Naaman Y, Pinkas L, Roitman S, Ikher S, Oustinov N, Vaisbuch E, Yachnin A, Ben-Arie A
Department of Obstetrics & Gynecology, Kaplan Medical Center, Rehovot, Israel.
Faculty of Medicine, The Hebrew University, Jerusalem, Israel.
Ann Surg Oncol. 2016 Feb;23(2):450-5. doi: 10.1245/s10434-015-4877-5. Epub 2015 Oct 5.
This study was designed to evaluate the detection rate (DR) and sensitivity of sentinel lymph node (SLN) mapping in patients with endometrial cancer using TC99m colloid and blue dye and to evaluate the contribution of preoperative planar lymphoscintigraphy (PLSG) and SPECT/CT.
A retrospective analysis of patients who underwent SLN mapping as part of their primary surgery for endometrial cancer. Patients underwent preoperative PLSG and later with additional SPECT/CT. Intraoperative detection was performed using TC99m colloid and blue dye by cervical injections. SLNs were sent separately for pathologic evaluation with ultrastaging.
Fifty-three patients were included in this study. Successful preoperative mapping was achieved in 31 of 37 patients (84 %) who underwent SPECT/CT compared with only 30 of 45 patients (67 %) who underwent PLSG. SPECT/CT localizations of SLNs were anatomically accurate in 91 % of cases. Intraoperative DR of at least one SLN was 77 %, whilst the bilateral DR was 49 %. DR was significantly better using combined blue dye and TC99m colloid injections compared with blue dye alone: 81 versus 57 % for unilateral and 54 versus 28 % for bilateral mapping (P = 0.01, 0.009, respectively). Six cases of nodal metastasis were diagnosed: four by positive SLNs, and two cases were diagnosed using side-specific full dissection according to the SLN algorithm when SLN detection failed. There were no cases of false-negative results.
SLN detection using cervical injections of TC99m colloid and blue dye is feasible and sensitive for patients with endometrial cancer. SPECT/CT aids to accurate locating of the SLN.
本研究旨在评估使用锝99m胶体和蓝色染料对子宫内膜癌患者进行前哨淋巴结（SLN）定位的检出率（DR）和敏感性，并评估术前平面淋巴闪烁显像（PLSG）和SPECT/CT的作用。
对作为子宫内膜癌初次手术一部分接受SLN定位的患者进行回顾性分析。患者术前接受PLSG，随后进行额外的SPECT/CT检查。术中通过宫颈注射锝99m胶体和蓝色染料进行检测。SLN分别送检进行超分期病理评估。
本研究纳入53例患者。接受SPECT/CT检查的37例患者中有31例（84%）成功进行了术前定位，而接受PLSG检查的45例患者中只有30例（67%）成功定位。SLN的SPECT/CT定位在91%的病例中解剖学上准确。至少一个SLN的术中DR为77%，双侧DR为49%。与单独使用蓝色染料相比，联合使用蓝色染料和锝99m胶体注射的DR明显更好：单侧定位分别为81%和57%，双侧定位分别为54%和28%（P分别为0.01和0.009）。诊断出6例淋巴结转移：4例通过阳性SLN诊断，2例在SLN检测失败时根据SLN算法使用侧方特异性全层解剖诊断。没有假阴性结果的病例。
对子宫内膜癌患者使用宫颈注射锝99m胶体和蓝色染料进行SLN检测是可行且敏感的。SPECT/CT有助于准确定位SLN。
