术中分层冷冻切片在乳腺癌前哨淋巴结活检中的诊断价值

发布时间：2018-05-11 10:17

本文选题：乳腺肿瘤 + 前哨淋巴结　；参考：《中国现代医学杂志》2017年28期

【摘要】：目的探讨术中应用不同分层冷冻切片检测前哨淋巴结(SLN)的方法在乳腺癌手术治疗中的应用价值。方法 67例乳腺癌患者术中行亚甲蓝示踪并成功行前哨淋巴结活检(SLNB),SLN均行术中冷冻切片HE染色,依次记录单层切片组、3层切片组及6层切片组冷冻病理结果,术后SLN常规HE染色石蜡切片为确诊SLN转移的标准。不同切片方法冷冻病理诊断结果与石蜡切片HE染色结果进行比较分析。结果 67例患者常规石蜡切片结果中19例SLN阳性,3例为SLNB假阴性,假阴性率为13.6%(3/22)。不同切片方法冷冻病理结果与SLN石蜡切片HE染色结果比较:单层切片的敏感性为21.1%(4/19)、符合率为73.1%(49/67)、特异性为100%(45/45);3层切片的敏感性为31.6%(6/19)、符合率为76.1%(51/67)、特异性为97.8%(44/45);6层切片的敏感性为84.2%(16/19)、符合率为91.1%(61/67)、特异性为95.6%(43/45)。敏感性和符合率,6层切片组与3层切片组、单层切片组分别比较,差异有统计学意义(P0.05),6层切片组高于3层切片组、单层切片组。而单层切片组与3层切片组比较,差异无统计学意义(P0.05)。结论 SLN术中冷冻病理检查诊断SLN转移可靠而快速,多层切片方法可以提高SLN微小转移灶的检出率,6层切片组冷冻病理检查结果与术后石蜡切片结果接近。
[Abstract]:Objective to evaluate the value of different stratified frozen sections in detecting sentinel lymph node (SLN) in the surgical treatment of breast cancer. Methods 67 patients with breast cancer underwent methylene blue tracer and sentinel lymph node biopsy. He staining of frozen sections was performed in all cases. The results of cryopreservation in single layer group and 6 layer group were recorded in turn. Postoperative SLN routine HE staining paraffin sections were the criteria for the diagnosis of SLN metastasis. The results of frozen pathological diagnosis of different sections were compared with HE staining of paraffin sections. Results among the 67 cases of routine paraffin section, 19 cases were SLN positive, 3 cases were false negative for SLNB, and the false negative rate was 13.66% 3 / 22%. The frozen pathological results of different sections were compared with the results of HE staining of SLN paraffin sections: the sensitivity of monolayer sections was 21. 1 / 4 / 19, the coincidence rate was 73. 1 / 49 / 67, the specificity was 100% 45 / 45 and the sensitivity of 3 layers was 31. 6 / 6 / 19, the coincidence rate was 76. 1 / 51 / 67 and the specificity was 97. 88 / 44 / 45 / 6. The sensitivity is 84.2 / 19, the coincidence rate is 91.1 / 67, the specificity is 95.663 / 45. The sensitivity and coincidence rate were significantly higher in the 6th layer group than in the third layer group and the monolayer section group respectively. The difference was statistically significant between the six layer group and the third layer group and the monolayer section group. There was no significant difference between monolayer group and 3 layer group (P 0.05). Conclusion SLN intraoperative frozen pathological examination is reliable and rapid in diagnosis of SLN metastasis. Multilayer section method can improve the detection rate of micrometastases of SLN. The results of frozen pathological examination in 6 layers group are close to those of paraffin section after operation.
【作者单位】：湖北省妇幼保健院甲乳外科;
【基金】：湖北省自然科学基金(No:2013CFB047)
【分类号】：R737.9

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