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术中细胞学印片法诊断乳腺癌前哨淋巴结转移的准确性分析

李旻1,谢博遥2,何国栋2,谢怡1,魏茜1
  

  1. 1 518109广东深圳深圳市龙华新区人民医院病理科 2 518109 深圳市龙华新区人民医院乳腺外科
  • 收稿日期:2016-05-05 修回日期:2016-08-29 出版日期:2016-10-30 发布日期:2016-10-30

Accuracy analysis of intraoperative imprint cytology on rapid diagnosis of sentinel lymph node metastases in breast cancer

  1. Department of Pathology, Long Hua New District People’s Hospital, Shenzhen 518109,China
  • Received:2016-05-05 Revised:2016-08-29 Online:2016-10-30 Published:2016-10-30

摘要: 目的探讨细胞学印片评估乳腺癌前哨淋巴结转移的准确性。方法 选择70例早期乳腺癌患者进行前哨淋巴结检查,前哨淋巴结切除后立即送检,沿前哨淋巴结短轴每隔2~3 mm剖开,每个剖面均进行印片细胞学检查,印片使用HE染色。印片后的淋巴结分别行石蜡包埋切片,将印片结果与石蜡切片的HE染色结果进行对比。结果 共检出134枚淋巴结。印片细胞学检查乳腺癌淋巴结转移的灵敏度为96.2%(25/26),特异度为98.1%(106/108),准确度为97.8%(131/134)。阳性预测值与阴性预测值分别为92.6%(25/27)、99.1%(106/107)。假阳性原因主要是组织细胞形态学与分化好的癌细胞相似;假阴性原因是转移灶微小。结论 印片细胞学对乳腺癌前哨淋巴结术中病理诊断有较高的价值,可以准确提供术中诊断信息,与石蜡切片有很高的一致性。

Abstract: Objective To evaluate the accuracy of intraoperative imprint cytology on rapid diagnosis of sentinel lymph node metastases in breast cancer. Methods Sentinel lymph node biopsy was performed in 70 selected patients with early-stage breast cancer. All the sentinel lymph nodes were sent to the Department of Pathology in 10 minutes and cut into pieces along the short axis every 2-3 millimeters. Imprint slides were made of each pieces of the sentinel lymph nodes, and then stained with HE. Finally,the node pieces were handled by histological specimen procedure. Intraoperative imprint cytology results were compared with the final paraffin HE pathology. Results In this study, 134 sentinel lymph nodes were identified. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of intraoperative imprint cytology for 134 sentinel nodes were 96.2%(25/26), 98.1%(106/108), 97.8(131/134), 92.6%(25/27)and 99.1%(106/107), respectively. The cause of false positive of imprint cytology was that confusing morphological similarities existed between histiocytes and high-differentiated cancer cells. And the factor that results in false negative was mainly the limited quantity of metastasizing cells. Conclusion Imprint cytology is a simple, effective and rapid method for intraoperative pathological evaluation of sentinel lymph node for early breast cancer patients,which has a high concordance with the paraffin results, and can provide accurate and rapid diagnostic information for the surgeons during operation.

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