Service de Gynécologie-Obstétrique, hôpital Tenon, AP-HP, CancerEst, Université Pierre et Marie Curie, Paris VI, France.
BMC Cancer. 2010 Aug 30;10:465. doi: 10.1186/1471-2407-10-465.
Lymphadenectomy is debated in early stages endometrial cancer. Moreover, a new FIGO classification of endometrial cancer, merging stages IA and IB has been recently published. Therefore, the aims of the present study was to evaluate the relevance of the sentinel node (SN) procedure in women with endometrial cancer and to discuss whether the use of the 2009 FIGO classification could modify the indications for SN procedure.
Eighty-five patients with endometrial cancer underwent the SN procedure followed by pelvic lymphadenectomy. SNs were detected with a dual or single labelling method in 74 and 11 cases, respectively. All SNs were analysed by both H&E staining and immunohistochemistry. Presumed stage before surgery was assessed for all patients based on MR imaging features using the 1988 FIGO classification and the 2009 FIGO classification.
An SN was detected in 88.2% of cases (75/85 women). Among the fourteen patients with lymph node metastases one-half were detected by serial sectioning and immunohistochemical analysis. There were no false negative case. Using the 1988 FIGO classification and the 2009 FIGO classification, the correlation between preoperative MRI staging and final histology was moderate with Kappa = 0.24 and Kappa = 0.45, respectively. None of the patients with grade 1 endometrioid carcinoma on biopsy and IA 2009 FIGO stage on MR imaging exhibited positive SN. In patients with grade 2-3 endometrioid carcinoma and stage IA on MR imaging, the rate of positive SN reached 16.6% with an incidence of micrometastases of 50%.
The present study suggests that sentinel node biopsy is an adequate technique to evaluate lymph node status. The use of the 2009 FIGO classification increases the accuracy of MR imaging to stage patients with early stages of endometrial cancer and contributes to clarify the indication of SN biopsy according to tumour grade and histological type.
在早期子宫内膜癌中，淋巴结切除术存在争议。此外，最近发布了一种新的FIGO 子宫内膜癌分类，将 IA 期和 IB 期合并。因此，本研究旨在评估前哨淋巴结（SN）在子宫内膜癌患者中的相关性，并讨论 2009 FIGO 分类的使用是否会改变 SN 术的适应证。
85 例子宫内膜癌患者行 SN 术联合盆腔淋巴结切除术。74 例和 11 例患者分别采用双标记和单标记法检测 SN。所有 SN 均采用 H&E 染色和免疫组化法进行分析。所有患者均根据 MR 成像特征采用 1988 FIGO 分类和 2009 FIGO 分类进行术前评估。
88.2%（75/85 例）患者检测到 SN。14 例淋巴结转移患者中，半数通过连续切片和免疫组化分析检测到。无一例假阴性病例。使用 1988 FIGO 分类和 2009 FIGO 分类，术前 MRI 分期与最终组织学之间的相关性中等，Kappa 值分别为 0.24 和 0.45。活检为 1 级子宫内膜样癌且 MR 成像为 IA 2009 FIGO 期的患者无一例 SN 阳性。MR 成像为 2-3 级子宫内膜样癌且 IA 期的患者中，SN 阳性率为 16.6%，微转移率为 50%。
本研究表明 SN 活检是评估淋巴结状态的一种充分技术。2009 FIGO 分类的使用提高了 MR 成像分期早期子宫内膜癌患者的准确性，并有助于根据肿瘤分级和组织学类型明确 SN 活检的适应证。
