Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., NY, NY 10065, USA.
Gynecol Oncol. 2011 Aug;122(2):251-4. doi: 10.1016/j.ygyno.2011.04.030. Epub 2011 May 12.
To compare the incidence of metastatic cancer cells in sentinel lymph nodes (SLN) vs. non-sentinel nodes in patients who had lymphatic mapping for endometrial cancer and to determine the contribution of metastases detected on ultrastaging to the overall nodal metastasis rate.
All patients who underwent lymphatic mapping for endometrial cancer were reviewed. Cervical injection of blue dye was used in all cases. Sentinel nodes were examined by routine hematoxylin and eosin (H&E), and if negative, by standardized institutional pathology protocol that included additional sections and immunohistochemistry (IHC).
Between 09/2005 and 03/2010, 266 patients with endometrial cancer underwent lymphatic mapping. Sentinel node identification was successful in 223 (84%) cases. Positive nodes were diagnosed in 32/266 (12%) patients. Of those, 8/266 patients (3%) had the metastasis detected only by additional section or IHC as part of SLN ultrastaging. Excluding the 8 cases with positive SLN on ultrastaging only, 24/801 (2.99%) SLN and 30/2698 (1.11%) non-SLN were positive for metastatic disease (p=0.0003).
Using a cervical injection for mapping, metastatic cells from endometrial cancer are three times as likely to be detected in SLN than in the non-sentinel nodes. This finding strongly supports the concept of lymphatic mapping in endometrial cancer to fine tune the nodal dissection topography. By adding SLN mapping to our current surgical staging procedures we may increase the likelihood of detecting metastatic cancer cells in regional lymph nodes. An additional benefit of incorporating pathologic ultrastaging of SLN is the detection of micrometastasis, which may be the only evidence of extrauterine spread.
比较行淋巴管造影术的子宫内膜癌患者前哨淋巴结（SLN）与非前哨淋巴结转移癌细胞的发生率，并确定超微结构检查发现的转移灶对淋巴结转移总发生率的贡献。
对所有行淋巴管造影术的子宫内膜癌患者进行回顾性分析。所有患者均行宫颈注射蓝染剂。SLN 经常规苏木精-伊红（H&E）染色检查，若为阴性，则按照机构标准化病理方案进一步行额外切片和免疫组化（IHC）检查。
2005 年 9 月至 2010 年 3 月，266 例子宫内膜癌患者行淋巴管造影术。223 例（84%）患者成功识别出 SLN。266 例患者中 32 例（12%）淋巴结阳性。其中 8 例（3%）仅通过 SLN 超微结构检查中的额外切片或 IHC 发现转移灶。排除仅在超微结构检查中发现阳性 SLN 的 8 例患者，24/801（2.99%）SLN 和 30/2698（1.11%）非 SLN 存在转移性疾病（p=0.0003）。
使用宫颈注射法进行定位，子宫内膜癌转移细胞在 SLN 中检测到的可能性是在非前哨淋巴结中的 3 倍。这一发现有力地支持了在子宫内膜癌中进行淋巴造影术以精确调整淋巴结解剖区域的概念。通过将 SLN 映射添加到我们目前的手术分期程序中，我们可能会增加在区域淋巴结中检测到转移性癌细胞的可能性。纳入 SLN 超微结构检查的另一个益处是发现微转移灶，这可能是子宫外扩散的唯一证据。
