Vieira Sabas C, Sousa Rodrigo B, Tavares Marília B A C, Silva Jeany B, Abreu Benedita A L, Santos Lina G, da Silva Benedito B, Zeferino Luiz C
Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2009 Jul;145(1):96-9. doi: 10.1016/j.ejogrb.2009.03.025. Epub 2009 May 6.
To analyze concordance between preoperative lymphoscintigraphy and intraoperative lymphatic mapping (ILM) for sentinel lymph node identification using technetium 99m-labeled-dextran 500 (99m-Tc) and patent blue dye in patients with early cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy, as well as to evaluate sentinel lymph node (SLN) detection.
Forty-seven patients underwent surgical treatment for cervical cancer. For SLN identification, 99m-Tc and blue patent were injected into the cervix on the eve and day of surgery, respectively. Preoperative pelvic lymphoscintigraphy was performed in all patients after 99m-Tc injection. Concordance between preoperative lymphoscintigraphy and ILM was evaluated.
Of the 56 patients who underwent preoperative lymphoscintigraphy, 43 (81.13%) had at least one lymph node identified. Bilateral lymph nodes were identified in 21 (37.5%) patients. Sentinel lymph nodes detected on ILM had been previously found on preoperative lymphoscintigraphy in 66.7%, 67.2% and 0% in the right, left and central locations, respectively. In 14 patients (25%), only one lymph node was identified on preoperative lymphoscintigraphy, but more than one sentinel lymph node was detected on intraoperative mapping. In nine (16.1%) patients, lymphoscintigraphy showed only unilateral lymph nodes, but ILM identified bilateral sentinel lymph nodes.
The combination of patent blue and radionuclide techniques produced excellent results for SLN detection in cervical cancer. Preoperative lymphoscintigraphy does not offer any advantage over ILM for SLN identification.
分析术前淋巴闪烁显像与术中淋巴管造影（ILM）在使用锝99m标记右旋糖酐500（99m-Tc）和专利蓝染料对早期宫颈癌患者进行根治性子宫切除术和盆腔淋巴结清扫术中前哨淋巴结识别方面的一致性，同时评估前哨淋巴结（SLN）的检测情况。
47例宫颈癌患者接受了手术治疗。为识别SLN，分别在手术前夕和手术当天将99m-Tc和专利蓝注入宫颈。所有患者在注射99m-Tc后均进行了术前盆腔淋巴闪烁显像。评估术前淋巴闪烁显像与ILM之间的一致性。
在56例行术前淋巴闪烁显像的患者中，43例（81.13%）至少识别出一个淋巴结。21例（37.5%）患者识别出双侧淋巴结。ILM检测到的前哨淋巴结在术前淋巴闪烁显像中，右侧、左侧和中央部位分别有66.7%、67.2%和0%被先前发现。14例（25%）患者在术前淋巴闪烁显像中仅识别出一个淋巴结，但术中造影检测到多个前哨淋巴结。9例（16.1%）患者淋巴闪烁显像仅显示单侧淋巴结，但ILM识别出双侧前哨淋巴结。
专利蓝和放射性核素技术相结合在宫颈癌SLN检测中取得了优异结果。术前淋巴闪烁显像在SLN识别方面并不比ILM具有任何优势。
