Sniadecki Marcin, Wydra Dariusz Grzegorz, Wojtylak Szymon, Wycinka Ewa, Liro Marcin, Sniadecka Nikola, Mrozinska Agnieszka, Sawicki Sambor
Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, Poland.
Department of Pathology, Medical University of Gdansk, Poland.
Ginekol Pol. 2019;90(1):20-30. doi: 10.5603/GP.2019.0004.
To assess the significance of pathologic ultrastaging (PU) of sentinel (SLN) and non-sentinel (nSLN) lymph nodes (LNs) and the influence on cancer staging in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IB1 cervical cancer.
A retrospective study was conducted with 54 patients divided into two equal-sized groups. In test group (n1), at least one SLN/patient was detected with blue dye. All excised LNs in this group were subjected to PU (4 μm slices/150 μm intervals) with hematoxylin-eosin staining and immunohistochemistry (AE1-AE3 antibodies). In none of the control group (n2) was PU performed, but in 2 patients SLN concept was performed. Patients in both groups underwent radical hysterectomy and lymphadenectomy. The effect of PU was expressed in puTNM and compared with both standard pTNM and FIGO systems. The influence of PU on patients' disease-free survival (DFS) and overall survival (OS) was assessed using Kaplan-Meier curves.
In total, 516 LNs were extracted (66 SLNs, 36% bilaterally). Micrometastases (MIC) or isolated tumor cells (ITC) were detected in 34 of the 482 LNs (7.1%), including 16 MICs and 9 ITC in non-SLNs. False negative rates were: 3.7%/side-specific, and 7.4%/both sides. The use of PU resulted in stage change in 2 cases (N and M status change), FIGO stage did not changed. No PU impact on DFS or OS was observed.
The risk of TNM stage migration in early cervical cancer is low, is more likely in inattentively evaluated patients, and has indeterminate prognostic and predictive value. Selection of cases with cT ≤ 2 cm and cN0 is sufficient to avoid the risk of improper staging.
评估前哨淋巴结（SLN）和非前哨淋巴结（nSLN）的病理超分期（PU）的意义及其对国际妇产科联盟（FIGO）IA2 - IB1期宫颈癌患者癌症分期的影响。
进行一项回顾性研究，将54例患者分为两组，每组人数相等。在试验组（n1）中，用蓝色染料检测到至少一个SLN/患者。该组所有切除的淋巴结均进行PU（4μm切片/150μm间隔），采用苏木精 - 伊红染色和免疫组织化学（AE1 - AE3抗体）。对照组（n2）均未进行PU，但2例患者采用了SLN概念。两组患者均接受根治性子宫切除术和淋巴结清扫术。PU的效果用puTNM表示，并与标准pTNM和FIGO系统进行比较。采用Kaplan - Meier曲线评估PU对患者无病生存期（DFS）和总生存期（OS）的影响。
共提取516个淋巴结（66个SLN，36%为双侧）。在482个淋巴结中的34个（7.1%）检测到微转移（MIC）或孤立肿瘤细胞（ITC），包括非SLN中的16个MIC和9个ITC。假阴性率为：单侧特异性3.7%，双侧7.4%。PU的应用导致2例患者分期改变（N和M状态改变），FIGO分期未改变。未观察到PU对DFS或OS有影响。
早期宫颈癌TNM分期迁移的风险较低，在评估不仔细的患者中更有可能发生，且预后和预测价值不确定。选择cT≤2 cm和cN0的病例足以避免分期不当的风险。
