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題名:Intra-operative Frozen Section for Sentinel Lymph Node: A Pathologic Study of 262 Patients with Breast Cancer     (12點)
術中前哨淋巴結冰凍切片檢查:262位乳癌病人的研究
著者:Ren-Ching Wang(王任卿) ;Yee-Jee Jan(詹以吉) ;John Wang(王約翰) ;Dah-Cherng Yeh(葉大成) ;Cheng-Chung Wu(吳誠中)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:axillary lymph node ; breast cancer ; intra-operative frozen section ; sentinel lymph node biopsy (SLNB)
刊名:Formosan journal of surgery
卷期:39卷2期(2006.4)
頁碼:66-71
語言:英語
摘要: 中文摘要PDF ; 英文摘要PDF

前哨淋巴結切片檢查已發展來評估乳癌的分期,以降低完全腋下淋巴結摘除的後遺症。手術中冰凍切片檢查可用在乳癌哨兵淋巴結的檢查,有陽性結果的病人可以馬上接受完全腋下淋巴結摘除,避免二次手術,而陰性結果的病人可免於完全腋下淋巴之後遺症。本研究評估術中前哨淋巴結冰凍切片的敏感度及特異度。 在西元2000年一月至2004年二月之間,因乳癌而在台中榮總接受前哨淋巴結手術中冰凍切片檢查的病人都被列入本研究。冰凍切片檢查後的組織,都再經過一般標準的組織處理程序切片及染色,其結果將視為評估術中哨兵淋巴結檢查的診斷標準。 總共從262位病患身上摘除了9雙顆前哨淋巴結。術中前哨淋巴結冰凍切片檢查的敏感度及特異度分別是68.6%及99.6%。而依據轉移病灶的大小,對巨轉移、小轉移、微轉移的敏感度分別是95.5%、25%、及14.3%。 術中前哨淋巴結的冰凍切片檢查對巨轉移的病灶是具有高敏感度及特異度的檢查,但是對小轉移及微轉移的病灶則是高特異度、低敏感度的檢查。若設備及人員許可,對小轉移及微轉移的病灶需要用更複雜的方法,包括連續切片、壓印細胞學、超快速免疫組織化學染色,以幫助正確診斷。冰凍切片檢查後的組織仍須經過標準的組織切片處理,以找出潛藏的轉移病灶。而對於術中前哨淋巴結冰凍切片檢查結果為偽陰性的病人,則需接受兩階段式手術(乳房切除併哨兵淋巴結切片和完全腋下淋巴結摘除)。
Background: Sentinel lymph node biopsy (SLNB) has been developed for assessment of the staging of breast cancer patients to minimize the morbidity of complete axillary lymph node dissection (ALND). This study evaluates the sensitivity and specificity of intra-operative frozen section (FS) examination of sentinel lymph node biopsy. Materials and Methods: Between January 2000 and February 2004, samples were collected from breast cancer patients at the Taichung Veterans General Hospital who underwent intra-operative FS for SLNB. The frozen tissue also underwent standard paraffin tissue processing afterwards and the result of each paraffin section was regarded as the gold standard of intra-operative FS. Results: A total of 952 sentinel lymph nodes from 262 patients were harvested. The overall sensitivity and specificity for intra-operative FS were 68.6% (72/105) and 99.6% (844/847) respectively. When further stratified according to metastatic size, the sensitivity for macrometastases, micrometastases, and submicrometastases were 95.5% (64/67), 25% (6/24), and 14.3% (2/14) respectively. Conclusions: Intra-operative FS of SLNB is a highly specific and sensitive method for detecting macrometastases, while showing high specificity and low sensitivity for micrometastases and submicrometastases. For such metastases, more precise methods may help in accurate diagnosis. Following studies of the histological sections of negative sentinel nodes after using frozen sections are necessary to find occult metastases, and a two-step operation is essential for such patients.


    

本卷期目次
Formosan journal of surgery 39卷2期 (2006.4)
Traumatic Diaphragmatic Hernia: Report of Two Cases/ Wei-Yu ChiuJane-Yi Hsu
Intra-operative Frozen Section for Sentinel Lymph Node: A Pathologic Study of 262 Patients with Breast Cancer/ Ren-Ching WangYee-Jee JanJohn WangDah-Cherng YehCheng-Chung Wu
The Changes of Serum Amino Acids after Major Burn and Smoke Inhalation Injuries in Rats/ Yu-Wen Tang
Primary Small Bowel Volvulus in an Adult: Report of a Case/ Yuan-Chia ChengTung-Lian HuangFeng-Fu ChouShih-Ho Wang
Sciatic Neuropathy Caused by Focal Myositis: Report of a Case/ Chou-Li ChiangFang-Yuh Hsieh
Palliative Surgery for Colon Cancer with Unresectable Liver Metastasis/ Hsin-Yuan HungJy-Ming ChiangChung-Rong ChangchienChien-Yuh YehJinn-Siun ChenRei-Ping TangWen-Sy TsaiPao-Shiu HsiehChung-Wei Fan
Spinal Seeding in Recurrent Primary Intracranial Fibrosarcoma: Report of a Case/ Wei-Chieh ChangMei-Cieng WenHung-Chuan PanChiung-Chyi Shen
Management of Bleeding Pseudoaneurysm with Arterial Embolization in ERCP-related Pancreatitis: Report of a Case/ Jun-Te HsuChih-Yuan FuHan-Ming ChenChien-Fu HungTsann-Long HwangYi-Yin JanMiin-Fu Chen
Traumatic Diaphragmatic Hernia: Report of Two Cases/ Wei-Yu ChiuJane-Yi Hsu
Palliative Surgery for Colon Cancer with Unresectable Liver Metastasis/ Hsin-Yuan HungJy-Ming ChiangChung-Rong ChangchienChien-Yuh YehJinn-Siun ChenRei-Ping TangWen-Sy TsaiPao-Shiu HsiehChung-Wei Fan
Intra-operative Frozen Section for Sentinel Lymph Node: A Pathologic Study of 262 Patients with Breast Cancer/ Ren-Ching WangYee-Jee JanJohn WangDah-Cherng YehCheng-Chung Wu
The Changes of Serum Amino Acids after Major Burn and Smoke Inhalation Injuries in Rats/ Yu-Wen Tang
Spinal Seeding in Recurrent Primary Intracranial Fibrosarcoma: Report of a Case/ Wei-Chieh ChangMei-Cieng WenHung-Chuan PanChiung-Chyi Shen
Management of Bleeding Pseudoaneurysm with Arterial Embolization in ERCP-related Pancreatitis: Report of a Case/ Jun-Te HsuChih-Yuan FuHan-Ming ChenChien-Fu HungTsann-Long HwangYi-Yin JanMiin-Fu Chen
Sciatic Neuropathy Caused by Focal Myositis: Report of a Case/ Chou-Li ChiangFang-Yuh Hsieh
Primary Small Bowel Volvulus in an Adult: Report of a Case/ Yuan-Chia ChengTung-Lian HuangFeng-Fu ChouShih-Ho Wang
 
   
 
   

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