经阴道超声引导下肌内注射放射性示踪剂（TUMIR）：子宫内膜癌前哨淋巴结检测的新方法。
Transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR): a new method for sentinel lymph node detection in endometrial cancer.
机构信息
Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain.
Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain.
出版信息
Gynecol Oncol. 2013 Jan;128(1):88-94. doi: 10.1016/j.ygyno.2012.10.008. Epub 2012 Oct 17.
OBJECTIVE
The objective of this prospective study was to determine the feasibility, safety and performance of a new method for sentinel lymph node (SLN) detection in endometrial cancer (EC) using transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR).
METHODS
From 2006 to 2011, 74 patients with high-risk EC were included in the study. Twenty-four hours before surgery 148MBq of (99m)Tc-nanocolloid (8mL) was injected into two spots in the anterior and posterior myometrium using an ultrasound-guided transvaginal puncture. SLN was localized preoperatively by lymphoscintigraphy and intraoperatively with gamma probe. After SLN biopsy the patients underwent a complete laparoscopic pelvic and paraaortic lymphadenectomy.
RESULTS
The TUMIR method was successfully achieved in 67/74 patients (90.5%). SLN was identified in 55 women (74.3%). No adverse effects were observed. Pelvic drainage was observed in 87.2% of women and paraaortic SLN was identified in 45.4%, with 12.8% of the patients draining only in this area. The mean number of SLN retrieved was 2.8 per patient (range 1 to 9). Metastatic disease was found in 13 (23.6%) patients. Metastatic involvement of the paraaortic lymph nodes was observed in 4 (30.7%) cases. All were identified by TUMIR. The sensitivity and negative predictive value of SLN detected by TUMIR to detect metastasis were 92.3% (95% CI 22.9-100) and 97.7% (95% CI 82.0-100), respectively.
CONCLUSIONS
TUMIR is a safe, feasible method to detect SLN in patients with EC, has a good detection rate and provides representative information of the lymphatic drainage of EC.
目的
本前瞻性研究旨在确定使用经阴道超声引导的肌内注射放射性示踪剂（TUMIR）检测子宫内膜癌（EC）前哨淋巴结（SLN）的可行性、安全性和性能。
方法
2006 年至 2011 年，纳入 74 例高危 EC 患者。手术前 24 小时，使用经阴道超声引导的穿刺将 148MBq（99m）Tc-纳米胶体（8mL）注射到前肌和后肌的两个部位。术前通过淋巴闪烁显像术和术中伽马探针定位 SLN。SLN 活检后，患者接受完全腹腔镜盆腔和腹主动脉旁淋巴结切除术。
结果
67/74 例（90.5%）成功实施 TUMIR 方法。55 例女性（74.3%）识别出 SLN。未观察到不良反应。87.2%的女性出现盆腔引流，45.4%识别出腹主动脉旁 SLN，12.8%的患者仅在该区域引流。每位患者平均检出 SLN 数为 2.8 个（范围 1 至 9）。13 例（23.6%）患者发现转移性疾病。4 例（30.7%）患者观察到腹主动脉旁淋巴结转移。所有病例均通过 TUMIR 识别。TUMIR 检测到的 SLN 检测转移的敏感性和阴性预测值分别为 92.3%（95%CI 22.9-100）和 97.7%（95%CI 82.0-100）。
结论
TUMIR 是一种安全、可行的方法，可用于检测 EC 患者的 SLN，具有较高的检出率，并提供 EC 淋巴引流的代表性信息。
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