Roca I, Caresia A P, Gil-Moreno A, Pifarre P, Aguade-Bruix S, Castell-Conesa J, Martínez-Palones J M, Xercavins J
Servei de Medicina Nuclear, Hospital Universitari Vall d'Hebron, 08035, Barcelona, Spain.
Eur J Nucl Med Mol Imaging. 2005 Oct;32(10):1210-6. doi: 10.1007/s00259-005-1834-8. Epub 2005 May 21.
Sentinel lymph node (SLN) mapping in combination with surgical biopsy is an emerging technique for use in the early stages of cervical cancer. The purpose of this study was to evaluate the technique in a series of 40 consecutive women with early stage cervical cancer.
Forty patients with early stage cervical cancer [FIGO stage IA2 (2), IB1 (34), IB2 (1) or IIA (3)] were referred for radical hysterectomy with pelvic lymphadenectomy. Patients were submitted to preoperative lymphoscintigraphy (four 99mTc-nanocolloid injections around the tumour) and intraoperative SLN detection. Hand-held or laparoscopic gamma probes were used to locate SLNs during surgery.
The mean number of SLNs was 2.5 per patient (interiliac 49%, external iliac 19%). Of the total of 99 SLNs, six, in four women, showed metastases (all 68 non-SLNs removed were negative). In the other 36 patients, all the removed lymph nodes (sentinel and non-sentinel) were negative (0% false negative rate). During the follow-up (median 25 months), only two patients presented distant metastases: one died 6 months after surgery (two of three SLNs positive, both hot and blue), while the second patient is alive 4 years after surgery (lung metastasis, no isotope drainage, negative blue SLN). The survival rate was 95% and disease-free survival, 97%.
SLN surgical biopsy based on lymphoscintigraphy and blue dye is a feasible and useful technique to avoid lymph node dissection in the early stages of cervical cancer. It has a high negative predictive value, can be incorporated into clinical routine (laparoscopy or open surgery) and is close to achieving validation in this setting.
前哨淋巴结（SLN）定位联合手术活检是一种用于宫颈癌早期的新兴技术。本研究的目的是在连续40例早期宫颈癌女性患者中评估该技术。
40例早期宫颈癌患者[国际妇产科联盟（FIGO）分期IA2期（2例）、IB1期（34例）、IB2期（1例）或IIA期（3例）]接受了根治性子宫切除术及盆腔淋巴结清扫术。患者术前接受淋巴闪烁显像（在肿瘤周围注射4次99mTc-纳米胶体）及术中SLN检测。手术过程中使用手持或腹腔镜γ探测器定位SLN。
每位患者SLN的平均数量为2.5个（髂间淋巴结占49%，髂外淋巴结占19%）。在总共99个SLN中，4例女性患者的6个SLN出现转移（所有切除的68个非SLN均为阴性）。在其他36例患者中，所有切除的淋巴结（前哨和非前哨）均为阴性（假阴性率为0%）。在随访期间（中位时间25个月），仅2例患者出现远处转移：1例患者术后6个月死亡（3个SLN中的2个阳性，均为热区和蓝色区），而另1例患者术后4年仍存活（肺转移，无同位素引流，蓝色SLN为阴性）。生存率为95%，无病生存率为97%。
基于淋巴闪烁显像和蓝色染料的SLN手术活检是一种可行且有用的技术，可避免宫颈癌早期的淋巴结清扫。它具有较高的阴性预测价值，可纳入临床常规操作（腹腔镜或开放手术），且在这种情况下已接近获得验证。
