Farghali Mohamed M, Allam Ihab S, Abdelazim Ibrahim A, El-Kady Osama S, Rashed Ahmed R, Gareer Waheed Y, Sweed Mohammed S
Professor of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt, and Ahmadi Kuwait Oil Company (KOC) Hospital, Kuwait E-mail :
Asian Pac J Cancer Prev. 2015;16(15):6691-6. doi: 10.7314/apjcp.2015.16.15.6691.
Endometrial carcinoma is the most common gynecological cancer and its treatment is still controversial, especially in its early stages. There are conflicting data about the efficacy of retroperitoneal lymphadenectomy during abdominal hysterectomy and bilateral salpingoophrectomy treatment. Lymphadenectomy carries a risk of severe complications, especially in women with co-morbidities. Selective lymphadenectomy has been widely employed for staging evaluation of endometrial carcinoma because it is simple and seems to provide reliable data regarding nodal metastasis. This study was designed to evaluate accuracy of sentinel node sampling in detecting lymph node metastasis in primary endometrial carcinoma during staging laparotomy.
Ninety-three women with endometrial carcinoma at high-risk for nodal metastasis were studied. During laparotomy, methylene blue dye was injected into sub-serosal myometrium, then retroperitoneal spaces were opened and blue lymph nodes within pelvic and para-aortic regions were removed as separate specimens for histopathological examination (sentinel lymph nodes=SLNs). Hysterectomy and selective lymphadenectomy then performed for all women included in this study.
Deposition of methylene dye into at least one lymph node was observed in 73.1% (68/93) of studied cases. 18.3% (17/93) of studied women had positive lymph node metastasis and 94.1% (16/17) of them had positive metastasis in SLNs. In this study, SNLs had 94.4% sensitivity and 100% specificity in prediction of lymph node metastasis. Mean number of lymph nodes removed from each case decreased when SLNs biopsy were taken.
SLNs are the key lymph nodes in endometrial tumor metastasis and their involvement could be an indicator for whether or not complete systematic lymphadenectomy is needed during staging laparotomy.
子宫内膜癌是最常见的妇科癌症，其治疗仍存在争议，尤其是在早期阶段。关于腹式子宫切除术和双侧输卵管卵巢切除术治疗期间腹膜后淋巴结清扫术的疗效，存在相互矛盾的数据。淋巴结清扫术有发生严重并发症的风险，尤其是在患有合并症的女性中。选择性淋巴结清扫术已被广泛用于子宫内膜癌的分期评估，因为它操作简单，似乎能提供有关淋巴结转移的可靠数据。本研究旨在评估前哨淋巴结取样在分期剖腹手术中检测原发性子宫内膜癌淋巴结转移的准确性。
对93例有淋巴结转移高危风险的子宫内膜癌女性进行了研究。在剖腹手术期间，将亚甲蓝染料注入浆膜下肌层，然后打开腹膜后间隙，将盆腔和腹主动脉旁区域内的蓝色淋巴结作为单独标本切除，进行组织病理学检查（前哨淋巴结=SLNs）。然后对本研究纳入的所有女性进行子宫切除术和选择性淋巴结清扫术。
在73.1%（68/93）的研究病例中观察到亚甲蓝染料沉积到至少一个淋巴结中。18.3%（17/93）的研究女性有阳性淋巴结转移，其中94.1%（16/17）在SLNs中有阳性转移。在本研究中，前哨淋巴结在预测淋巴结转移方面的敏感性为94.4%，特异性为100%。当进行前哨淋巴结活检时，每个病例切除的淋巴结平均数量减少。
前哨淋巴结是子宫内膜肿瘤转移中的关键淋巴结，其受累情况可作为分期剖腹手术期间是否需要进行完整系统性淋巴结清扫术的指标。
