de Hullu J A, Hollema H, Piers D A, Verheijen R H, van Diest P J, Mourits M J, Aalders J G, van Der Zee A G
Departments of Gynecologic Oncology, Pathology, and Nuclear Medicine, University Hospital Groningen, Groningen, The Netherlands.
J Clin Oncol. 2000 Aug;18(15):2811-6. doi: 10.1200/JCO.2000.18.15.2811.
To determine the diagnostic accuracy of the sentinel lymph node procedure in patients with squamous cell carcinoma of the vulva and to investigate whether step sectioning and immunohistochemistry of sentinel lymph nodes increase the sensitivity for detection of metastases.
Between July 1996 and July 1999, 59 patients with primary vulvar cancer were entered onto a two-center prospective study. All patients underwent sentinel lymph node procedure with the combined technique (preoperative lymphoscintigraphy with technetium-99m-labeled nanocolloid and intraoperative blue dye). Radical excision of the primary tumor with uni- or bilateral inguinofemoral lymphadenectomy was performed subsequently. Sentinel lymph nodes and lymphadenectomy specimens were sent for histopathologic examination separately. Sentinel lymph nodes, negative at the time of routine pathologic examination, were re-examined with step sectioning and immunohistochemistry.
In 59 patients, 107 inguinofemoral lymphadenectomies were performed (11 unilateral and 48 bilateral). All sentinel lymph nodes, as observed on preoperative lymphoscintigram, were identified successfully intraoperatively. Routine histopathologic examination showed lymph node metastases in 27 groins, all of which were detected by the sentinel lymph node procedure. The negative predictive value for a negative sentinel lymph node was 100% (97.5% confidence interval [CI], 95% to 100%). Step sectioning and immunohistochemistry showed four additional metastases in 102 sentinel lymph nodes (4%; 95% CI, 1% to 9%) that were negative at the time of routine histopathologic examination.
Sentinel lymph node procedure with the combined technique is highly accurate in predicting the inguinofemoral lymph node status in patients with early-stage vulvar cancer. Future trials should focus on the safe clinical implementation of the sentinel lymph node procedure in these patients. Step sectioning and immunohistochemistry slightly increase the sensitivity of detecting metastases in sentinel lymph nodes and should be included in these trials.
确定前哨淋巴结活检术对外阴鳞状细胞癌患者的诊断准确性，并研究前哨淋巴结的连续切片检查和免疫组化是否能提高转移灶的检测敏感性。
1996年7月至1999年7月，59例原发性外阴癌患者进入一项双中心前瞻性研究。所有患者均采用联合技术进行前哨淋巴结活检术（术前用99m锝标记的纳米胶体进行淋巴闪烁显像和术中使用蓝色染料）。随后对原发性肿瘤进行根治性切除，并进行单侧或双侧腹股沟股淋巴结清扫术。前哨淋巴结和淋巴结清扫标本分别送去做组织病理学检查。对常规病理检查时为阴性的前哨淋巴结进行连续切片检查和免疫组化复查。
59例患者共进行了107次腹股沟股淋巴结清扫术（11例单侧，48例双侧）。术前淋巴闪烁显像观察到的所有前哨淋巴结在术中均成功识别。常规组织病理学检查显示27个腹股沟区有淋巴结转移，所有这些转移灶均通过前哨淋巴结活检术检测到。前哨淋巴结为阴性时的阴性预测值为100%（97.5%可信区间[CI]，95%至100%）。连续切片检查和免疫组化显示，在102个常规组织病理学检查时为阴性的前哨淋巴结中又发现了4处转移灶（4%；95%CI，1%至9%）。
联合技术的前哨淋巴结活检术在预测早期外阴癌患者腹股沟股淋巴结状态方面具有高度准确性。未来的试验应关注该前哨淋巴结活检术在这些患者中的安全临床应用。连续切片检查和免疫组化可略微提高前哨淋巴结转移灶的检测敏感性，应纳入这些试验。
