Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
Int J Gynaecol Obstet. 2018 Dec;143(3):313-318. doi: 10.1002/ijgo.12651. Epub 2018 Sep 19.
To evaluate sentinel lymph node (SLN) mapping for endometrial cancer, using radioisotope and indocyanine green (ICG) injections.
A prospective study was conducted between April 1, 2014, and December 27, 2017, among women with endometrial cancer, excluding those with suspected peritoneal dissemination and lymph node metastasis, at a University hospital in Kagoshima, Japan. Patients with low-risk endometrial cancer underwent pelvic SLN mapping using uterine cervix radioisotope injections; intermediate/high-risk patients underwent pelvic SLN with/without intraoperative para-aortic SLN mapping with ICG subserosal injections. Primary endpoints were estimated detection rates, sensitivity, and negative predict values (NPV) of SLN mapping.
Of 113 patients evaluated, comprehensive pelvic lymphadenectomy was performed after SLN detection in all patients; additional para-aortic lymphadenectomy was performed in 38 (34%) patients. The detection rates for pelvic SLN (≥1), bilateral pelvic SLN, and para-aortic SLN (≥1) were 96%, 80%, and 55%, respectively. Pelvic and para-aortic lymph node metastasis were found in (10%) (12/113) and 18% (6/33) patients, respectively. Isolated para-aortic lymph node metastasis was not observed. In pelvic SLN analysis, sensitivity was 91% and NPV was 99%. In para-aortic SLN analysis, sensitivity and NPV were 100%.
SLN biopsy may be useful to avoid comprehensive pelvic lymphadenectomy in low-risk patients. In high-risk patients, SLN mapping revealed high detection rates, sensitivity, and NPV, including those for para-aortic SLN.
评估使用放射性同位素和吲哚菁绿（ICG）注射进行子宫内膜癌前哨淋巴结（SLN）检测。
本前瞻性研究于 2014 年 4 月 1 日至 2017 年 12 月 27 日在日本鹿儿岛的一家大学医院进行，纳入了子宫内膜癌患者（排除疑似腹膜播散和淋巴结转移的患者）。低危型子宫内膜癌患者采用子宫颈放射性同位素注射行盆腔 SLN 检测；中高危型患者采用 ICG 亚浆膜注射行盆腔 SLN 检测和/或术中腹主动脉旁 SLN 检测。主要终点是 SLN 检测的估计检出率、灵敏度和阴性预测值（NPV）。
在 113 例接受评估的患者中，所有患者均在检出 SLN 后行全面盆腔淋巴结切除术；38 例（34%）患者进一步行腹主动脉旁淋巴结切除术。盆腔 SLN（≥1 个）、双侧盆腔 SLN 和腹主动脉旁 SLN（≥1 个）的检出率分别为 96%、80%和 55%。盆腔和腹主动脉旁淋巴结转移分别见于 10%（12/113）和 18%（6/33）的患者。未观察到孤立的腹主动脉旁淋巴结转移。在盆腔 SLN 分析中，灵敏度为 91%，NPV 为 99%。在腹主动脉旁 SLN 分析中，灵敏度和 NPV 均为 100%。
SLN 活检可能有助于避免低危型患者行全面盆腔淋巴结切除术。高危型患者中，SLN 检测显示出高的检出率、灵敏度和 NPV，包括对腹主动脉旁 SLN 的检测。
