액와 림프절 전이가 없는 유방암 환자에 있어 감시 림프절의 잠재적 미세 전이
Occult Micrometastasis of Sentinel Lymph Node in Node-negative Breast Cancer
최운정, 박원철, 이광만, 윤기중,
소속 상세정보
최운정 ( Choi Un-Jong )
원광대학교 의과대학 외과학교실
박원철 ( Park Won-Cheol )
원광대학교 의과대학 외과학교실
이광만 ( Lee Kwang-Man )
원광대학교 의과대학 외과학교실
윤기중 ( Yun Ki-Jung )
원광대학교 의과대학 병리학교실
KMID : 0371320010610040379
Abstract
Purpose : Sentinel lymph node (SLN) biopsy is thought to be a highly accurate method of assessing axillary nodal status in breast cancer. Furthermore, it can improve axillary staging by providing a more detailed examination of selected
lymph
nodes with a high probability of metastasis rather than the entire axillary nodes. The purpose of this study was to assess the incidence of SLN micrometastasis in node-negative breast cancer.
Methods : SLN biopsy was performed in 40 patients with clinically node-negative breast cancer using vital blue dye and/or radioisotope methods; the blue dye method was used in 21 cases, the isotope method in 14 cases, and a combination of
both
methods in 5 cases. All lymph nodes were evaluated by routine pathologic examination, and a more detailed examination was performed on sentinel nodes in node-negative cases; sentinel nodes were serially sectioned at an interval of 40㎛ depth
followed by
H&E and cytokeratin immunohistochemical (IHC) staining.
Results : Sentinel nodes were detected in 35 of 40 patients (87.5%). The mapping technique used in the remaining 5 cases was vital blue dye method only. Axillary node metastasis was found in 16 of 40 patients. Sentinel node biopsy
accurately
reflected the axillary node status in all cases; the sensitivity, specificity, and overall accuracy were 100, 100 and 100%, respectively. In 11 of 16 node-positive patients (68.8%), sentinel nodes were the only metastatic nodes. Occult
micrometastases
were found in SLN by serial section and IHC staining in 4 of 19 patients diagnosed as node-negative by routine pathological examination (21.1%). Occult micrometastasis of SLN was not correlated with primary tumor size, histologic grade or
lymphovascular
invasion with the exception of the S-phase fraction (P=0.023).
Conclusion : SLN biopsy was a highly accurate method of assessing axillary node metastasis in breast cancer. Serial sectioning and IHC staining of SLN were sensitive methods in the detection of occult lymph node metastasis.
키워드
유방암; 감시 림프절; 잠재적 미세전이; Breast cancer; Sentinel lymph node; Occult mir crometastasis;
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