Ballester Marcos, Rouzier Roman, Coutant Charles, Kerrou Khaldoun, Daraï Emile
Department of Obstetrics and Gynecology, Hospital Tenon, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie Paris 6, France.
Gynecol Oncol. 2009 Feb;112(2):348-52. doi: 10.1016/j.ygyno.2008.11.004. Epub 2008 Dec 11.
Lymph node status in endometrial cancer is a major prognostic factor. Sentinel lymph node (SLN) biopsy using radiocolloid and blue dye labeling has emerged as an alternative to systematic lymphadenectomy. This technique requires a preoperative lymphoscintigraphy. The aim of this study was to evaluate the limits of day-before preoperative lymphoscintigraphy to SLN biopsy.
Between July 2002 and March 2007, 38 patients with endometrial cancer underwent laparoscopic SLN procedure using radiocolloid and blue dye. Those with early-stage I endometrial cancer (35 patients) underwent a SLN procedure followed by systematic pelvic lymphadenectomy and a hysterectomy with bilateral salpingo-oophorectomy while those with presumed stage IIB on MR imaging (3 patients) underwent a radical hysterectomy. Omentectomy and paraaortic lymphadenectomy were also performed for women with clear cell or serous papillary carcinoma (5 patients). The SLN identification rates and false-negative rates were studied.
The detection rate of lymphoscintigraphy was 84.5% (32/38), with 1.9 nodes per patient. Eight of 17 patients (47%) with unilateral sentinel lymph node on lymphoscintigraphy had bilateral SLNs at surgery and three of 15 patients (20%) with bilateral SLN on lymphoscintigraphy had unilateral SLN at surgery. The correlation was poor (kappa=0.266). When categorized in <2 and > or =2 sentinel nodes, the correlation between lymphoscintigraphic and surgical SLN mapping was moderate (kappa=0.33).
Our results demonstrated the low correlation between day-before lymphoscintigraphy and surgical SLN mapping raising issues of its usefulness and cost-effectiveness in routine practice.
子宫内膜癌的淋巴结状态是一个主要的预后因素。使用放射性胶体和蓝色染料标记的前哨淋巴结（SLN）活检已成为系统性淋巴结清扫术的替代方法。该技术需要术前进行淋巴闪烁显像。本研究的目的是评估术前一天淋巴闪烁显像对SLN活检的局限性。
2002年7月至2007年3月期间，38例子宫内膜癌患者接受了使用放射性胶体和蓝色染料的腹腔镜SLN手术。早期I期子宫内膜癌患者（35例）接受SLN手术，随后进行系统性盆腔淋巴结清扫术以及子宫切除术加双侧输卵管卵巢切除术，而磁共振成像显示为IIB期的患者（3例）接受根治性子宫切除术。对于透明细胞或浆液性乳头状癌患者（5例）还进行了大网膜切除术和腹主动脉旁淋巴结清扫术。研究了SLN的识别率和假阴性率。
淋巴闪烁显像的检测率为84.5%（32/38），每位患者平均有1.9个淋巴结。淋巴闪烁显像显示单侧前哨淋巴结的17例患者中有8例（47%）在手术时发现双侧SLN，淋巴闪烁显像显示双侧SLN的15例患者中有3例（20%）在手术时发现单侧SLN。相关性较差（kappa=0.266）。当分为<2个和≥2个前哨淋巴结时，淋巴闪烁显像和手术SLN定位之间的相关性为中等（kappa=0.33）。
我们的结果表明术前一天淋巴闪烁显像与手术SLN定位之间的相关性较低，这引发了其在常规实践中的实用性和成本效益问题。
