Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague, General University Hospital in Prague, Czech Republic.
Institute for Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Gynecol Oncol. 2018 Mar;148(3):456-460. doi: 10.1016/j.ygyno.2018.01.001. Epub 2018 Feb 1.
The aim of this study was to assess the detection rate, false-negative rate and sensitivity of SLN in LN staging in tumors over 2cm on a large cohort of patients.
Data from patients with stages pT1a - pT2 cervical cancer who underwent surgical treatment, including SLN biopsy followed by systematic pelvic lymphadenectomy, were retrospectively analyzed. A combined technique with blue dye and radiocolloid was modified in larger tumors to inject the tracer into the residual cervical stroma.
The study included 350 patients with stages pT1a - pT2. Macrometastases, micrometastases, and isolated tumor cells were found in 10%, 8%, and 4% of cases. Bilateral detection rate was similar in subgroups with tumors<2cm, 2-3.9cm, and ≥4cm (79%, 83%, 76%) (P=0.460). There were only two cases with false-negative SLN ultrastaging for pelvic LN status among those with bilateral SLN detection. The false negative rate was very low in all three subgroups of different tumor sizes (0.9%, 0.9%, and 0.0%; P=0.999). Sensitivity reached 96% in the whole group and was high in all three groups (93%, 93%, 100%; P=0.510).
If the tracer application technique is adjusted in larger tumors, SLN biopsy can be equally reliable in pelvic LN staging in tumors smaller and larger than 2cm. The bilateral detection rate and false negative rate did not differ in subgroups of patients with tumors<2cm, 2-3.9cm, and ≥4cm.
本研究旨在评估在一个大的患者队列中，对于超过 2cm 的肿瘤，前哨淋巴结（SLN）在淋巴结分期中的检测率、假阴性率和敏感性。
回顾性分析了接受手术治疗（包括 SLN 活检和系统盆腔淋巴结清扫术）的 pT1a-pT2 期宫颈癌患者的数据。对于较大的肿瘤，改良了联合使用蓝色染料和放射性胶体的技术，将示踪剂注入残余的宫颈基质中。
本研究共纳入 350 例 pT1a-pT2 期患者。大、微转移灶和孤立肿瘤细胞在 10%、8%和 4%的病例中被发现。肿瘤<2cm、2-3.9cm 和≥4cm 的亚组双侧 SLN 检测率相似（79%、83%和 76%）（P=0.460）。在双侧 SLN 检测的患者中，仅有 2 例 SLN 超分期对盆腔淋巴结状态呈假阴性。在所有三个不同肿瘤大小的亚组中，假阴性率均非常低（0.9%、0.9%和 0.0%；P=0.999）。整个组的敏感性达到 96%，在所有三个组中均较高（93%、93%和 100%；P=0.510）。
如果调整较大肿瘤中的示踪剂应用技术，SLN 活检在肿瘤<2cm、2-3.9cm 和≥4cm 的亚组中，在盆腔淋巴结分期中同样可靠。肿瘤<2cm、2-3.9cm 和≥4cm 的亚组中，双侧检测率和假阴性率无差异。
