Ballester Marcos, Dubernard Gil, Rouzier Roman, Barranger Emmanuel, Darai Emile
Department of Gynecology and Obstetrics, Service de Gynécologie, Hôpital Tenon, 4 rue de la Chine, 75020, AP-HP, CancerEst, Université Pierre et Marie Curie ParisVI, France.
Ann Surg Oncol. 2008 May;15(5):1523-9. doi: 10.1245/s10434-008-9841-1. Epub 2008 Mar 6.
Lymph node status is a major prognostic factor and a criterion for adjuvant therapy in endometrial cancer. The sentinel lymph node (SN) procedure has emerged as a possible alternative to systematic lymphadenectomy. The aims of this study were to determine the detection rate and the false-negative rate of the SN procedure, and its contribution to the staging of women with endometrial cancer.
Forty-six patients with endometrial cancer underwent the sentinel node procedure followed by pelvic lymphadenectomy. SNs were detected with a dual or single labelling method in 39 and 7 cases, respectively. All SNs were analysed by both hematoxylin and eosin (H&E) staining and immunochemistry.
SNs were identified in 40 patients (87%), whose mean number of SN was 2.6 (range 1-5). The SN detection rate was significantly lower with the single label than with the dual label (p = 0.01). Ten women (25%) had a positive SN on final histology (i.e. there were no false negatives). A correlation was observed between lymph node involvement and both histological grade (p = 0.01) and lymphovascular space involvement (p = 0.001). The stage predicted by magnetic resonance (MR) imaging correlated poorly with the Federation International of Gynaecology and Obstetrics (FIGO) stage. Among the ten women with a positive SN, three of the four women with a grade 1 tumour at biopsy had grade 2-3 disease on final histology. Seven of the ten women with a positive SN underwent external pelvic radiotherapy, based solely on their SN involvement.
The SN procedure can reliably determine lymph node status in women with endometrial cancer. Given the limited capacity of MR imaging to detect myometrial invasion, and of biopsy to determine histological grade, our results support the systematic use of the SN procedure in women with endometrial cancer, including those with presumed early-stage disease and/or well-differentiated tumours.
淋巴结状态是子宫内膜癌的主要预后因素及辅助治疗的标准。前哨淋巴结（SN）活检已成为系统性淋巴结清扫术的一种可能替代方法。本研究的目的是确定SN活检的检出率和假阴性率，及其对子宫内膜癌女性分期的贡献。
46例子宫内膜癌患者接受了前哨淋巴结活检，随后进行盆腔淋巴结清扫术。分别采用双标记法和单标记法检测SN，39例和7例患者分别采用这两种方法。所有SN均进行苏木精-伊红（H&E）染色和免疫化学分析。
40例患者（87%）检测到SN，平均每个患者的SN数量为2.6个（范围1 - 5个）。单标记法的SN检出率显著低于双标记法（p = 0.01）。10名女性（25%）最终组织学检查显示SN阳性（即无假阴性）。观察到淋巴结受累与组织学分级（p = 0.01）和淋巴管间隙受累（p = 0.001）之间存在相关性。磁共振（MR）成像预测的分期与国际妇产科联合会（FIGO）分期相关性较差。在10例SN阳性的女性中，活检时肿瘤为1级的4名女性中有3名最终组织学检查显示为2 - 3级疾病。10例SN阳性的女性中有7例仅基于SN受累接受了盆腔外放疗。
SN活检能够可靠地确定子宫内膜癌女性的淋巴结状态。鉴于MR成像检测肌层浸润的能力有限，以及活检确定组织学分级的能力有限，我们的结果支持对子宫内膜癌女性系统性地使用SN活检，包括那些推测为早期疾病和/或高分化肿瘤的女性。
