Doering D L, Barnhill D R, Weiser E B, Burke T W, Woodward J E, Park R C
Department of Obstetrics and Gynecology, Uniformed Services University of Health Sciences, Bethesda, Maryland.
Obstet Gynecol. 1989 Dec;74(6):930-3.
In patients with stage I endometrial adenocarcinoma, the incidence of pelvic and para-aortic lymph node metastasis is related to the grade of the tumor and the depth of myometrial invasion. Although the grade of the tumor may be predicted preoperatively by endometrial sampling, the depth of myometrial invasion cannot be determined until after the uterus has been removed. Although complications have been attributed to lymph node sampling, failure to perform the procedure in patients at risk for nodal metastasis may result in underdiagnosis of extrauterine disease, leading to inadequate therapy. Gross visual examination of the cut surface of the tumor at the time of hysterectomy accurately determined the depth of myometrial invasion in 135 of 148 prospectively studied patients (91%) (P less than .001). The sensitivity of the test was 0.71, the specificity was 0.96, and the positive predictive value was 0.80. Intraoperative assessment of the depth of myometrial invasion is a simple, inexpensive, and useful technique for selecting those patients with stage I endometrial adenocarcinoma who might benefit from selective para-aortic lymphadenectomy.
在I期子宫内膜腺癌患者中，盆腔及腹主动脉旁淋巴结转移的发生率与肿瘤分级及肌层浸润深度有关。虽然肿瘤分级可通过术前子宫内膜取样进行预测，但肌层浸润深度在子宫切除后才能确定。尽管淋巴结取样会引发并发症，但对于有淋巴结转移风险的患者不进行该操作可能导致子宫外疾病诊断不足，从而导致治疗不充分。在对148例前瞻性研究患者进行子宫切除时，通过对肿瘤切面进行大体视觉检查，准确确定了135例患者（91%）的肌层浸润深度（P<0.001）。该检查的敏感性为0.71，特异性为0.96，阳性预测值为0.80。术中评估肌层浸润深度是一种简单、廉价且有用的技术，可用于选择那些可能从选择性腹主动脉旁淋巴结清扫术中获益的I期子宫内膜腺癌患者。
