de Freitas Rosyane Rena, Baiocchi Glauco, Hatschbach Sérgio Bruno Bonatto, Linhares José Clemente, Guerreiro João Antônio, Minari Claudiane Ligia, Ribeiro Reitan, Jung Juliana, Zukovski Taiza, Lopes Ademar
Department of Gynecologic Oncology, Hospital São Francisco de Assis, Jacareí, Brazil,
Ann Surg Oncol. 2015 May;22(5):1564-9. doi: 10.1245/s10434-014-4245-x. Epub 2014 Nov 18.
The aims of this study were to determine the sensitivity and negative predictive value (NPV) of sentinel lymph node (SLN) detection in cervical cancer using a combination technique, and to test the SLN algorithm that was proposed by the Memorial Sloan Kettering Cancer Center (MSKCC).
The study included 57 FIGO stage IA2-IIA patients who were treated at the Erasto Gaertner Hospital, Curitiba, from 2008 to 2010. The patients underwent SLN mapping by technetium lymphoscintigraphy and patent blue dye injection. Following SLN detection, standard radical hysterectomy, including parametrectomy and systematic bilateral pelvic lymphadenectomy, was performed. The SLNs were examined by immunohistochemistry (IHC) when the hematoxylin and eosin results were negative.
The median age of patients was 42 years (range 24-71), the median SLN count was 2 (range 1-4), and the median total lymph node (LN) count was 19 (range 11-28). At least one SLN was detected in 48 (84.2 %) patients, while bilateral pelvic detection of SLNs was noted in 28 (58.3 %) cases-one case had bilateral pelvic SLNs and a para-aortic SLN, 19 (39.6 %) had unilateral pelvic LNs, and one (2.1 %) had an SLN in the para-aortic area. Metastatic LNs were found in 9 of 57 (15.8 %) patients. Eight of nine patients with LN metastasis had a positive SLN, yielding an overall sensitivity of 88.9 % and NPV of 97.5 %. Of the 75 sides that were mapped, the SLN detection method predicted LN involvement in 74 (98.6 %) hemi-pelvises. A total of ten hemi-pelvises had LN metastasis, nine of which involved the SLN, resulting in a sensitivity of 90 %, NPV of 98.5 %, and a false negative (FN) of 10 %. In two cases (4.2 %), the SLN was positive only after IHC.
Our SLN procedure is a safe and accurate technique that increases metastatic nodal detection rates by 4.2 % after IHC. The SLN method performed better when analyzing each side; however, one FN occurred, even after applying the MSKCC algorithm.
本研究旨在确定联合技术检测宫颈癌前哨淋巴结（SLN）的敏感性和阴性预测值（NPV），并测试纪念斯隆凯特琳癌症中心（MSKCC）提出的SLN算法。
该研究纳入了2008年至2010年在库里蒂巴埃拉斯托·盖特纳医院接受治疗的57例国际妇产科联盟（FIGO）分期为IA2-IIA期的患者。患者接受了锝淋巴闪烁显像和专利蓝染料注射进行SLN定位。在检测到SLN后，进行了标准的根治性子宫切除术，包括子宫旁组织切除术和系统性双侧盆腔淋巴结清扫术。当苏木精和伊红染色结果为阴性时，通过免疫组织化学（IHC）检查SLN。
患者的中位年龄为42岁（范围24-71岁），SLN的中位数量为2个（范围1-4个），总淋巴结（LN）的中位数量为19个（范围11-28个）。48例（84.2%）患者检测到至少一个SLN，28例（58.3%）患者双侧盆腔检测到SLN——1例患者双侧盆腔有SLN且主动脉旁有一个SLN，19例（39.6%）患者单侧盆腔有LN，1例（2.1%）患者主动脉旁区域有一个SLN。57例患者中有9例（15.8%）发现有转移淋巴结。9例有LN转移的患者中有8例SLN呈阳性，总体敏感性为88.9%，NPV为97.5%。在75个进行定位的侧别中，SLN检测方法预测74个（98.6%）半盆腔有LN转移。共有10个半盆腔有LN转移，其中9个涉及SLN，敏感性为90%，NPV为98.5%，假阴性（FN）为10%。在2例（4.2%）患者中，SLN仅在IHC后呈阳性。
我们的SLN程序是一种安全且准确的技术，在IHC后可将转移淋巴结的检测率提高4.2%。在分析每个侧别时，SLN方法表现更好；然而，即使应用了MSKCC算法，仍出现了1例假阴性。
