Papadia Andrea, Gasparri Maria Luisa, Siegenthaler Franziska, Imboden Sara, Mohr Stefan, Mueller Michael D
Department of Obstetrics and Gynecology, University Hospital of Berne, University of Berne, Effingerstrasse 102, 3010, Bern, Switzerland.
Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
J Cancer Res Clin Oncol. 2017 Mar;143(3):491-497. doi: 10.1007/s00432-016-2303-4. Epub 2016 Nov 11.
To compare two surgical strategies used to identify lymph node metastases in patients with preoperative diagnosis of complex atypical hyperplasia (CAH), grade 1 and 2 endometrial cancer (EC).
Data on patients with preoperative diagnosis of CAH, grade 1 and 2 EC undergoing laparoscopic indocyanine green (ICG) sentinel lymph node (SLN) mapping followed by frozen section of the uterus were collected. When risk factors were identified at frozen section, patients were subjected to a systematic lymphadenectomy. False negative (FN) rates, negative predictive values (NPV), positive predictive values (PPV) and correlation with stage IIIC EC were calculated for the systematic lymphadenectomy based on frozen section of the uterus and for the SLN mapping.
Six (9.5%) out of 63 patients had lymph nodal metastases. Based on frozen section of the uterus, 22 (34.9%) and 15 (22.2%) patients underwent a pelvic and a pelvic and paraaortic lymphadenectomy, respectively. Five patients with stage IIIC disease were identified with a FN rate of 16.7% and a NPV and PPV of 97.6 and 27.3%, respectively. Overall and bilateral detection rates of ICG SLN mapping were 100 and 97.6%, respectively; no FN were recorded. The identification of patients with stage IIIC disease with ICG SLN mapping showed a NPV and PPV of 100%. Correlation between indication to lymphadenectomy and stage IIIC disease was poor (κ = 0.244) when based on frozen section of the uterus and excellent (κ = 1) when based on SLN mapping.
ICG SLN mapping reduces the number of unnecessary systematic lymphadenectomies and the risk of underdiagnosing patients with metastatic lymph nodes.
比较两种手术策略，用于在术前诊断为复杂非典型增生（CAH）、1级和2级子宫内膜癌（EC）的患者中识别淋巴结转移。
收集术前诊断为CAH、1级和2级EC且接受腹腔镜吲哚菁绿（ICG）前哨淋巴结（SLN）定位并随后进行子宫冰冻切片检查的患者数据。当在冰冻切片检查中发现危险因素时，患者接受系统性淋巴结清扫术。基于子宫冰冻切片检查的系统性淋巴结清扫术和SLN定位，计算假阴性（FN）率、阴性预测值（NPV）、阳性预测值（PPV）以及与IIIC期EC的相关性。
63例患者中有6例（9.5%）发生淋巴结转移。基于子宫冰冻切片检查，分别有22例（34.9%）和15例（22.2%）患者接受了盆腔淋巴结清扫术和盆腔及腹主动脉旁淋巴结清扫术。5例IIIC期疾病患者被识别出来，FN率为16.7%，NPV和PPV分别为97.6%和27.3%。ICG SLN定位的总体和双侧检出率分别为10%和97.6%；未记录到FN。通过ICG SLN定位识别IIIC期疾病患者的NPV和PPV为100%。基于子宫冰冻切片检查时，淋巴结清扫术指征与IIIC期疾病的相关性较差（κ =0.244），而基于SLN定位时相关性极佳（κ =1）。
ICG SLN定位减少了不必要的系统性淋巴结清扫术的数量以及漏诊有转移性淋巴结患者的风险。
