Detection efficiency and clinicopathological analysis of sentinel lymph node metastasis in breast cancer

WANG Yaohui; ZHANG Yifen; ZHU Changle; WANG Shuangshuang; KE Fei; WANG Jianrong

doi:10.3969/j.issn.1009-0460.2019.01.011

Abstract：Objective To explore the detection efficiency of sentinel lymph node (SLN) metastases of breast cancer by various detection methods, and the relationship between SLN metastasis and clinicopathological characteristics. Methods From December2015 to June 2017, 139 cases of breast cancer patients with sentinel lymph node (SLN) biopsy specimens were collected. The detection efficiency of intraoperative frozen HE serial section, imprint cytology and postoperative paraffin HE sections and CK19 immunohistochemical stain was compared. The relationship of SLN metastasis with clinicopathological characteristics of breast cancer was analyzed. Results In 139 cases of breast cancer patients, macrometastasis was found in 36 cases, micrometastasis (MM) in 10 cases and isolated tumor cell (ITC) in 11 cases. There were 11 false negative cases of frozen pathology during operation, including 1 case of macrometastasis, 3 cases of MM and 7 cases of ITC. The false negative rate was 19. 3％ (11/57). Frozen HE serial sections showed high detection rate of macrometastasis (35 cases), 7 cases of MM and 4 cases of ITC. 29 cases of macrometastasis were detected by imprint cytology, and MM and ITC were negative. Postoperative paraffin HE sections showed only 3 cases of ITC, and 8 cases of ITC were detected by CK19 immunohistochemical staining. Age, tumor location, number of SLN, pathological type, histological grade, hormone receptor state, HER-2 state, triple negative breast cancer and Ki-67 index were not related to SLN metastasis, but related to tumor size and vascular cancer embolus (P ＜ 0. 05). Conclusion Intraoperative frozen HE serial sections with the addition of imprint cytology can improve the detection efficiency of SLN metastasis in breast cancer during surgery, and immunohistochemistry can improve the detection efficiency of ITC after operation. Primary lesion over 2 cm and positive intravascular thrombus suggest increased risk of SLN metastasis in breast cancer.