[Detection of micrometastases in sentinel lymph nodes of breast cancer].
OBJECTIVE
To investigate an optimal examination method to detect micrometastases in sentinel lymph nodes (SLNs) of breast cancer.


METHODS
Firstly, the SLNs of breast cancer were found by 99mTc-DX isotope method. Secondly, all the SLNs which were negative by routine HE examination were serially sectioned at a 100 microm interval and stained by both HE and immunohistochemistry for detecting micrometastases. All tumor tissue paraffin blocks were also sectioned and stained with HE and immunohistochemistry as control.


RESULTS
Totally, 121 SLNs and 44 tumors of 59 patients were examined. Micrometastasis was found to be positive in 17 SLNs (14.0%) of 14 patients (23.7%). When examined number of sections was increased from one to three, more positive micrometastatic SLNs were detected by HE staining only (3, 7, 10 for 1, 2, 3 sections, respectively). When HE staining was combined with immunohistochemical staining for AE1/3 or CK19 or muc1, much more positive micrometastatic SLNs were found (14, 12, 16 for 1, 2, 3 sections, respectively). The more sections were examined, the more micrometastases in SLNs were found. Furthermore, micrometastasis was also found to be positively correlated with the tumor size and the expression of c-erbB2, MMP-2, VEGF. The larger the tumor size was or the stronger expression of the above mentioned biomarkers, the more micrometastases in SLNs could be found.


CONCLUSIONS
Serially sections at a 100 microm interval and staining with both HE and immunohistochemical technique using muc1 antibody may be the best way to detect micrometastases in sentinel lymph nodes in breast cancer patients.
Zhang
Tao
T
Department of Surgical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Peking Medical College, Beijing 100021, China. Doctor.ZT@163.com
Zhang
Bao-Ning
BN
Zhang
Hong-Tu
HT
Sun
Yun-Tian
YT
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D003911:Dextrans; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D008207:Lymphatic Metastasis; D020778:Matrix Metalloproteinase 2 / Q000378:metabolism; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011877:Radionuclide Imaging; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
D003911:Dextrans; D020778:Matrix Metalloproteinase 2; D015609:Organotechnetium Compounds; D018719:Erb-b2 Receptor Tyrosine Kinases; D042461:Vascular Endothelial Growth Factor A; C034146:technetium Tc 99m dextran