现场快速评估技术在乳腺癌前哨淋巴活检术中的应用价值研究

汤琦; 李惠; 晋萍; 张祥武; 唐一吟; 周绍强; 陈德滇

doi:10.12354/j.issn.1000-8179.2022.20220708

现场快速评估技术在乳腺癌前哨淋巴活检术中的应用价值研究

doi: 10.12354/j.issn.1000-8179.2022.20220708

汤琦^1,,
李惠¹,
晋萍²,
张祥武²,
唐一吟¹,
周绍强¹,
陈德滇^1, ,

1.
云南省肿瘤医院(昆明医科大学第三附属医院)乳腺二科（昆明市650118）
2.
病理科

基金项目: 本文课题受云南省高层次卫计人才项目（编号：H2017040）和昆明医科大学研究生创新基金项目（编号：2021S072）资助

详细信息

作者简介:
汤琦：专业方向为乳腺肿瘤外科临床治疗及乳房重建生物材料等基础研究

通讯作者:
陈德滇　chendedian2006@126.com

计量
- 文章访问数: 101
- HTML全文浏览量: 19
- PDF下载量: 25
- 被引次数: 0
出版历程
- 收稿日期: 2022-05-09
- 录用日期: 2022-09-05
- 修回日期: 2022-08-20

Application value of rapid on-site evaluation in sentinel lymph node biopsy of breast cancer

1.
2nd Department of Breast Surgery
2.
Department of Pathology, Yunnan Tumor Hospital/The Third Affiliated Hospital of Kunming Medical University, Kunming 650118, China

Funds: This work was supported by High-Level Medical Personnel Funding of Yunnan Provincial (No. H2017040), Postgraduate Innovation Fund of Kunming Medical University (No. 2021S072）

More Information

Corresponding author: Dedian Chen ; E-mail: chendedian2006@126.com

摘要

摘要: 目的探讨现场快速评估(rapid on-site evaluation，ROSE)技术在乳腺癌前哨淋巴结活检术（sentinel lymph node biopsy，SLNB)中的应用准确性及临床价值。方法纳入2019年12月至2021年12月于云南省肿瘤医院确诊的早期乳腺癌患者375例，分为行SLNB组195例（A组）、新辅助化疗后行SLNB组180例（B组），术中应用ROSE技术联合冰冻对A组444枚和B组479枚的前哨淋巴结进行快速诊断。以术后石蜡病理检查为金标准，同时再行细胞学巴氏染色及H&E染色对诊断结果进行比较，绘制各检测方法受试者工作特征( receiver operating characteristic，ROC) 曲线，计算ROC 曲线下面积( area under curve，AUC)并行McNemar 检验，评估ROSE技术的诊断效率、准确度、敏感度及特异度。结果 ROSE技术平均诊断时间为6.53 min /例。A组和B组的ROSE技术的 AUC值分别为0.929和0.961、敏感度分别为82.35%和93.81%、特异度分别为97.56%和98.43%，A、B组与其他常规检测诊断方法比较，差异均无统计学意义（P=0.180、P=1.000）。结论 ROSE技术联合冰冻用于乳腺癌SLNB能有效提高诊断效率，具有良好的临床应用及推广价值。
- 现场快速评估技术 /
- 乳腺癌 /
- 前哨淋巴结活检术
Abstract: Objective To investigate the accuracy and clinical value of rapid on-site evaluation (ROSE) in sentinel lymph node biopsy (SLNB) of breast cancer. Methods Three-hundred and seventy-five patients diagnosed with breast cancer at Yunnan Tumor Hospital from December 2019 to December 2021 were enrolled. One-hundred and ninety-five patients (group A) diagnosed with early breast cancer underwent SLNB alone, and 180 patients (group B) with locally advanced breast cancer underwent SLNB after neoadjuvant therapy. ROSE was used intraoperatively for rapid evaluation and diagnosis of 444 and 479 SLNs in group A and B, respectively. Paraffin was used as the gold standard to compare the diagnostic results. Meanwhile, intraoperative Papanikolaou (PAP) and hematoxylin and eosin (H & E) staining results between the two groups were compared to evaluate the diagnostic accuracy, sensitivity, and specificity of ROSE by McNemar test. The receiver operating characteristic (ROC) curve of each detection method was drawn, and the area under the ROC curve (AUC) was calculated. Results The average diagnosis time of ROSE was 6.53 min/case. The AUC of group A in ROSE was 0.929, with 82.35% sensitivity and 97.56% specificity. The AUC of group B in ROSE was 0.961, with 93.81% sensitivity and 98.43% specificity. The diagnostic results of ROSE showed no statistical differences on using other detection methods（P=0.180, P=1.000). Conclusions ROSE can improve the diagnostic efficiency while reducing the diagnostic cost of SLNB for breast cancer. Moreover, apart from having good clinical application and popularization value, it is expected to become a new method for intraoperative SLNB assessment.
- rapid on-site evaluation /
- breast cancer /
- sentinel lymph node biopsy

