Cibula D, Kuzel D, Sláma J, Fischerova D, Dundr P, Freitag P, Zikán M, Pavlista D, Tomancova V
Oncogynecological Center, Department of Obstetrics and Gynecology, General Teaching Hospital in Prague, First Medical School, Charles University, Apolinarska 18, Prague 2, Czech Republic.
Oncogynecological Center, Department of Obstetrics and Gynecology, General Teaching Hospital in Prague, First Medical School, Charles University, Apolinarska 18, Prague 2, Czech Republic.
Gynecol Oncol. 2009 Oct;115(1):46-50. doi: 10.1016/j.ygyno.2009.06.017. Epub 2009 Jul 31.
Sentinel lymph node (SLN) biopsy can significantly contribute to the management of locally advanced cervical cancers with high risk of lymph node (LN) positivity. However, low detection rate and sensitivity were reported in larger tumors, albeit on a small number of cases. It was the aim of our study to verify the SLN reliability in large tumors, with modified dye application technique and a careful identification of side-specific lymphatic drainage.
The study involved 44 patients with tumors 3 cm in diameter or larger, stages IB1 to IIA, or selected IIB. In cases where SLN could not be detected, systematic pelvic lymphadenectomy was performed on the respective side. Systematic pelvic lymphadenectomy was performed during the second step radical procedure if not already done.
Detection rate in the whole cohort reached 77% per patient and 59% bilaterally. No significant difference was found whether a blue dye or a combined method was used (75% vs 80%, and 55% vs 67%). Systematic pelvic lymphadenectomy was performed in cases with undetected SLN unilaterally in 8 and bilaterally in 10 women. A systematic pelvic lymphadenectomy was included in the second step radical procedure in 19 cases and no positive LN were found. There was no case of false-negative SLN result in patients who underwent surgical treatment.
Detection rate in locally advanced cervical cancer could be improved by a careful dye application technique. Low false-negative SLN rate could be achieved if pelvic lymphatic drainage is evaluated on a side-specific principle by performing systematic lymphadenectomy if SLN is not detected.
前哨淋巴结（SLN）活检对局部晚期宫颈癌伴淋巴结（LN）转移高风险患者的治疗有重要意义。然而，尽管病例数较少，但有报道称较大肿瘤的SLN检出率和敏感性较低。本研究旨在通过改良染料应用技术和仔细识别侧方特异性淋巴引流，验证SLN在大肿瘤中的可靠性。
本研究纳入44例直径3 cm及以上的肿瘤患者，分期为IB1至IIA期，或部分IIB期。若未检测到SLN，则对相应侧进行系统性盆腔淋巴结清扫术。若在第二步根治性手术中尚未进行系统性盆腔淋巴结清扫术，则进行该操作。
整个队列中每位患者的检出率达到77%，双侧检出率为59%。使用蓝色染料或联合方法时未发现显著差异（75%对80%，55%对67%）。8例单侧未检测到SLN和10例双侧未检测到SLN的患者进行了系统性盆腔淋巴结清扫术。19例患者在第二步根治性手术中进行了系统性盆腔淋巴结清扫术，未发现阳性LN。接受手术治疗的患者中未出现假阴性SLN结果。
通过仔细的染料应用技术可提高局部晚期宫颈癌的检出率。若根据侧方特异性原则评估盆腔淋巴引流，未检测到SLN时进行系统性淋巴结清扫术，可实现较低的假阴性SLN率。
