유방암 감시림프절에서 미세전이에 관한 연구
Detection of Breast Cancer Micrometastases in Sentinel Lymph Nodes
김성원, 오승근, 최국진, 윤여규, 노동영, 강희준, 박성신, 안수정,
소속 상세정보
김성원 ( Kim Sung-Won )
서울대학교 의과대학 외과학교실
오승근 ( Oh Seung-Keun )
서울대학교 의과대학 외과학교실
최국진 ( Choi Kook-Jin )
서울대학교 의과대학 외과학교실
윤여규 ( Youn Yeo-Kyu )
서울대학교 의과대학 외과학교실
노동영 ( Roh Dong-Young )
서울대학교 의과대학 외과학교실
강희준 ( Kang Hee-Joon )
서울대학교 의과대학 외과학교실
박성신 ( Park Sung-Shin )
서울대학교 의과대학 병리학교실
안수정 ( Ahn Soo-Jung )
서울대학교 의과대학 외과학교실
KMID : 0371320010600020154
Abstract
Purpose: Axillary lymph node status is a powerful prognostic factor in breast carcinomas. However, patients without axillary lymph node metastases are not completely devoid of risk for relapse. Also, the axillary lymph node micrometastases significantly contribute to the selection of high-risk patients. Recently, sentinel lymph node (SLN) biopsy has been proposed as a potential alternative to full axillary lymph node dissection for staging breast carcinomas. To validate this hypothesis, we evaluated the distribution of occult metastases in sentinel and nonsentinel lymph nodes.
Methods: Twenty patients who had breast carcinomas and who underwent a SLN biopsy followed by an axillary lymph node dissection during March and July 2000 at Seoul National University Hospital were evaluated. Thirty SLNs devoid of metastasis, as determined by hematoxylin and eosin (H&E) staining, were evaluated for micrometastases by pan- cytokeratin immunohistochemistry (IHC) and reverse transcriptase polymerase chain reaction (RT-PCR) using Keratin 19 mRNA and MUC1 mRNA. Nonsentinel lymph nodes (NSLN) were also evaluated by pan-cytokeratin IHC.
Results: One out of the 30 SLNs (3.3%) had occult metastases which were identified by IHC and 4 out of the 30 SLNs (13.3%) had occult metastases which were identified by RT-PCR. NSLNs devoid of metastases by H&E staining proved to be free of micrometastases by IHC.
Conclusion: IHC and RT-PCR are more sensitive methods for detecting micrometastases than conventional H&E staining alone. If an SLN is tumor free by IHC or RT-PCR, we can assume that the remaining lymph nodes in the axilla are also tumor free, consequently, an SLN biopsy can be a substitute for axillary lymph node dissection.
키워드
감시림프절;미세전이;유방암
Sentinel lymph node;Micrometastases;Breast carcinoma
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