Sonoda Kenzo, Yahata Hideaki, Okugawa Kaoru, Kaneki Eisuke, Ohgami Tatsuhiro, Yasunaga Masafumi, Baba Shingo, Oda Yoshinao, Honda Hiroshi, Kato Kiyoko
Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Oncology. 2018;94(2):92-98. doi: 10.1159/000484049. Epub 2017 Nov 15.
Trachelectomy, a fertility-sparing surgery for early-stage cervical cancer, can be performed only when there is no extrauterine extension present. Therefore, identifying the sentinel lymph nodes (SLNs) and using them to obtain an intraoperative pathologic diagnosis can provide information on the feasibility and safety of trachelectomy. Our aim was to assess the value of an intraoperative SLN diagnosis.
We retrospectively analyzed the accuracy of intraoperative imprint cytology and frozen-section examination in 201 patients at our institution in whom trachelectomy was planned.
All patients could be evaluated for SLNs; a total of 610 SLNs were analyzed. Although the specificity of both imprint cytology and frozen-section examination was 100.0%, the sensitivity was only 58.6 and 65.5%, respectively. The diagnostic sensitivity was higher in 2-mm slices along the short axis than on bisection along the longitudinal axis. Imprint cytology correctly diagnosed 2 patients who had false-negative results on frozen section. The nature of the metastatic foci that caused an intraoperative false-negative diagnosis was either micrometastasis or isolated tumor cells.
The accuracy of intraoperative SLN diagnosis requires improvement, especially when small metastatic foci are present.
根治性宫颈切除术是一种用于早期宫颈癌的保留生育功能手术，仅在不存在子宫外扩散时才可进行。因此，识别前哨淋巴结（SLN）并利用其进行术中病理诊断可为根治性宫颈切除术的可行性和安全性提供信息。我们的目的是评估术中SLN诊断的价值。
我们回顾性分析了我院201例计划行根治性宫颈切除术患者术中印片细胞学检查和冰冻切片检查的准确性。
所有患者均可对SLN进行评估；共分析了610个SLN。虽然印片细胞学检查和冰冻切片检查的特异性均为100.0%，但敏感性分别仅为58.6%和65.5%。沿短轴切成2毫米切片的诊断敏感性高于沿纵轴二等分切片。印片细胞学检查正确诊断出2例冰冻切片结果为假阴性的患者。导致术中假阴性诊断的转移灶性质为微转移或孤立肿瘤细胞。
术中SLN诊断的准确性有待提高，尤其是存在小转移灶时。
