两种用于检测早期宫颈癌和子宫内膜癌淋巴结转移的超分期方案。
Two ultrastaging protocols for the detection of lymph node metastases in early-stage cervical and endometrial cancers.
机构信息
Obstetrics and Gynecology, Hospital San Gerardo, Monza, Lombardia, Italy.
Pathology, Hospital San Gerardo, Monza, Lombardia, Italy.
出版信息
Int J Gynecol Cancer. 2020 Sep;30(9):1404-1410. doi: 10.1136/ijgc-2020-001298. Epub 2020 May 5.
OBJECTIVE
To date, there is no universal consensus on which is the optimal ultrastaging protocol for sentinel lymph node (SLN) evaluation in gynecologic malignancies. To estimate the impact of different ultrastaging methods of SLNs on the detection of patients with nodal metastases in early-stage cervical and endometrial cancers and to describe the incidence of low-volume metastases between two ultrastaging protocols.
METHODS
We retrospectively compared two ultrastaging protocols (ultrastaging-A vs ultrastaging-B) in patients with clinical stage I endometrial cancer or FIGO stage IA-IB1 cervical cancer who underwent primary surgery including SLN biopsy from October 2010 to December 2017 in our institution. The histologic subtypes and grades of the tumors were evaluated according to WHO criteria. Only SLNs underwent ultrastaging, while other lymph nodes were sectioned and examined by routine hematoxylin and eosin (H&E).
RESULTS
Overall 224 patients were reviewed (159 endometrial cancer and 65 cervical cancer). Lymph node involvement was noted in 15% of patients with endometrial cancer (24/159): 24% of patients (9/38) with the ultrastaging protocol A and 12% (15/121) with the ultrastaging protocol B (p=0.08); while for cervical cancer, SLN metastasis was detected in 14% of patients (9/65): 22% (4/18) in ultrastaging-A and 11% (5/47) in ultrastaging-B (p=0.20). Overall, macrometastasis and low-volume metastases were 50% and 50% for endometrial cancer and 78% and 22% for cervical cancer. Median size of nodal metastasis was 2 (range 0.9-8.5) mm for the ultrastaging-A and 1.2 (range 0.4-2.6) mm for the ultrastaging-B protocol in endometrial cancer (p=0.25); 4 (range 2.5-9.8) mm for ultrastaging-A and 4.4 (range 0.3-7.8) mm for ultrastaging-B protocol in cervical cancer (p=0.64).
CONCLUSION
In endometrial or cervical cancer patients, the incidence of SLN metastasis was not different between the two different types of ultrastaging protocol.
目的
目前，对于前哨淋巴结（SLN）评估的最佳超微结构分期方案，尚无普遍共识。本研究旨在评估不同 SLN 超微结构分期方法对早期宫颈癌和子宫内膜癌患者淋巴结转移检测的影响，并描述两种超微结构分期方案之间低容量转移的发生率。
方法
我们回顾性比较了 2010 年 10 月至 2017 年 12 月期间在我院接受包括 SLN 活检在内的原发性手术的临床分期 I 期子宫内膜癌或 FIGO 分期 IA-IB1 期宫颈癌患者的两种超微结构分期方案（超微结构 A 与超微结构 B）。肿瘤的组织学亚型和分级根据世界卫生组织（WHO）标准进行评估。仅对 SLN 进行超微结构分期，而其他淋巴结则通过常规苏木精和伊红（H&E）切片进行检查。
结果
共回顾了 224 例患者（159 例子宫内膜癌和 65 例宫颈癌）。159 例子宫内膜癌患者中，有 15%（24/159）存在淋巴结受累：超微结构 A 方案中为 24%（9/38），超微结构 B 方案中为 12%（15/121）（p=0.08）；65 例宫颈癌患者中，有 14%（9/65）的 SLN 转移：超微结构 A 方案中为 22%（4/18），超微结构 B 方案中为 11%（5/47）（p=0.20）。总体而言，子宫内膜癌中，大转移和低容量转移的比例分别为 50%和 50%，宫颈癌中，这两种转移的比例分别为 78%和 22%。子宫内膜癌中超微结构 A 方案的淋巴结转移中位大小为 2（范围 0.9-8.5）mm，超微结构 B 方案为 1.2（范围 0.4-2.6）mm（p=0.25）；超微结构 A 方案中为 4（范围 2.5-9.8）mm，超微结构 B 方案中为 4.4（范围 0.3-7.8）mm（p=0.64）。
结论
在子宫内膜癌或宫颈癌患者中，两种不同类型的超微结构分期方案之间 SLN 转移的发生率没有差异。
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