Institute Clinic of Gynecology, Obstetrics, and Neonatology, Clinical Hospital of Barcelona, Barcelona, Spain -
Department of Surgical Oncology, Claudius Regaud Institute, Cancer University Institute of Toulouse - Oncopole, Toulouse, France -
Q J Nucl Med Mol Imaging. 2023 Mar;67(1):37-45. doi: 10.23736/S1824-4785.20.03246-X. Epub 2020 Feb 18.
In endometrial cancer (EC), sentinel lymph node (SLN) mapping has emerged as an alternative to systematic lymphadenectomy. Little is known about factors that might influence SLN preoperative detection. The aim of our study was to evaluate the clinical and technical variables that may influence on the success of SLN detection in preoperative lymphatic mapping in patients with intermediate and high-risk EC when performing transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR).
Between March 2006 and March 2017, we prospectively enrolled patients with histologically confirmed EC with intermediate or high-risk of lymphatic involvement. All women underwent SLN detection by using TUMIR approach. After radiotracer injection, pelvic and abdominal planar and SPECT/CT images were acquired to obtain a preoperative lymphoscintigraphic mapping. Pattern of drainage was registered and analyzed to identify the factors directly involved in drainage. Sonographer learning curves to perform TUMIR approach were created following Cumulative Sum and Wright methods. Univariate and multivariate analyses were performed using logistic regression.
During study period, 123 patients were included. SLN preoperative detection rate was 70.7%. Age under 75 years at diagnosis (P<0.01), radiotracer injection above 4 mL -high-volume- (P<0.01), and tumoral size below 2 cm (P=0.04) were associated with higher SLN preoperative detection rate. Twenty-five procedures were necessary to attain an adequate performance in TUMIR approach.
The higher SLN preoperative detection rate in women with intermediate and high-risk endometrial cancer after TUMIR approach was related with younger age, smaller tumors and high-volume injection of radiotracer. Sonographers are required to perform 25 procedures before acquiring an expertise in radiotracer injection.
在子宫内膜癌（EC）中，前哨淋巴结（SLN）检测已成为系统淋巴结清扫术的替代方法。对于可能影响 SLN 术前检测的因素知之甚少。我们的研究目的是评估可能影响经阴道超声引导肌内注射放射性示踪剂（TUMIR）进行术前淋巴定位时中高危 EC 患者 SLN 检测成功率的临床和技术变量。
2006 年 3 月至 2017 年 3 月，我们前瞻性地招募了经组织学证实的具有中高危淋巴受累风险的 EC 患者。所有女性均采用 TUMIR 方法进行 SLN 检测。放射性示踪剂注射后，采集盆腔和腹部平面和 SPECT/CT 图像以获得术前淋巴闪烁图。登记引流模式并进行分析以确定直接涉及引流的因素。使用 Cumulative Sum 和 Wright 方法创建了超声医师执行 TUMIR 方法的学习曲线。使用逻辑回归进行单变量和多变量分析。
在研究期间，共纳入 123 例患者。SLN 术前检测率为 70.7%。诊断时年龄小于 75 岁（P<0.01）、放射性示踪剂注射量超过 4 毫升（高容量）（P<0.01）和肿瘤大小小于 2 厘米（P=0.04）与更高的 SLN 术前检测率相关。需要 25 次操作才能获得 TUMIR 方法的足够性能。
TUMIR 方法后中高危子宫内膜癌患者 SLN 术前检测率较高与年龄较小、肿瘤较小和放射性示踪剂高容量注射有关。超声医师需要进行 25 次操作才能获得放射性示踪剂注射的专业技能。
