Department of Obstetrics and Gynecology, Kocaeli University School of Medicine, Kocaeli, Turkey
Department of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey.
Int J Gynecol Cancer. 2020 Mar;30(3):325-331. doi: 10.1136/ijgc-2019-000860. Epub 2020 Feb 5.
To evaluate the relationship between pelvic/para-aortic sentinel lymph node status and two different injection sites of 99m-technetium (Tc)-labeled phytate in patients with endometrial cancer.
This was a randomized controlled trial involving 81 patients with endometrial cancer. In the cervical group (n=40), injections of Tc were performed at the 3 and 9 o'clock positions of the uterine cervix. In the endometrial group (n=41), Tc was injected into the fundal endometrium using a transcervical catheter. Sentinel lymph nodes were detected through pre-operative lymphoscintigraphy and intra-operatively using a handheld gamma probe. All patients underwent complete pelvic and para-aortic lymphadenectomy procedures. Pathologic ultra-staging was performed with immunostaining for cytokeratin in sentinel lymph nodes after routine hematoxylin and eosin histological examinations. The primary endpoint was the estimation of detection rates, sensitivity, false-negative rates, negative predictive value, and analysis of the distribution of pelvic and para-aortic sentinel lymph nodes.
The rate of detection of at least one sentinel lymph node, sensitivity, and the negative predictive value was 80%, 66.6%, 96.6% for the cervical group and 85%, 66.6%, 96.9% for the endometrial group, respectively. False-negative sentinel lymph nodes were detected in one patient from each group . There was no significant difference between the groups in terms of total sentinel lymph node count, sentinel pelvic lymph node count, and pelvic bilaterality, but the para-aortic sentinel lymph node count was significantly higher in the endometrial group (p<0.001). Ultra-staging examination of the pelvic sentinel lymph nodes revealed isolated tumor cells in one patient from each group.
Transcervical endometrial tracer injection in endometrial cancer revealed similar pelvic but significantly higher para-aortic sentinel lymph node detection.
评估 99m 锝-标记植酸钠在宫颈癌患者宫颈和宫底两种不同注射部位的前哨淋巴结状态与盆腔和腹主动脉旁淋巴结状态的关系。
这是一项随机对照试验，共纳入 81 例子宫内膜癌患者。宫颈组（n=40）在宫颈 3 点和 9 点位置注射 Tc，宫底组（n=41）通过经宫颈导管向宫底子宫内膜注射 Tc。术前淋巴闪烁显像和术中使用手持式伽马探针检测前哨淋巴结。所有患者均行全盆腔和腹主动脉旁淋巴结清扫术。前哨淋巴结行常规苏木精-伊红（HE）组织学检查后，用免疫组化法检测细胞角蛋白进行病理超分期。主要终点是评估检测率、灵敏度、假阴性率、阴性预测值以及分析盆腔和腹主动脉旁前哨淋巴结的分布。
宫颈组和宫底组至少检测到一个前哨淋巴结的比例分别为 80%和 85%，灵敏度分别为 66.6%和 66.6%，阴性预测值分别为 96.6%和 96.9%。两组各有 1 例假阴性前哨淋巴结。两组总的前哨淋巴结计数、盆腔前哨淋巴结计数和盆腔双侧性均无显著差异，但宫底组的腹主动脉旁前哨淋巴结计数显著更高（p<0.001）。盆腔前哨淋巴结的超分期检查显示两组各有 1 例患者存在孤立肿瘤细胞。
在子宫内膜癌中，经宫颈子宫内膜示踪剂注射可检测到类似的盆腔前哨淋巴结，但腹主动脉旁前哨淋巴结的检出率显著更高。
