'C' Department of Obstetrics and Gynecology, Tunis Maternity and Neonatology Center, El Manar University, Tunis City, Tunisia.
Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada.
Gynecol Oncol. 2018 Mar;148(3):485-490. doi: 10.1016/j.ygyno.2017.12.026. Epub 2017 Dec 28.
To determine the risk of endometrial cancer (EC) and lymph node involvement in patients with a preoperative diagnosis of "AH-only" versus "AH - cannot rule out carcinoma" and to study the value of SLN mapping.
We reviewed all patients with a preoperative diagnosis of atypical hyperplasia, who underwent primary surgery with SLN mapping followed by pelvic lymphadenectomy. Sensitivity and negative predictive value (NPV) of SLN and rates of endometrial cancer were calculated.
Overall, 64/120 (53.3%) patients were found to have EC on final pathology: 58 stage IA, 3 IB, and 3 IIIC1. In patients with preoperative diagnosis of "AH", 44.3% (31/70) had EC on final pathology compared to 66% (33/50) in patients with "AH - cannot rule out cancer" (p=0.02). Overall, 3.3% of the patients (4/120) had lymph node involvement. In patients with EC with a pre-operative diagnosis of "AH", none had lymph node metastasis (0/31), compared to 12.1% (4/33) in patients with "AH - cannot rule out cancer" (p=0.06). Elevated preoperative CA125 levels (>25U/mL) were statistically associated with the risk of lymph node metastasis on final pathology (p=0.024). Unilateral and bilateral SLN detection occurred in 93.7% and 78.1% respectively. In patients with EC and bilateral SLN mapping, sensitivity and NPV were respectively 66.6% and 97.9%. There was one false negative (ITCs in non-SLN).
Our data indicate that the risk of lymph node involvement in patients with a preoperative diagnosis of "AH-only" is null. Lymph node assessment could be omitted in those patients. Conversely this risk is significant in patients with "AH - cannot rule out cancer". SLN mapping could be a valuable staging procedure in these patients.
确定术前诊断为“单纯 AH”与“不能排除癌的 AH”的患者中子宫内膜癌（EC）和淋巴结受累的风险，并研究 SLN 绘图的价值。
我们回顾了所有术前诊断为不典型增生，接受 SLN 绘图联合盆腔淋巴结切除术的原发性手术的患者。计算了 SLN 的敏感性和阴性预测值（NPV）以及子宫内膜癌的发生率。
总体而言，64/120（53.3%）例患者最终病理诊断为 EC：58 例 IA 期，3 例 IB 期和 3 例 IIIC1 期。术前诊断为“AH”的患者中，44.3%（31/70）最终病理诊断为 EC，而术前诊断为“不能排除癌的 AH”的患者中为 66%（33/50）（p=0.02）。总体而言，120 例患者中有 3.3%（4/120）有淋巴结受累。在术前诊断为“AH”的 EC 患者中，无淋巴结转移（31/31），而术前诊断为“不能排除癌的 AH”的患者中为 12.1%（4/33）（p=0.06）。术前 CA125 水平升高（>25U/mL）与最终病理淋巴结转移的风险具有统计学关联（p=0.024）。单侧和双侧 SLN 检测分别发生在 93.7%和 78.1%的患者中。在 EC 且双侧 SLN 绘图的患者中，敏感性和 NPV 分别为 66.6%和 97.9%。有 1 例假阴性（非 SLN 的 ITCs）。
我们的数据表明，术前诊断为“单纯 AH”的患者淋巴结受累的风险为零。可以省略这些患者的淋巴结评估。相反，在术前诊断为“不能排除癌的 AH”的患者中，这种风险是显著的。SLN 绘图可能是这些患者有价值的分期程序。