HTML全文

图 1 研究方案操作流程

A:A组;B:B组

下载: 全尺寸图片幻灯片

图 2 行SLNB未见转移的正常SLN细胞

A：ROSE；B：冰冻；C：细胞学巴氏染色；D：H&E 染色；E：石蜡病理检查（VG×40）

下载: 全尺寸图片幻灯片

图 3 行SLNB可见转移的SLN细胞

A：ROSE；B：冰冻；C：细胞学巴氏染色；D：H&E 染色；E：石蜡病理检查（VG×40）

下载: 全尺寸图片幻灯片

图 4 新辅助化疗后ROSE染色的SLN转移可见部分退化坏死（ROSE×40）

A： SLN转移细胞拥挤重叠网丝状坏死；B：SLN转移细胞染色质结构消失

下载: 全尺寸图片幻灯片

表 1 375例乳腺癌患者基本特征

病理因素	A组（n=195）	B组（n=180）
肿瘤大小
Tis	25 （12.82）	0 （0）
T1	112（57.44）	20 （11.11）
T2	52 （26.67）	124（68.89）
T3	6 （3.07）	36 （20.00）
病理类型
原位癌	25 （11.79）	0 （0）
非特殊浸润性癌	168（87.18）	166（92.22）
其他类型癌	2 （1.03）	14 （7.78）
HER-2状态
扩增	24 （12.31）	34（18.89）
未扩增	171（87.69）	146（81.11）
激素受体状态
ER阳性及PR阳性	85 （43.59）	76（42.22）
ER阳性及PR阴性	36 （18.46）	48（26.67）
ER阴性及PR阳性	15 （7.69）	37（20.56）
ER阴性及PR阴性	59 （30.26）	19（10.55）
Ki-67增值指数（%）
≤20	76（38.97）	21（11.67）
>20	119（61.03）	159（88.33）
（）内单位为%

下载: 导出CSV

表 2 各诊断技术可见转移SLN数目（枚）

诊断方法	A组	B组
ROSE	30	91
细胞学巴氏染色	28	79
H&E染色	30	82
术中冰冻	29	84
术后石蜡病理检查	34	97

下载: 导出CSV

表 3 各诊断技术Z检验及McNemar检验比较

统计学方法	A组				B组
统计学方法	ROSE	细胞学巴氏染色	H&E染色	术中冰冻	ROSE	细胞学巴氏染色	H&E染色	术中冰冻
AUC	0.929	0.903	0.923	0.971	0.961	0.894	0.902	0.909
敏感度（%）	82.35	88.29	85.29	88.24	93.81	81.44	84.60	86.67
特异度（%）	97.56	98.29	99.27	97.07	98.43	93.72	93.72	95.13
McNemar 检验	P=0.180	P=1.000	P=0.077	P=0.727	P=1.000	P=0.185	P=0.099	P=0.383

下载: 导出CSV

参考文献(13)

[1]	DeSantis CE, Ma J, Gaudet MM, et al. Breast cancer statistics, 2019[J]. CA Cancer J Clin, 2019, 69(6):438-451. doi: 10.3322/caac.21583
[2]	Rahool R, Haider G, Hayat M, et al. Factors associated with treatment delay in breast cancer: a prospective study[J]. Cureus, 2021, 13(2):e13242.
[3]	Zhang JL, Wang T, Yan CJ, et al. Clinical practice status of sentinel lymph node biopsy for early-stage breast cancer patients in China: a multicenter study[J]. Clin Epidemiol, 2020, 12:917-924. doi: 10.2147/CLEP.S264349
[4]	Aldoheyan T, Klein J. Quality assurance review: intra-operative evaluation of sentinel lymph nodes in breast cancer[J]. Cancer Med, 2021, 10(20):7213-7221. doi: 10.1002/cam4.4264
[5]	中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2021年版)[J].中国癌症杂志,2021,31(10):954-1040. doi: 10.19401/j.cnki.1007-3639.2021.10.013
[6]	Jain D, Allen TC, Aisner DL, et al. Rapid on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspirations for the diagnosis of lung cancer: a perspective from members of the pulmonary pathology society[J]. Arch Pathol Lab Med, 2018, 142(2):253-262. doi: 10.5858/arpa.2017-0114-SA
[7]	Huang ZQ, Zhuang DC, Feng AR, et al. Real-time and accuracy of rapid on-site cytological evaluation of lung cancer[J]. Transl Cancer Res, 2021, 10(1):479-486. doi: 10.21037/tcr-20-3294
[8]	Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial[J]. JAMA, 2013, 310(14):1455-1461. doi: 10.1001/jama.2013.278932
[9]	郭宝良,李挺,刘荫华,等.早期乳腺癌染料法前哨淋巴结活检专家共识及技术操作指南(2018版)[J].中国实用外科杂志,2018,38(8):855-858. doi: 10.19538/j.cjps.issn1005-2208.2018.08.04
[10]	Wang HS, Ren T, Wang X, et al. Rapid on-site evaluation of touch imprints of biopsies improves the diagnostic yield of transbronchial biopsy for endoscopically nonvisible malignancy: a retrospective study[J]. Jpn J Clin Oncol, 2021, 51(4):622-629. doi: 10.1093/jjco/hyaa245
[11]	Petropoulou T, Kapoula A, Mastoraki A, et al. Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer[J]. Breast Cancer (Dove Med Press), 2017, 9:325-330.
[12]	Mohammadnia Avval M, Hosseinzadeh M, Farahi Z, et al. Comparing scraping cytology with touch imprint cytology and frozen section analysis in the intraoperative diagnosis of sentinel lymph node metastasis in breast cancer[J]. Diagn Cytopathol, 2021, 49(4):475-479. doi: 10.1002/dc.24695
[13]	Classe JM, Loaec C, Gimbergue P, et al. Sentinel lymph node biopsy without axillary lymphadenectomy after neoadjuvant chemotherapy is accurate and safe for selected patients: the GANEA 2 study[J]. Breast Cancer Res Treat, 2019, 173(2):343-352. doi: 10.1007/s10549-018-5004-7