Bats Anne-Sophie, Frati Albane, Mathevet Patrice, Orliaguet Isabelle, Querleu Denis, Zerdoud Slimane, Leblanc Eric, Gauthier Hélène, Uzan Catherine, Deandreis Désirée, Darai Emile, Kerrou Khaldoun, Marret Henri, Lenain Emilie, Froissart Marc, Lecuru Fabrice
Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Chirurgie Cancérologique Gynécologique et du Sein, Paris, France; INSERM UMR-S 747, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Chirurgie Cancérologique Gynécologique et du Sein, Paris, France.
Gynecol Oncol. 2015 May;137(2):264-9. doi: 10.1016/j.ygyno.2015.02.018. Epub 2015 Feb 26.
To evaluate the contribution of preoperative lymphoscintigraphy to intraoperative lymphatic mapping (ILM) in early cervical cancer
We conducted an ancillary analysis of the multicenter prospective SENTICOL study in early cervical cancer. Radiocolloid was injected intracervically on the day before (long protocol) or morning of (short protocol) surgery, lymphoscintigraphy was performed, and the results of a centralized image review were communicated to the surgeons. ILM was performed on combined radioactivity/patent blue detection. Sentinel lymph nodes (SLNs) were electively sampled before routine bilateral pelvic lymphadenectomy by laparoscopy.
Of 139 patients in the modified intention-to-diagnose analysis, 114 had centrally reviewed lymphoscintigrams, which showed 352 SLNs in 100 patients. Lymphoscintigraphy and ILM detection rates were 87.8% and 97.8%, respectively. Agreement between lymphoscintigraphy and ILM was low for the number of SLNs (κ=0.23; -0.04; 0.49) and bilateral SLNs (κ=0.36; 0.2; 0.52). No patient without SLNs by ILM had SLNs by lymphoscintigraphy. Lymphoscintigraphy identified substantial proportions of unusual drainage pathways. No patients with metastatic nodes had SLNs by lymphoscintigraphy but not by ILM in the relevant territory. In 1 of the 2 patients with false-negative SLN results, SLNs were bilateral by lymphoscintigraphy and unilateral by ILM.
Although the detection rate was lower by lymphoscintigraphy than by ILM, the substantial proportions of SLNs in unusual territories provided valuable guidance for the surgical exploration. Awareness of the limited agreement between lymphoscintigraphic and surgical detection might help surgeons decrease the false-negative rate.
评估术前淋巴闪烁造影对早期宫颈癌术中淋巴图谱绘制（ILM）的贡献。
我们对早期宫颈癌的多中心前瞻性SENTICOL研究进行了辅助分析。在手术前一天（长方案）或手术当天上午（短方案）宫颈内注射放射性胶体，进行淋巴闪烁造影，并将集中图像审查的结果告知外科医生。通过联合放射性/专利蓝检测进行ILM。在通过腹腔镜进行常规双侧盆腔淋巴结清扫术前，选择性地取样前哨淋巴结（SLN）。
在改良意向性诊断分析的139例患者中，114例进行了集中审查的淋巴闪烁造影，其中100例显示有352个SLN。淋巴闪烁造影和ILM的检测率分别为87.8%和97.8%。淋巴闪烁造影和ILM在SLN数量（κ=0.23；-0.04；0.49）和双侧SLN（κ=0.36；0.2；0.52）方面的一致性较低。没有ILM检测到无SLN的患者通过淋巴闪烁造影发现有SLN。淋巴闪烁造影识别出相当比例的异常引流途径。在相关区域，没有转移性淋巴结的患者通过淋巴闪烁造影未发现SLN，但通过ILM发现有SLN。在2例前哨淋巴结假阴性结果的患者中，有1例通过淋巴闪烁造影显示双侧SLN，而通过ILM显示单侧SLN。
尽管淋巴闪烁造影的检测率低于ILM，但在异常区域中相当比例的SLN为手术探查提供了有价值的指导。认识到淋巴闪烁造影和手术检测之间的一致性有限可能有助于外科医生降低假阴性率。
