Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
Int J Gynecol Cancer. 2020 May;30(5):626-630. doi: 10.1136/ijgc-2019-001154. Epub 2020 Mar 21.
Endometrial cancer is the most common gynecologic cancer, and lymph node metastasis is one of the most important prognostic factors. Increasing evidence shows that sentinel lymph node (SLN) mapping is an effective alternative to comprehensive lymphadenectomy. Single photon emission CT with computed tomography (SPECT/CT) is associated with a high SLN detection rate.
To compare the clinical efficacy of SPECT/CT with that of lymphoscintigraphy in detecting SLNs in patients with endometrial cancer.
Between May 2014 and October 2018, 151 patients with endometrial cancer were enrolled in this study at the Department of Obstetrics and Gynecology of the Kagoshima University Hospital. Inclusion criteria were patients with endometrial cancer, older than 18 years, and with pre-operative International Federation of Gynecology and Obstetrics (FIGO) staging of I and II. All patients underwent pre-operative CT, and patients with suspected peritoneal dissemination and lymph node metastasis were excluded from this study. Pelvic SLNs were detected by injection of tecnetium-99m-labeled phytate into the uterine cervix. The number and locations of SLNs detected using lymphoscintigraphy and SPECT/CT were evaluated. JMP software (version 14, SAS Institute Inc., Cary, North Carolina, USA) was used for statistical analysis.
A total of 151 patients who underwent pre-operative lymphoscintigraphy and SPECT/CT were included in the study. The median age was 57 years (range 24-79), and the median body mass index was 24.3 kg/m (range 16-40). The final pathology was as follows: 135 (89%) endometrioid carcinoma, 11 (7%) serous carcinoma, one (1%) clear cell carcinoma, and four (3%) other histotypes. Based on SPECT/CT, 204 pelvic SLNs were detected. The bilateral pelvic SLN detection rate was better for SPECT/CT (43% (65/151)) than for lymphoscintigraphy (32% (48/151)) (p<0.0001). The overall pelvic SLN detection rate (at least one pelvic SLN detected) was also better with SPECT/CT (77% (16/151)) vs lymphoscintigraphy (68% (102/151)) (p<0.0001). The distribution of SLN locations detected using SPECT/CT was as follows: external iliac, 91 (45%); obturator, 61 (30%); common iliac, 28 (14%); internal iliac, 19 (9%); para-aortic, 2 (1%); parametrium, 2 (1%), and presacral, 1 (1%). The SLN detection rate using SPECT/CT was significantly worse in patients of advanced age (p<0.0001).
Overall and bilateral SLN detection rate was better with SPECT/CT than with lymphoscintigraphy in patients with stage I/II endometrial cancer.
子宫内膜癌是最常见的妇科恶性肿瘤，淋巴结转移是最重要的预后因素之一。越来越多的证据表明，前哨淋巴结（SLN）定位是一种替代全面淋巴结清扫术的有效方法。单光子发射 CT 与计算机断层扫描（SPECT/CT）具有较高的 SLN 检出率。
比较 SPECT/CT 与淋巴闪烁显像术在检测子宫内膜癌患者 SLN 中的临床疗效。
2014 年 5 月至 2018 年 10 月，在鹿儿岛大学医院妇产科对 151 例子宫内膜癌患者进行了本研究。纳入标准为子宫内膜癌患者，年龄>18 岁，术前国际妇产科联合会（FIGO）分期为 I 期和 II 期。所有患者均行术前 CT 检查，对疑似腹膜播散和淋巴结转移的患者排除本研究。经宫颈注射锝-99m 标记植酸钠检测盆腔 SLN。评估淋巴闪烁显像术和 SPECT/CT 检测到的 SLN 的数量和位置。使用 JMP 软件（版本 14，SAS Institute Inc.，Cary，North Carolina，USA）进行统计分析。
共有 151 例患者接受了术前淋巴闪烁显像术和 SPECT/CT 检查，纳入本研究。中位年龄为 57 岁（范围 24-79），中位体重指数为 24.3kg/m（范围 16-40）。最终病理为：子宫内膜样癌 135 例（89%），浆液性癌 11 例（7%），透明细胞癌 1 例（1%），其他组织学类型 4 例（3%）。基于 SPECT/CT，共检测到 204 个盆腔 SLN。与淋巴闪烁显像术相比，SPECT/CT 的双侧盆腔 SLN 检出率更好（43%（65/151）vs 32%（48/151））（p<0.0001）。SPECT/CT 的总体盆腔 SLN 检出率（至少检出一个盆腔 SLN）也优于淋巴闪烁显像术（77%（16/151）vs 68%（102/151））（p<0.0001）。SPECT/CT 检测到的 SLN 位置分布如下：髂外 91 例（45%）；闭孔 61 例（30%）；髂总 28 例（14%）；髂内 19 例（9%）；腹主动脉旁 2 例（1%）；宫旁 2 例（1%）；骶前 1 例（1%）。SPECT/CT 对高龄患者的 SLN 检出率明显较差（p<0.0001）。
在 I/II 期子宫内膜癌患者中，SPECT/CT 与淋巴闪烁显像术相比，整体和双侧 SLN 检出率更高。
