Fader A Nickles, Edwards R P, Cost M, Kanbour-Shakir A, Kelley J L, Schwartz B, Sukumvanich P, Comerci J, Sumkin J, Elishaev E, Rohan L Cencia
Department of Obstetrics, School of Medicine, University of Pittsburgh, Magee-Womens Hospital, Pittsburgh, PA 15213, USA.
Gynecol Oncol. 2008 Oct;111(1):13-7. doi: 10.1016/j.ygyno.2008.06.009. Epub 2008 Aug 5.
To determine the diagnostic accuracy of sentinel lymph node (SLN) detection using lymphoscintigraphy, intraoperative blue dye, and radiocolloid in patients with early-stage cervical cancer.
Intra-cervical injection of technetium-99 sulfur colloid and lymphoscintigraphy were performed preoperatively. Isosulfan blue was injected intra-cervically immediately prior to surgery. SLNs were excised and examined intraoperatively (imprint cytology and frozen section) and postoperatively (H and E histology and immunohistochemistry (IHC) for cytokeratin).
Thirty eight patients were evaluable. Laparoscopy and laparotomy were performed in 28.9% and 71.1%, respectively. Subjects had squamous cell carcinoma (n=26), adenocarcinoma (n=10) or adenosquamous (n=2) histologies. 55.3% had cervical tumors <2 cm. The overall SLN detection rate was 92.1%. The external iliac region just distal to the common iliac bifurcation was the most common SLN location. A mean of 2.1 SLNs were detected per patient with bilateral SLNs observed in 47.4%. On final pathology, metastatic nodal disease was identified in 15.7% of patients. Of these, 83.3% were detected in the SLNs. Sensitivity of SLN detection of metastasis was 100% for patients with cervical tumors <2 cm. However intraoperative evaluation by imprint cytology and frozen section correctly identified lymph node metastasis in only 33.3%.
SLN detection is feasible and accurately reflects pelvic nodal basin status when performed in early-stage cervical cancer patients. However, while current intraoperative pathology techniques for assessing nodal metastases reliably detect metastases larger than 2 mm, they lack sufficient sensitivity to detect micrometastasis and isolated tumor cells.
确定在早期宫颈癌患者中使用淋巴闪烁显像、术中蓝色染料和放射性胶体检测前哨淋巴结（SLN）的诊断准确性。
术前进行宫颈内注射99锝硫胶体和淋巴闪烁显像。手术即将开始前在宫颈内注射异硫蓝。术中切除前哨淋巴结并进行检查（印片细胞学检查和冰冻切片），术后进行检查（苏木精和伊红染色组织学检查以及细胞角蛋白免疫组织化学（IHC）检查）。
38例患者可进行评估。分别有28.9%和71.1%的患者接受了腹腔镜检查和剖腹手术。患者的组织学类型包括鳞状细胞癌（n = 26）、腺癌（n = 10）或腺鳞癌（n = 2）。55.3%的患者宫颈肿瘤<2 cm。前哨淋巴结的总体检测率为9%.髂总动脉分叉远端的髂外区域是最常见的前哨淋巴结位置。每位患者平均检测到2.1个前哨淋巴结，47.4%的患者观察到双侧前哨淋巴结。在最终病理检查中，15.7%的患者发现有转移性淋巴结疾病。其中，83.3%在前哨淋巴结中被检测到。宫颈肿瘤<2 cm的患者中，前哨淋巴结转移检测的敏感性为100%。然而，术中通过印片细胞学检查和冰冻切片评估仅能正确识别33.3%的淋巴结转移。
在前哨淋巴结检测在早期宫颈癌患者中进行时是可行的，并且能够准确反映盆腔淋巴结状态。然而，虽然目前用于评估淋巴结转移的术中病理技术能够可靠地检测出大于2 mm的转移灶，但它们缺乏足够的敏感性来检测微转移和孤立肿瘤细胞。
