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유방암 환자의 수술 중 rapid cytokeratin 면역화학 염색법을 이용한 감시림프절의 평가

Other Titles
 Intraoperative Examination of Sentinel Lymph Nodes Using Rapid Cytokeratin Immunohistochemical Staining in Breast Cancer Patients 
 이일균  ;  정준  ;  이희대  ;  유영훈  ;  오기근  ;  홍순원  ;  정우희  ;  박병우  ;  장항석 
 Journal of Korean Breast Cancer Society (한국유방암학회지), Vol.7(3) : 154-160, 2004 
Journal Title
Journal of Korean Breast Cancer Society(한국유방암학회지)
Issue Date
Breast cancer ; Sentinel lymph node ; Frozen section ; Rapid immunohistochemistry ; Cytokeratin ; 유방암 ; 감시림프절 ; 동결절편검사 ; 신속면역조직화학염색
Purpose: Sentinel lymph node (SLN) biopsy has become a new standard procedure in the treatment of patients with early breast cancer. Furthermore, many institutions have begun offering the sentinel lymph node biopsy without simultaneous axillary dissection as a possible standard procedure when the SLN was free from tumors. For appropriate intraoperative decision making on the presence of cancer cells in axillary lymph nodes, a fast and accurate method to assess the SLN is required. The authors performed a prospective investigation of the relative merits of rapid cytokeratin immunohistochemical (IHC) staining of the SLN removed during the operations of breast cancer patients.

Methods: Between December 2002 and August 2003, 38 patients with T1and T2 breast cancer were enrolled after undergoing successful sentinel lymph node biopsy. A total of 60 sentinel lymph nodes (mean number, 1.58) were biopsied and first examined by hematoxylin-eosin (H&E) staining. All the tumor free sentinel lymph nodes by H&E stained section were immunostained for cytokeratin using a rapid immunohistochemical assay (Cytokeratin (PAN), 1:50,Newcastle, UK) during the operation. Finally, the sentinel lymph nodes were submitted for paraffin embedding and serial section after surgery. Both H&E stained and cytokeratin immunostained sections were also performed.

Results: This technique has a turnaround time of less than 20 minutes during the operation. Rapid IHC staining revealed 4 positive sentinel lymph nodes that were negative for metastasis by H&E staining. Among these false negative 4 cases, two cases had problems with the frozen section of H&E staining and the other 2 cases had problems due to micrometastasis. This study showed a sensitivity of 88.89%, a specificity of 100%, an accuracy of 98.33%, and a negative predictive value of 98.08%. The false-negative case (1 of 52), which was negative on H&E staining and rapid IHC staining during the operation, was disclosed as positive only after a serial permanent section examination with IHC stain.

Conclusion: The introperative examination of sentinel lymph nodes is a highly accurate and effective way of predicting the axillary lymph node status of patients with breast cancers. This may be a promising technique in deciding whether to spare axillary lymph node dissection for the patient in the operating room
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Byeong Woo(박병우) ORCID logo https://orcid.org/0000-0003-1353-2607
Oh, Ki Keun(오기근)
Ryu, Young Hoon(유영훈) ORCID logo https://orcid.org/0000-0002-9000-5563
Lee, Il Kyun(이일균)
Lee, Hy De(이희대)
Chang, Hang Seok(장항석) ORCID logo https://orcid.org/0000-0002-5162-103X
Jung, Woo Hee(정우희)
Jeong, Joon(정준) ORCID logo https://orcid.org/0000-0003-0397-0005
Hong, Soon Won(홍순원) ORCID logo https://orcid.org/0000-0002-0324-2414
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