Liang S C, Wang Z Q, Wang J L
Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 Sep 25;52(9):605-611. doi: 10.3760/cma.j.issn.0529-567X.2017.09.006.
To evaluate the feasibility and clinical value of identifying sentinel lymph node (SLN) and to assess possible factors associated with detection rate in both cervical cancer and endometrial cancer. Retrospective study of 76 cases (39 with cervical cancer and 37 with endometrial cancer) were conducted in Peking University Peoples Hospital. All patients underwent SLN biopsy with tracers of indocyanine green (ICG) and (or) carbon nanoparticles. All mapped SLN was resected and followed by procedures that systematic pelvic lymphadenectomy and hysterectomy according to National Comprehensive Cancer Network (NCCN) guidelines. All the lymph nodes were examined postoperatively for the routine paraffin section of hematoxylin and eosin (HE) staining. Detection rate, sensitivity and negative predictive value of SLN were calculated and factors associated with the detection rate were analyzed. The overall detection rate was 95% (72/76), with 74% (56/76) positive bilaterally. The bilateral detection rate of SLN with combined technique was significantly higher than that with single technique (0.05). The difference of SLN detection rate between cervical and endometrial cancer patients were not significant (0.05). SLN were mostly recognized in obturator (32.1%, 114/355) and external iliac areas (32.4%, 115/355) in cervical cancer, and in external iliac (41.2%, 91/221) and obturator areas (39.4%,87/221) in endometrial cancer. Among 55 patients underwent systematic pelvic lymphadenectomy, the sensitivity of SLN detection was 75% and the negative predictive value was 96%. The sensitivity and negative predictive value were both 100% in patients with successfully bilateral mapped of SLN. s The overall detection rate of SLN in cervical and endometrial cancer is the highest with the combined technique of ICG and carbon nanoparticles. The detection rate and located regions of SLN are similar between cervical and endometrial cancer, and SLN are mostly recognized in the external iliac and obturator areas. The sensitivity and negative predictive value of SLN detection are high, especially when SLN are bilateral mapped.
评估识别前哨淋巴结（SLN）的可行性和临床价值，并评估宫颈癌和子宫内膜癌中与检测率相关的可能因素。北京大学人民医院对76例患者（39例宫颈癌患者和37例子宫内膜癌患者）进行了回顾性研究。所有患者均接受了吲哚菁绿（ICG）和（或）碳纳米颗粒示踪剂的SLN活检。所有标记的SLN均被切除，随后根据美国国立综合癌症网络（NCCN）指南进行系统性盆腔淋巴结清扫术和子宫切除术。术后对所有淋巴结进行苏木精和伊红（HE）染色的常规石蜡切片检查。计算SLN的检测率、敏感性和阴性预测值，并分析与检测率相关的因素。总体检测率为95%（72/76），双侧阳性率为74%（56/76）。联合技术的SLN双侧检测率显著高于单一技术（P<0.05）。宫颈癌和子宫内膜癌患者的SLN检测率差异无统计学意义（P>0.05）。宫颈癌中，SLN大多位于闭孔区（32.1%，114/355）和髂外区（32.4%，115/355）；子宫内膜癌中，SLN大多位于髂外区（41.2%，91/221）和闭孔区（39.4%，87/221）。在55例行系统性盆腔淋巴结清扫术的患者中，SLN检测的敏感性为75%，阴性预测值为96%。SLN成功双侧标记的患者中，敏感性和阴性预测值均为100%。ICG和碳纳米颗粒联合技术在宫颈癌和子宫内膜癌中SLN的总体检测率最高。宫颈癌和子宫内膜癌中SLN的检测率和定位区域相似，且SLN大多位于髂外区和闭孔区。SLN检测的敏感性和阴性预测值较高，尤其是当SLN双侧标记时。
