Raoufi Jalal, İşcan Serhan Can, Hanedan Candost, Özkan Emine Elif, Çerçi Sevim Süreyya, Erdemoğlu Ebru, Erdemoğlu Evrim
Süleyman Demirel University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Isparta, Turkey.
Süleyman Demirel University Faculty of Medicine, Department of Radiation Oncology, Isparta, Turkey.
Turk J Obstet Gynecol. 2018 Jun;15(2):99-104. doi: 10.4274/tjod.12144. Epub 2018 Jun 21.
There is scarce information about axillary lymph node involvement in gynecologic cancers. We analyzed the incidence of suspicious axillary lymph nodes in gynecologic cancers.
We retrospectively analyzed the positron emission tomography/computed tomography findings of 251 patients with endometrial, cervical, and ovarian cancer. There is no cut-off value documented for axillary metastases from gynecologic cancers; therefore we adopted the cut-off standardized uptake values (SUVs) proclaimed in breast cancer.
A total of 251 patients records were available for analysis; 40 patients (15.9%) with suspicious axillary lymph nodes were included in the study. Twenty-one and a half percent (n=20/93) of patients with endometrium cancer, 14.1% (n=14/99) of patients with ovarian cancer, and 10% (n=6/59) of those with cervical cancer had suspicious axillary lymph nodes. Patients with an maximum SUV (SUV) uptake higher than 3 underwent axillary lymph node biopsy. None of them was found to have axillary metastases of gynecologic cancers in the pathologic evaluation. In one patient with endometrial cancer, an obscure breast ductal carcinoma was diagnosed, another patient with endometrial cancer was found to have follicular lymphoma. The third patient with endometrial cancer had no malignancy in axillary lymph node biopsy, but had Hurthle cell neoplasia in a thyroid biopsy; the patient did not accept any surgical or medical treatment for endometrial cancer and died 23 months later. There were three (7.5%) metachronous cancers out of 40 gynecologic cancers; two patients were explained above, the third patient with endometrium cancer, who was not histopathologically evaluated although the axillary SUV was <3, had rectosigmoid cancer and glioblastoma metachronously.
Our study shows that an important ratio (14-21%) of patients with gynecologic cancer has suspicious axillary lymph nodes. Increased SUV, particularly above 3, might be used as an indication for axillary biopsy and may help to identify secondary metastatic cancer.
关于妇科癌症腋窝淋巴结受累的信息较少。我们分析了妇科癌症中可疑腋窝淋巴结的发生率。
我们回顾性分析了251例子宫内膜癌、宫颈癌和卵巢癌患者的正电子发射断层扫描/计算机断层扫描结果。目前尚无关于妇科癌症腋窝转移的截断值记录；因此，我们采用了乳腺癌中公布的截断标准化摄取值（SUV）。
共有251例患者的记录可供分析；40例（15.9%）有可疑腋窝淋巴结的患者被纳入研究。子宫内膜癌患者中有21.5%（n=20/93）、卵巢癌患者中有14.1%（n=14/99）、宫颈癌患者中有10%（n=6/59）有可疑腋窝淋巴结。SUV最大值高于3的患者接受了腋窝淋巴结活检。在病理评估中，未发现他们中有任何一人患有妇科癌症的腋窝转移。在1例子宫内膜癌患者中，诊断出隐匿性乳腺导管癌，另1例子宫内膜癌患者被发现患有滤泡性淋巴瘤。第3例子宫内膜癌患者腋窝淋巴结活检未发现恶性肿瘤，但甲状腺活检发现有许特莱细胞肿瘤；该患者未接受任何针对子宫内膜癌的手术或药物治疗，23个月后死亡。40例妇科癌症中有3例（7.5%）为异时性癌症；上述解释了2例患者，第3例子宫内膜癌患者，尽管腋窝SUV<3，但未进行组织病理学评估，同时患有乙状结肠癌和胶质母细胞瘤。
我们的研究表明，相当比例（14-21%）的妇科癌症患者有可疑腋窝淋巴结。SUV升高，特别是高于3，可能用作腋窝活检的指征，并可能有助于识别继发性转移癌。
