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The Study of Sentinel Lymph Node Biopsy and Micrometastasis Detection of Breast Cancer

Author: LvPengWei
Tutor: GuYuanTing
School: Zhengzhou University
Course: Surgery
Keywords: Breast Cancer Sentinel lymph node biopsy Axillary lymph node dissection Magnetic resonance Sentinel lymph node Micrometastasis Cytokeratin Human tumor-associated mucin
CLC: R737.9
Type: Master's thesis
Year: 2009
Downloads: 65
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Abstract

Background and purpose of the first part of the sentinel lymph node biopsy: Breast cancer is one of malignant tumors that endanger women's health, in recent years, its incidence is increasing every year. Some big cities in the country female cancer incidence has become a serious threat to women's health. 1894 Halsted radical mastectomy (Radical Mastectomy), over the years, become the only method of surgical treatment of breast cancer radical mastectomy. With a better understanding of the biological behavior of breast cancer surgery alone mode gradually integrated therapy replaced by the extent of surgery is becoming more conservative. Surgical approach for breast cancer experienced extended radical mastectomy, modified radical mastectomy, breast-conserving surgery the (BreastConserving Surgery, BCS), but these surgical axillary lymph node dissection (AxillaryLymph Node Dissection, ALND) lymph node involvement to understand the need, in order to determine the prognosis to guide postoperative adjuvant therapy. In recent years, breast cancer sentinel lymph node biopsy (Sentinel Lymph Node Biopsy, SLNB) is an important advance in the field of breast surgery. Its significance lies in the predictable axillary lymph node metastasis, and axillary lymph node-negative breast cancer patients free line of ALND, thereby improving the quality of life of patients. This paper aims to dye method line breast cancer SLNB clinical validation study to examine the clinical factors affecting SLNB. And in some patients the SLNB alternative to the ALND the clinical application. MATERIALS AND METHODS: Since March 2007, the use of the dye methylene blue on the Zheng YiFuYuan Breast Surgery continuous admitted 78 patients with early breast cancer underwent SLNB, 67 patients after conventional ALND surgery, to select 11 cases patients to avoid ALND, and follow-up prognosis. 26 patients with preoperative breasts dynamic contrast-enhanced magnetic resonance (MRD joint diffusion-weighted imaging scan results: There were 78 cases, 72 cases of successful detection of sentinel lymph node (Sentinel Lymph Node SLN) detection rate of 92.31%. Were detected SLN156 gold, 1 to 6 per case 2.20 per case, close to 80% of cases the SLN for 1 or 2 with the practice of the increase of the number of cases, the detection rate gradually. the quick frozen SLN positive 39, negative 117 conventional pathology confirmed 39 true-positive, 112 true-negative, five false-negative and false-positive 0. frozen section of a false negative rate of 11.37%, a false positive rate of 0% success rate of SLNB and the patient's age independent of tumor size, tumor quadrant where the pathological type, and other factors (all P> 0.05). axillary lymph node staging with preoperative, preoperative not palpable axillary lymph node enlargement cases a higher success rate (P < 0.05) 26 routine MRI cases in 17 cases axillary lymph node development, SLNB were detected in two cases MRI prompt internal mammary lymph nodes, SLNB were not detected. MRI in benign and malignant lymph nodes to determine the sensitivity was 57.14%, 94.74%, and specificity, and accuracy of 84.62% of 11 patients without ALND cases were followed up for 6 to 23 months, the median follow-up time of 11 months and found no ipsilateral axillary recurrence. conclusions: 1. dye method SLNB can accurately predict axillary lymph node metastasis status: the success rate of 2.SLNB and false negative rate and the patient's age, tumor size, tumor quadrant where the pathological type, and other factors unrelated;, SLNB alternative of ALND 3.SLN negative early alternative work mucinous adenocarcinoma, intraductal carcinoma microinvasion elderly patients and other special cases carried out; preoperative MRI imaging can help determine lymph node status, guidance SLNB second part of the sentinel lymph node micrometastasis research background Objective: breast cancer sentinel lymph node biopsy (Scntinel Lymph Node Biopsy, SLNB) SLNB axillary lymph node-negative breast cancer patients without axillary lymph node dissection (the Axillary LymphNode Dissection ALND) accurately determine the sentinel lymph node (the sentinel lymph node SLN) metastasis status is a key SLNB accurately predict axillary lymph node status. intraoperative frozen section is sometimes very difficult to detect micrometastases in SLN, false negative rate, easily lead to misdiagnosis. This study was designed by the multilayer spaced slices and immunohistochemistry to investigate methods to reduce false negative rate of the SLN. MATERIALS AND METHODS: 72 cases of successful SLNB quick frozen pathology negative SLN micrometastases detection method for the multi-layered interval slices and immunohistochemistry staining were detected in 51 patients, 117 lymph nodes. cytokeratin immunohistochemistry (Cytokeratin 19, CK19), joint detection of human tumor-associated mucin (MUC1) on the full set of 78 cases in 26 cases of positive lymph node metastasis primary and metastatic lymph nodes of ER, PR and C-erbB-2 immunohistochemical detection results: through a multi-layered slice interval and immunohistochemistry were detected in 51 cases of a total of 117 lymph nodes were found in 11 cases (21.57%) patients 15 (12.82%) SLN micrometastases. frozen section 5 of the false-negative SLN micrometastases 2 found false negative rate dropped to 6.82% from 11.37% when using a staining method, each additional level, the number of detection of micrometastases have increased. different markers in micrometastasis detection rate to a single indicator detected micrometastases with clinical stage, and C-erbB-2 expression related to 26 cases accepted primary tumor and metastatic lymph nodes ER, PR and C-erbB-2 immune histochemical detection. breast primary tumor ER, PR, C-erbB-2 positive expression rate of 69.23%, 65.38% and 42.31%, respectively. axillary lymph node metastases, ER, PR, C-erbB-2 positive expression rate were 65.38%, 53.85% and 19.23%, respectively. breast primary tumor and lymph node metastases ER and PR expression correlation, the correlation coefficient (r) were 0.920 and 0.786, where ER is higher. breast primary tumor and lymph node metastasis foci C-erbB-2 expression low correlation (r = 0.498). conclusions: 1. joint CK19 and MUC1 immune sensitive method of staining is found SLNB micrometastases. 2.SLNB micrometastases and tumor clinical stage, and C-erbB-2 expression. 3.SLN detection of micrometastasis in the SLNB alternative ALND clinical applications breast primary the tumor (cTx) unable to assess significance., you can use the transfer lymph nodes ER, PR status to guide endocrine therapy and targeted therapy, not C-erbB-2 status by virtue of metastatic lymph nodes.

The Study of Sentinel Lymph Node Biopsy and Micrometastasis Detection of Breast Cancer

Abstract

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