND) 。术后淋巴结行常规病检。RT2PCR 检测CK19 mRNA 以判断SLN 有无微转移。术后均行辅助性全身化疗+ 放射治疗,随访患者的临床转归, 所有数据行χ2 检验。结果 83 例中腋窝SLN 定位失败4 例,79 例病人共定位SLN127 个, 常规病检SLN 阳性率为26. 6 %(21/ 79), 其中微转移检出率13. 9 %(11/ 79), RT2PCR 检测微转移均阳性。SLN (89 个) 阴性病人58 例,RT2PCR 检测,SLN 阳性病人14 例,阳性率为31. 6 %(25/ 79) 。常规病理检查与RT2PCR 检测结果差异( P < 0. 01) 。79 例病人中微转移阳性组5 年远处转移率、生存率与阴性组之间差异有统计学意义( P < 0. 05), 但局部复发率和3 年生存率差异无统计学意义( P > 0. 05) 。结论 RT2 PCR 方法是检测淋巴结微转移的敏感方法;SLN 微转移有可能作为判断乳腺癌保乳治疗的一个独立预后因素。Abstract: Objective To study the significance of sentinel lymph node (SLN) micrometastasis detection in breast2cons ervation therapy of breast cancer. Methods 99m Tc2DX particles were injected into the breast tissue adjacent to the primary tumor or subcutaneously. Eighty2three patient s participated in this study, who were clinically judged to be suit to be carried out breast2conservation therapy. Af ter 2～4 hours the SLN identified by gamma detector were dissected out, followed by quadrantectomy plus axillary lymph node dissection (ALND) . The SLN were evaluated with histopathology, and reverse t ranscription poly2 merase chain reaction (RT2PCR) (examined CK19 mRNA) . Results There were 4 patient s failed to be find out the SLN. 127 SLN swere identified in 79 patient s, SLN metastasis positive rate was 26. 6 %(21/79) with histopathology, micrometastases positive rate of histopathology and RT2PCR were 13. 9 %(11/79) and 31. 6 %(25/ 79) respectively( P < 0. 01) . The rate of 5 years survival and distant metastasis in mi2 crometastases positive patient s cont rast with the negative were significant ( P < 0. 05), but the rate of 3 years survival and regional recurrence was not ( P > 0. 05) . Conclusion RT2PCR was a sensitive method to detect micrometastases. SLN micrometastases may be an independence prognostic factor of breast2con2 servation therapy.
下载:
