Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Int J Gynecol Cancer. 2019 Jan;29(1):53-59. doi: 10.1136/ijgc-2018-000008.
To identify factors that affect successful adaptation of sentinel lymph node mapping and those that lead to unintended adipose-only sentinel lymph node identification.
Surgical and pathological data were prospectively collected on patients with endometrial cancer who underwent sentinel lymph node mapping with indocyanine green with or without pelvic and/or para-aortic lymph node dissection between November 2013 and April 2017. All mapping cases were performed with the robotic system. Adipose-only specimens were defined as a sentinel lymph node without a pathologically identified lymph node after ultrastaging.
A total of 202 patients were included: 83% had endometrioid pathology, 12% serous, 3% carcinosarcoma, and 2% clear cell, with mixed pathology noted in 2%. The bilateral sentinel lymph node detection rate was 66%, and the rate of mapping at least a unilateral sentinel lymph node was 86%. Neither the bilateral nor the unilateral sentinel lymph node mapping rate changed with increased surgeon experience. The rate of adipose-only sentinel lymph node identification was more frequent when comparing the first 10 cases (37%), cases 11 - 30 (28%), and > 30 cases (9%) (P = 0.006). Body mass index > 30 kg/m, uterine fibroids, The International Federation of Gynecology and Obstetrics (FIGO) grade, and histology were not found to have a statistically significant impact on either sentinel lymph node identification or adipose-only sentinel lymph node identification. Adipose-only sentinel lymph nodes were more likely with increased time from cervical injection to identification of the sentinel lymph node in the right hemipelvis. The median range was 28 min (14-73) for true sentinel lymph node identification vs 33 min (23-74) for adipose-only sentinel lymph node identification (P = 0.02).
Patient and surgeon factors did not impact the identification of sentinel lymph nodes over time. Adipose-only sentinel lymph nodes were more frequently identified in the initial cases and represent a potential complication to adapting sentinel lymph node biopsy without lymphadenectomy. The increase in adipose-only sentinel lymph node identification that was associated with time from cervical injection may represent delayed or disrupted uptake of indocyanine green.
确定影响前哨淋巴结绘图成功适应的因素，以及导致意外脂肪-only 前哨淋巴结识别的因素。
2013 年 11 月至 2017 年 4 月期间，前瞻性收集了接受吲哚菁绿前哨淋巴结绘图术加或不加盆腔和/或主动脉旁淋巴结切除术的子宫内膜癌患者的手术和病理数据。所有绘图病例均采用机器人系统进行。脂肪-only 标本定义为在超分期后没有病理识别的淋巴结的前哨淋巴结。
共纳入 202 例患者：83%为子宫内膜样病理，12%为浆液性，3%为癌肉瘤，2%为透明细胞，2%为混合性。双侧前哨淋巴结检出率为 66%，至少单侧前哨淋巴结检出率为 86%。手术医生经验的增加并没有改变双侧或单侧前哨淋巴结绘图率。比较前 10 例（37%）、第 11-30 例（28%）和>30 例（9%），脂肪-only 前哨淋巴结识别率更高（P=0.006）。体重指数>30kg/m2、子宫肌瘤、国际妇产科联合会（FIGO）分级和组织学均未发现对前哨淋巴结识别或脂肪-only 前哨淋巴结识别有统计学显著影响。脂肪-only 前哨淋巴结更有可能在从宫颈注射到识别右骨盆前哨淋巴结的时间增加。真正的前哨淋巴结识别的中位范围为 28 分钟（14-73），而脂肪-only 前哨淋巴结识别的中位范围为 33 分钟（23-74）（P=0.02）。
患者和手术医生因素并未随着时间的推移影响前哨淋巴结的识别。在最初的病例中，脂肪-only 前哨淋巴结更频繁地被识别，这代表了在不进行淋巴结清扫的情况下适应前哨淋巴结活检的潜在并发症。与宫颈注射后时间相关的脂肪-only 前哨淋巴结识别增加可能代表吲哚菁绿摄取的延迟或中断。
