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目的:探讨免疫磁珠(immunomagnetic beads,IMB)联合扫描电镜(scanning electron microscope,SEM)检测乳腺癌患者骨髓微转移(bone marrow micrometastasis,BMM)的临床意义。方法:采用IMB富集联合SEM鉴定的方法检测106例乳腺癌患者骨髓有核细胞中上皮来源细胞的阳性发生率,分析其与原发肿瘤大小、临床分期、腋淋巴结转移、病理组织学分级、雌孕激素受体蛋白(ER、PR)表达及术后1年远端转移发生情况等常用病理学观测指标的关系。结果:106例乳腺癌骨髓标本中,37例检测到肿瘤细胞,骨髓微转移阳性率为34.9%;乳腺癌BMM阳性率与原发肿瘤大小正相关(P<0.05);临床分期越晚,出现BMM的概率也越高(P<0.01);BMM不仅与腋淋巴结是否转移有关(P<0.05),且随淋巴结转移数目增加,BMM阳性率亦增高(P<0.05);此外,乳腺癌BMM阳性率还与病理组织学分级正相关(P<0.05);与ER、PR蛋白在肿瘤组织中的表达负相关(P<0.05);与术后1年内患者是否发生远端转移正相关(P<0.05)。结论:IMB联合SEM检测骨髓微转移是具有潜在应用价值的乳腺癌早期诊断方法和预后指标。
Objective: To investigate the clinical significance of detecting bone marrow micrometastasis (BMM) in breast cancer patients by using immunomagnetic beads (IMB) combined with scanning electron microscope (SEM). Methods: The positive rate of epithelial-derived cells in 106 patients with breast cancer was detected by IMB enrichment combined with SEM. The correlation between the positive rate and the primary tumor size, clinical stage, axillary lymph node metastasis, histopathological grade, Estrogen and progesterone receptor protein (ER, PR) and 1 year after the operation of distant metastasis and other common pathological indicators. Results: The positive rate of bone marrow micrometastasis was detected in 37 of 106 breast cancer samples. The positive rate of bone marrow micrometastasis was 34.9%. The positive rate of BMM in breast cancer was positively correlated with the size of primary tumor (P <0.05). The later clinical stage appeared (P <0.05). The positive rate of BMM increased with the increase of lymph node metastasis (P <0.05). In addition, the positive rate of BMM in breast cancer The positive rate was also positively correlated with the histopathological grade (P <0.05), negatively correlated with the expression of ER and PR in tumor tissues (P <0.05), and with distant metastasis in one year after operation (P < 0.05). Conclusion: The detection of bone marrow micrometastasis by IMB combined with SEM is an early diagnostic method and prognostic indicator of breast cancer with potential value.