Frumovitz Michael, Coleman Robert L, Gayed Isis W, Ramirez Pedro T, Wolf Judith K, Gershenson David M, Levenback Charles F
Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Am J Obstet Gynecol. 2006 Apr;194(4):1186-93; discussion 1193-5. doi: 10.1016/j.ajog.2005.12.018.
The purpose of this study was to assess the value of preoperative lymphoscintigraphy before intraoperative lymphatic mapping for sentinel lymph node identification during radical hysterectomy.
Fifty patients underwent intraoperative lymphatic mapping on our institutional review board-approved protocol. The location of sentinel lymph nodes that were found on lymphoscintigraphy and intraoperative lymphatic mapping were compared.
Fifteen of 21 patients (71%) with solitary sentinel lymph nodes that were found on lymphoscintigraphy had multiple sentinel lymph node basins found during the operation. Thirteen of 25 patients (52%) with unilateral sentinel lymph node basins that were found on lymphoscintigraphy had bilateral sentinel lymph nodes at intraoperative lymphatic mapping. Of 15 patients with 2 sentinel lymph node locations that were identified on lymphoscintigraphy, 12 patients (80%) had > or = 3 found during the operation. Of the sentinel lymph nodes that were located on the external iliac basin (n = 47) on lymphoscintigraphy, only 20 lymph nodes (43%) were found at that location during the operation. Concordance between the 2 methods was poor. Seven of the 9 patients with lymph node metastases had disease that was limited to the sentinel lymph nodes.
Preoperative lymphoscintigraphy adds little value over intraoperative lymphatic mapping for sentinel lymph node identification during radical hysterectomy.
本研究旨在评估在根治性子宫切除术中，术前淋巴闪烁造影在术中淋巴管造影识别前哨淋巴结的价值。
50例患者按照我们机构审查委员会批准的方案接受术中淋巴管造影。比较淋巴闪烁造影和术中淋巴管造影发现的前哨淋巴结位置。
淋巴闪烁造影发现的21例有单个前哨淋巴结的患者中，15例（71%）在手术中发现多个前哨淋巴结区域。淋巴闪烁造影发现的25例有单侧前哨淋巴结区域的患者中，13例（52%）在术中淋巴管造影时有双侧前哨淋巴结。淋巴闪烁造影识别出有2个前哨淋巴结位置的15例患者中，12例（80%）在手术中发现≥3个。淋巴闪烁造影显示位于髂外区域的47个前哨淋巴结中，手术中仅在该位置发现20个（43%）。两种方法的一致性较差。9例有淋巴结转移患者中的7例，疾病局限于前哨淋巴结。
在根治性子宫切除术中，术前淋巴闪烁造影在识别前哨淋巴结方面比术中淋巴管造影增加的价值不大。
