CAJ | 학술논문

目的探讨GeneSearchTM乳腺淋巴结检测试剂盒(以下简称GeneSearch)在乳腺癌前哨淋巴结(SLN)术中诊断的临床实用性.方法对复旦大学附属肿瘤医院2009年2月至6月诊治的88例乳腺癌患者行SLN活检.首先垂直长轴将所得淋巴结切成数块厚约2 mm的组织块,对各切面进行术中细胞印片后,奇数号组织块用于术后连续切片检查,偶数号组织块采用GeneSearch进行检测,应用即时荧光定量逆转录聚合酶链反应检测SLN中CK19和乳腺球蛋白表达的Ct值.将GeneSearch以术后连续切片的诊断为准,与术中细胞印片、术后连续切片的病理结果分别进行比较.结果 88例共获得225枚SLN,其中宏转移淋巴结27枚,微转移淋巴结9枚,阴性淋巴结189枚(其中5枚为孤立肿瘤细胞).从切割淋巴结开始到最终形成报告,GeneSearch耗时范围为35～45 min(平均40 min).基于淋巴结数目,GeneSearch与术后连续切片的总体符合率为95.6%(215/225),其检测敏感度为86.1%(31/36),均高于术中细胞印片[分别为94.7%(213/225)和72.2%(26/36)].SLN转移灶大小与CKl9和乳腺球蛋白的Ct值存在统计学相关性(P＜0.01).结论 GeneSearch用于SLN术中诊断时,其检测敏感度高于术中细胞印片,达到比较满意的效果,但在应用中仍存在一些问题.
목적 탐토GeneSearchTM유선림파결검측시제합(이하간칭GeneSearch)재유선암전초림파결(SLN)술중진단적림상실용성.방법 대복단대학부속종류의원2009년2월지6월진치적88례유선암환자행SLN활검.수선수직장축장소득림파결절성수괴후약2 mm적조직괴,대각절면진행술중세포인편후,기수호조직괴용우술후련속절편검사,우수호조직괴채용GeneSearch진행검측,응용즉시형광정량역전록취합매련반응검측SLN중CK19화유선구단백표체적Ct치.장GeneSearch이술후련속절편적진단위준,여술중세포인편、술후련속절편적병리결과분별진행비교.결과 88례공획득225매SLN,기중굉전이림파결27매,미전이림파결9매,음성림파결189매(기중5매위고립종류세포).종절할림파결개시도최종형성보고,GeneSearch모시범위위35～45 min(평균40 min).기우림파결수목,GeneSearch여술후련속절편적총체부합솔위95.6%(215/225),기검측민감도위86.1%(31/36),균고우술중세포인편[분별위94.7%(213/225)화72.2%(26/36)].SLN전이조대소여CKl9화유선구단백적Ct치존재통계학상관성(P＜0.01).결론 GeneSearch용우SLN술중진단시,기검측민감도고우술중세포인편,체도비교만의적효과,단재응용중잉존재일사문제.
Objective To evaluate the application of GeneSearchTM breast lymph node assay in intraoperative detection of metastases in sentinel lymph node (SLN) from breast cancer patients. Methods A total of 225 SLN from 88 patients was prospectively studied. Each SLN was cut into 2 mm slabs which were examined by intraoperative imprint cytology (ⅡC) first, followed by GeneSearch assay and postoperative serial sectioning. GeneSearch used real-time fluorescence quantitative RT-PCR technology to detect the expression of CK19 and mammaglobin in SLN. The results of GeneSearch assay were correlated with those of ⅡC and post-operative serial sectioning. Results Amongst the 88 cases studied, 225 SLNs were found, and obvious metastatic carcinoma cells were identified in 27 SLNs and micrometastasis in 9 SLNs.One hundred and eight-nine SLNs were considered as "negative" (with "isolated tumor cells" present in 5 SLNs). The turn-around time of intraoperative GeneSearch assay ranged from 35 to 45 minutes (mean = 40 minutes). The concordance rate between GeneSearch assay and post-operative serial sectioning was 95.6% (215/225), with a sensitivity of 86.1% (31/36), compared with 94.7% (213/225) and 72.2% (26/36)respectively for ⅡC. The size of metastatic foci correlated with the Ct value of CK19 and mammaglobin (P ＜0.01). Conclusions GeneSearch assay for intraoperative detection of metastase in SLN has a satisfactory performance and demonstrates a relatively higher sensitivity than ⅡC. The potential clinical application still requires further evaluation of larger number of cases.