University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
Int J Gynecol Cancer. 2019 Mar;29(3):613-621. doi: 10.1136/ijgc-2018-000075. Epub 2019 Feb 1.
Sentinel lymph node (SLN) biopsy has been investigated as an alternative to conventional pelvic and para-aorticlymphadenectomy for the surgical staging of endometrial cancer. Clinical trials have established the accuracy of sentinel nodes in the detecting metastatic disease. Novel advancements in tracers from the historically favored blue dyes and radio labeled colloids to near infrared imaging of fluorescent dyes has improved the ability to detect sentinel nodes and increased options for surgeons. The uterine cervix has been shown to be a feasible and accurate injection site for tracer, though the potential for under-evaluation of the para-aortic nodes remains a controversy, particularly for high-risk cancers. Additionally, sentinel node evaluation provides qualitatively different information than traditional staging techniques by identifying lymph nodes outside of traditional sampling locations and through the identification of very low volume meta static disease implants, such as isolated tumor cells. It is unclear how this altered staging information should be interpreted, guide the prescription of adjuvant therapy and its impact on long term clinical outcomes such as recurrence and survival. In this review we will discuss the evidence that has supported the use of the SLN technique in the staging of endometrial cancer, the options for surgical technique and the implications of managing the results of staging pathology.
前哨淋巴结（SLN）活检已被研究作为替代传统的盆腔和腹主动脉淋巴结切除术，用于子宫内膜癌的手术分期。临床试验已经确定了前哨淋巴结在检测转移性疾病方面的准确性。从历史上受欢迎的蓝色染料和放射性标记胶体示踪剂到近红外荧光染料成像的新型示踪剂的进步，提高了检测前哨淋巴结的能力，并为外科医生提供了更多选择。已经证明子宫颈是示踪剂的可行和准确注射部位，尽管在评估腹主动脉淋巴结方面可能存在不足，特别是对于高危癌症。此外，前哨淋巴结评估通过识别传统采样位置以外的淋巴结以及通过识别非常低体积的转移性疾病植入物（如孤立肿瘤细胞），提供了与传统分期技术不同的定性信息。目前尚不清楚如何解释这种改变的分期信息，指导辅助治疗的处方及其对复发和生存等长期临床结果的影响。在这篇综述中，我们将讨论支持 SLN 技术在子宫内膜癌分期中的应用的证据、手术技术的选择以及分期病理学结果管理的影响。
