Allameh Tajossadat, Hashemi Vahidehsadat, Mohammadizadeh Fereshteh, Behnamfar Fariba
Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2015 Feb;20(2):169-73.
The sentinel lymph node (SLN) is defined as the first chain node in the lymphatic basin that receives primary lymphatic flow. If the SLN is negative for metastatic disease, then other nodes are expected to be disease-free. SLN techniques have been extensively applied in the staging and treatment of many tumors, including melanoma, breast and vulvar cancers. This study aims to evaluate our technique in SLN mapping in early stage endometrial and cervical cancers.
We scheduled a cross-sectional pilot study for patients undergoing staging surgery for endometrial and cervical cancer from November 2012 to February 2014 in Beheshti and Sadoughi Hospitals. Our SLN mapping technique included 1 h preoperative or intraoperative injection of 4 ml of 1% methylene blue dye in the tumor site. At the time of surgery, blue lymph nodes were removed and labeled as SLNs. Then systematic lymph node dissection was completed, and all of the nodes were sent for pathologic examination concerning metastatic involvement. All of the sentinel nodes were first stained with hematoxylin and eosin and examined. Those negative in this study were then stained with immunohistochemistry using anti-keratin antibody. Descriptive statistics, sensitivity, negative predictive values (NPV), false negative (FN) and detection rates were calculated.
Twenty-three patients including 62% endometrial and 38% cervical cancers enrolled in the study. Median of SLN count in the endometrial and cervical cancers was 3 and 2, respectively. Among endometrial and cervical cancers, detection rate of metastatic disease was 80% and 87.5%, respectively. The FN rate for this technique was 0 and the sensitivity and NPV are 100% for both endometrial and cervical cancers.
Considering the lower risk of metastases in early stage of both endometrial and cervical cancers, SLN technique allows for confident and accurate staging of cancer.
前哨淋巴结（SLN）被定义为淋巴引流区域中接受初级淋巴液流动的第一级淋巴结。如果前哨淋巴结未发现转移病变，那么其他淋巴结预计也无病变。前哨淋巴结技术已广泛应用于包括黑色素瘤、乳腺癌和外阴癌在内的多种肿瘤的分期和治疗。本研究旨在评估我们在前哨淋巴结定位技术在早期子宫内膜癌和宫颈癌中的应用。
我们对2012年11月至2014年2月在贝赫什提医院和萨杜基医院接受子宫内膜癌和宫颈癌分期手术的患者进行了一项横断面试点研究。我们的前哨淋巴结定位技术包括术前1小时或术中在肿瘤部位注射4毫升1%的亚甲蓝染料。手术时，切除蓝色淋巴结并标记为前哨淋巴结。然后完成系统性淋巴结清扫，并将所有淋巴结送去进行关于转移累及情况的病理检查。所有前哨淋巴结首先用苏木精和伊红染色并检查。本研究中呈阴性的淋巴结随后用抗角蛋白抗体进行免疫组化染色。计算描述性统计数据、敏感性、阴性预测值（NPV）、假阴性（FN）和检出率。
23例患者纳入研究，其中子宫内膜癌占62%，宫颈癌占38%。子宫内膜癌和宫颈癌前哨淋巴结计数的中位数分别为3个和2个。在子宫内膜癌和宫颈癌中，转移病变的检出率分别为80%和87.5%。该技术的假阴性率为0，子宫内膜癌和宫颈癌的敏感性和阴性预测值均为100%。
考虑到子宫内膜癌和宫颈癌早期转移风险较低，前哨淋巴结技术能够对癌症进行可靠且准确的分期。
