Daraï Emile, Lavoué Vincent, Rouzier Roman, Coutant Charles, Barranger Emmanuel, Bats Anne-Sophie
Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France.
Gynecol Oncol. 2007 Jul;106(1):251-6. doi: 10.1016/j.ygyno.2007.03.034. Epub 2007 May 8.
The required radicality of hysterectomy for women with early-stage cervical cancer is controversial owing to the risk of severe complications. The aim of this study was to determine the contribution of the sentinel node (SN) procedure to tailoring the radicality of hysterectomy in women with cervical cancer.
Between April 2001 and December 2005, 54 patients with early-stage or locally advanced cervical cancer underwent laparoscopic sentinel node (SN) biopsy based on combined patent blue and radiocolloid detection. Thirty-nine patients with early-stage cervical cancer underwent a laparoscopic SN procedure with complete pelvic lymphadenectomy and radical hysterectomy. Moreover, 15 women with locally advanced cervical cancer underwent an SN procedure with pelvic and para-aortic lymphadenectomy before concurrent neoadjuvant chemoradiotherapy.
The SN detection rate was 83.3%. The detection rate was higher in women with early-stage disease (90%) than in women with more advanced disease (66.6%) (p=0.03). At final histology, 14 metastatic SN were found in 11 (21.3%) of the 54 patients. They comprised macrometastases in 6 SN, micrometastases in 5 SN, and isolated tumour cells in 3 SN. Parametrial involvement with negative sentinel nodes was found in 15.1% of cases. The overall sensitivity, specificity, positive and negative predictive values and accuracy of intraoperative imprint cytology were 20%, 100%, 100%, 79.5% and 80.5%, respectively. Among the 39 women with early cervical cancer, five (12.8%) had parametrial involvement. In univariate analysis, parametrial involvement was significantly associated with large tumour size, advanced-stage disease, positive pelvic lymph nodes and lymphovascular space involvement. Parametrial involvement tended to be associated with positive sentinel nodes.
These results underline the contribution of the SN procedure to evaluating lymph node status. However, intraoperative imprint cytology appeared poorly accurate, and further histological or biological tools are needed to evaluate SN status and, hence, to tailor the radicality of hysterectomy.
由于存在严重并发症的风险，早期宫颈癌患者子宫切除术所需的根治程度存在争议。本研究的目的是确定前哨淋巴结（SN）程序对调整宫颈癌患者子宫切除术根治程度的作用。
2001年4月至2005年12月期间，54例早期或局部晚期宫颈癌患者基于专利蓝和放射性胶体联合检测进行了腹腔镜前哨淋巴结（SN）活检。39例早期宫颈癌患者接受了腹腔镜SN程序，并进行了完全盆腔淋巴结清扫和根治性子宫切除术。此外，15例局部晚期宫颈癌患者在同步新辅助放化疗前接受了SN程序及盆腔和腹主动脉旁淋巴结清扫。
SN检测率为83.3%。早期疾病患者的检测率（90%）高于晚期疾病患者（66.6%）（p=0.03）。在最终组织学检查中，54例患者中有11例（21.3%）发现14个转移性SN。其中6个SN为大转移灶，5个SN为微转移灶，3个SN为孤立肿瘤细胞。15.1%的病例发现前哨淋巴结阴性但宫旁受累。术中印片细胞学检查的总体敏感性、特异性、阳性和阴性预测值及准确性分别为20%、100%、100%、79.5%和80.5%。在39例早期宫颈癌患者中，5例（12.8%）有宫旁受累。单因素分析中，宫旁受累与肿瘤体积大、疾病分期晚、盆腔淋巴结阳性及淋巴管间隙受累显著相关。宫旁受累倾向于与前哨淋巴结阳性相关。
这些结果强调了SN程序对评估淋巴结状态的作用。然而，术中印片细胞学检查的准确性似乎较差，需要进一步的组织学或生物学工具来评估SN状态，从而调整子宫切除术的根治程度。
