Maccauro Marco, Lucignani Giovanni, Aliberti Gianluca, Villano Carlo, Castellani Maria Rita, Solima Eugenio, Bombardieri Emilio
Nuclear Medicine Division, Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy.
Eur J Nucl Med Mol Imaging. 2005 May;32(5):569-74. doi: 10.1007/s00259-004-1709-4. Epub 2004 Dec 30.
The purpose of this study was to assess the feasibility of sentinel lymph node (SLN) detection in endometrial cancer patients with a dual-tracer procedure after hysteroscopic peritumoural injection.
Twenty-six women with previously untreated endometrial adenocarcinoma underwent the hysteroscopic injection of 111 MBq 99mTc-Nanocoll and blue dye administered subendometrially around the lesion. On the same day, all 26 patients underwent lymphoscintigraphy, followed 3-4 h later by hysterotomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Para-aortic lymphadenectomy was also performed in cases of either serous or papillary carcinoma (n=7/26). All SLNs were removed and examined with haematoxylin and eosin staining and immunohistochemical techniques.
The procedure was well tolerated by patients, only two experiencing transient vagal symptoms. The sensitivity of this technique for correct identification of SLNs was 100%. Lymph node metastases were found in 4 out of the 26 patients (15%), bilaterally in the external iliac region (n=1), unilaterally in the external iliac region (n=1), unilaterally in the common iliac region (n=1) and unilaterally in the para-aortic region (n=1). In all four cases, nodal metastases were located within SLNs detected by lymphoscintigraphy. Only 10 of the 26 patients (38%) had significant blue dye staining. All blue-stained SLNs were radioactive.
In patients with endometrial cancer, it is feasible to use lymphatic mapping and SLN biopsy to define the topographic distribution of the lymphatic network and also to accurately detect lumbo-aortic and pelvic metastases within SLNs. In the majority of patients with early stage endometrial cancer, this procedure may avoid unnecessary radical pelvic lymphadenectomy. It may also guide para-aortic lymph node dissection on the basis of the SLN status.
本研究旨在评估经宫腔镜肿瘤周围注射双示踪剂法检测子宫内膜癌患者前哨淋巴结（SLN）的可行性。
26例未经治疗的子宫内膜腺癌患者接受了宫腔镜下111MBq 99mTc-纳米胶体注射，并在病变周围的子宫内膜下注射蓝色染料。同一天，所有26例患者均接受了淋巴闪烁显像，3 - 4小时后进行子宫切开术并双侧输卵管卵巢切除术及盆腔淋巴结清扫术。浆液性或乳头状癌患者（n = 7/26）还进行了腹主动脉旁淋巴结清扫术。所有前哨淋巴结均被切除，并用苏木精和伊红染色及免疫组化技术进行检查。
患者对该操作耐受性良好，仅2例出现短暂的迷走神经症状。该技术正确识别前哨淋巴结的敏感性为100%。26例患者中有4例（15%）发现淋巴结转移，分别为双侧髂外区域（n = 1）、单侧髂外区域（n = 1）、单侧髂总区域（n = 1）和单侧腹主动脉旁区域（n = 1）。在所有4例中，淋巴结转移均位于淋巴闪烁显像检测到的前哨淋巴结内。26例患者中仅10例（38%）有明显的蓝色染料染色。所有蓝色染色的前哨淋巴结均有放射性。
对于子宫内膜癌患者，使用淋巴绘图和前哨淋巴结活检来确定淋巴网络的地形分布以及准确检测前哨淋巴结内的腰主动脉和盆腔转移是可行的。对于大多数早期子宫内膜癌患者，该操作可避免不必要的根治性盆腔淋巴结清扫术。它还可根据前哨淋巴结状态指导腹主动脉旁淋巴结清扫。
