Smits Roos Marthe, Zusterzeel Petra L M, Bekkers Ruud L M
Department of Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Int J Gynecol Cancer. 2014 Jul;24(6):973-83. doi: 10.1097/IGC.0000000000000177.
The aims of this study were to evaluate the safety and impact of pretreatment surgical para-aortic lymph node staging (PALNS) in advanced cervical cancer (International Federation of Gynecology and Obstetrics stage IB2-IVA) and to evaluate the preoperative imaging of PALNs.
We searched in PubMed and the Cochrane Library to identify data investigating the role of surgical PALNS. Selection criteria included English-language and advanced-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IB2-IVA) articles.
Twenty-two articles were included. Para-aortic lymph node metastases were present in 18% (range, 8%-42%) of all patients with cervical cancer stage IB to IVA. The proportions of positive para-aortic nodes on histological analysis with suspicious para-aortic nodes on imaging (positive predictive value) were 20% to 66%, 0% to 27%, 86% to 100%, and 50% to 75% for computed tomographic (CT) scan, magnetic resonance imaging (MRI) scan, positron emission tomography (PET), and PET-CT, respectively. The negative predictive values of the imaging techniques were 53% to 92% for CT scan, 75% to 91% for MRI, 87% to 94% for PET, and 83% to 92% for PET-CT. The proportions of histologically proven PALN metastasis with normal findings on imaging were 9% to 35% for CT scan and MRI, 4% to 11% for PET, and 6% to 15% for PET-CT. The mean complication rate of PALNS is 9%, with a range of 4% to 24%, with lymphocysts being the most common complication.
Pretreatment surgical PALN dissection or sampling is feasible, with low complication rates and short delay in starting treatment. Pretreatment PET or PET-CT is the most accurate imaging method in detecting PALN metastases but has limitations detecting microscopic tumor volumes. Even with normal findings on PET-CT, PALN metastases are present in 4% to 15% of patients. Positive PALNs in stage IB2 to IVA cervical cancer will lead to modification of treatment and may lead to better overall and disease-free survival.
本研究旨在评估术前手术性腹主动脉旁淋巴结分期（PALNS）在晚期宫颈癌（国际妇产科联盟分期IB2-IVA期）中的安全性及影响，并评估PALN的术前影像学检查。
我们在PubMed和Cochrane图书馆中进行检索，以确定研究手术性PALNS作用的数据。选择标准包括英文文章及晚期宫颈癌（国际妇产科联盟分期IB2-IVA期）相关文章。
纳入22篇文章。IB至IVA期宫颈癌患者中，18%（范围8%-42%）存在腹主动脉旁淋巴结转移。对于CT扫描、磁共振成像（MRI）扫描、正电子发射断层扫描（PET）及PET-CT，影像学检查提示可疑腹主动脉旁淋巴结时，组织学分析显示腹主动脉旁淋巴结阳性的比例（阳性预测值）分别为20%至66%、0%至27%、86%至100%及50%至75%。CT扫描、MRI、PET及PET-CT的阴性预测值分别为53%至92%、75%至91%、87%至94%及83%至92%。CT扫描和MRI检查结果正常但组织学证实存在PALN转移的比例为9%至35%，PET为4%至11%，PET-CT为6%至15%。PALNS的平均并发症发生率为9%，范围为4%至24%，其中淋巴囊肿是最常见的并发症。
术前手术性PALN清扫或取样是可行的，并发症发生率低且开始治疗的延迟时间短。术前PET或PET-CT是检测PALN转移最准确的影像学方法，但在检测微小肿瘤体积方面存在局限性。即使PET-CT检查结果正常，仍有4%至15%的患者存在PALN转移。IB2至IVA期宫颈癌患者腹主动脉旁淋巴结阳性会导致治疗方案的改变，并可能带来更好的总生存率和无病生存率。
