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Comparing of three histology methods leading to the diagnosis.
DOLEJŠÍ, Lenka
The main aim of this thesis was to compare three methods of histology from both the theoretical analysis to determine the final diagnosis and resulting the level of surgical procedures. I compared the rapid intraoperative biopsy (RPB), dyeing of hematoxylineosin (HE) and immunostaining method (IHC) especailly monoclonal antibody Cytokeratin 7 (CK 7). All of the three methods of histology are being used to examine the sentinel lymph node (SN). The SN is removed to the patients with diagnosed breast cancer. I paid attention to describe individual procedures of the selected methods of histology in the first part of this thesis. I also pointed out the complications during detecting the nodes of the carcinom of breast. And I underlined the advantages of detecting SN, which is nowadays widely supplied to all patients compare to the method of axillary nodes dissection used before. Before the SN detecting method was implemented, there used to be an old method which primarily removed the axillary nodes from each patient after the carcinom of breast had been detected. This quite extensive action caused further complications regarding the deconditioning of the limbs dynamics and swelling. With this respect the patient´s following treatment and recovery went worse. Currently the axillary nodes are being removed only if metastasis in sentinel lymph node was detected. My thesis shows that there were found many more sentinel nodes without metastasis and therefore, these days, there are many patients saved from the dissection of axillary nodes. This is mainly assured by an early detection of carcinoma. The methodical part of my thesis was carried out in the hospital of České Budějovice in the pathological lab (PAO NCB), where I have been employed. This part is divided into pre-analytic, analytic and post-analytic phases. The pre-analytical phase emphasizes the importance of correct biopsy and trasport of its sample to the lab. The analytical phase pays attention to each method individually. I describe all the procedures which each sample must go through before a diagnosis can be done. The post analytical phase summarizes the diagnose itself. In the part of the thesis which is aimed at results, I show statistical evaluations of the whole amount of examined paraffine embedded tissues and sample forms within the period of 2003 2013. There is also intercepted annual grow of IHC since its implementation in 1998 until 2013. I analysed a continual change of primary antibodies used at PAO NCB. I also evaluated my own measured results. In the term from March 2013 to March 2014 I processed altogehter 142 SN, which were removed from proved breast cancer. Each SN was processed through RPB, followed by dyeing through HE and examined with IHC antibody CK 7. There were found 22 metastasis of breast cancer in SN through the rapid intraoperative biopsy, other 16 metastasis were detected through HE staining and another 7 positive results in SN were detected through IHC antibody CK 7. We found altogether 45 positive metastasis in SN. 97 sentinel lymph nodes were negative. According to the processed results we proved that the biggest detection of metastasis in SN was through the method of IHC antibody CK 7. I also analysed the impact of patients´ age regarding the metastasis in SN. I divided the patients into 5 categories according to the age (see graph 5, 6). The largest number of SN positive was in the category 61-70 years of age. In the discussion part I described the evaluation of measured results and pointed out strong changes of RPB, HE and IHC methods which have been processed in the PAO NCB department within the past few years.
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