Barranger Emmanuel, Cortez Annie, Grahek Dany, Callard Patrice, Uzan Serge, Darai Emile
Department of Gynecologic and Breast Tumors, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, France.
Ann Surg Oncol. 2004 Apr;11(4):445-52. doi: 10.1245/ASO.2004.09.006.
SN detection based on combined blue dye and radiocolloid labeling can reliably show lymph node status in cervical cancer, but the influence of prior neoadjuvant chemoradiotherapy has not yet been reported. The aim of this study was to evaluate the effect of neoadjuvant chemoradiotherapy on the accuracy of a dual-labeling laparoscopic sentinel node (SN) procedure in patients with cervical cancer.
Between July 2001 and June 2003, 26 patients (mean age, 50.3 years) with cervical cancer underwent a laparoscopic SN procedure based on dual labeling with patent blue and radiocolloid. After the SN procedure, all the patients underwent complete laparoscopic pelvic lymphadenectomy and laparoscopic radical hysterectomy (n=19), the Schauta-Amreich operation (n=5), or trachelectomy (n=2). The results of the SN procedure were compared between 11 patients who received neoadjuvant chemoradiotherapy and 15 patients who did not receive neoadjuvant treatment.
The SN identification rates were 100% in the 11 patients who underwent neoadjuvant chemoradiotherapy and 93.3% in the 15 patients who did not receive adjuvant therapy. A total of 59 SNs were removed. Eight SNs (13.6%) from five patients (19.2%) were found to be metastatic at the final histological assessment. Three SN involvements were detected by hematoxylin and eosin staining of the SN. Immunohistochemical studies identified five metastatic SNs in three patients. There were no false-negative SN results.
This study suggests that SN detection with a combination of radiocolloid and patent blue is feasible and accurate in patients with cervical cancer undergoing neoadjuvant chemoradiotherapy or primary surgery. The combination of laparoscopy and the SN procedure permits minimally invasive management of cervical cancer.
基于蓝色染料和放射性胶体联合标记的前哨淋巴结（SN）检测能够可靠地显示宫颈癌患者的淋巴结状态，但新辅助放化疗对其影响尚未见报道。本研究旨在评估新辅助放化疗对宫颈癌患者双标记腹腔镜前哨淋巴结（SN）手术准确性的影响。
2001年7月至2003年6月期间，26例（平均年龄50.3岁）宫颈癌患者接受了基于专利蓝和放射性胶体双标记的腹腔镜SN手术。SN手术后，所有患者均接受了完整的腹腔镜盆腔淋巴结清扫术和腹腔镜根治性子宫切除术（n = 19）、Schauta-Amreich手术（n = 5）或宫颈切除术（n = 2）。比较了11例接受新辅助放化疗的患者和15例未接受新辅助治疗的患者的SN手术结果。
11例接受新辅助放化疗的患者SN识别率为100%，15例未接受辅助治疗的患者SN识别率为93.3%。共切除59个SN。在最终组织学评估中，发现5例患者（19.2%）的8个SN（13.6%）有转移。通过SN的苏木精和伊红染色检测到3例SN受累。免疫组织化学研究在3例患者中鉴定出5个转移性SN。没有假阴性的SN结果。
本研究表明，对于接受新辅助放化疗或初次手术的宫颈癌患者，放射性胶体和专利蓝联合检测SN是可行且准确的。腹腔镜检查与SN手术相结合可实现宫颈癌的微创管理。
