Gynaecological Oncology, Maidstone Hospital, Maidstone, Kent, UK
Gynaecological Oncology, Maidstone Hospital, Maidstone, Kent, UK.
Int J Gynecol Cancer. 2022 Jan;32(1):15-20. doi: 10.1136/ijgc-2019-001082. Epub 2020 Jun 16.
Sentinel lymph node (SLN) biopsy aims to assess lymph node status with reduced surgical morbidity. The aim of the study was to determine the accuracy and safety of SLN biopsy in the management of early cervical carcinoma using a double technique (technetium-99m (Tc-99m) nanocolloid and methylene blue dye injection).
This was a 10-year study from January 2009 to January 2019 that recruited 103 consecutive women undergoing surgery for early cervical carcinoma, FIGO 2009 stage IA1 (grade 3, and grade 2 with lymphovascular space invasion) to IB1 (<2 cm), at the West Kent Gynaecological Oncology Centre, Maidstone, UK. All patients were given the choice of pelvic node dissection and SLN mapping or SLN only. All patients elected to undergo SLN only. In total 97 patients had SLN mapping performed laparoscopically. We used the combined method (Tc-99m nanocolloid and/or methylene blue dye). All SLN routinely underwent ultrastaging.
At least one SLN was detected in all 103 patients, using at least one of the combined methods (Tc-99m nanocolloid or blue dye). Bilaterally SLN were removed in 85/103 women with an 83% bilateral detection rate. The median SLN count was 2.3 (range 1-6) nodes. Of 103 patients, 7 (6.7%) patients had lymph node involvement. There were no pelvic or para-aortic lymph node recurrences with a median follow-up of 53 (range 8-120) months. The specificity and negative predictive value of a negative SLN was 100%. None of our 103 patients reported lower extremity lymphedema.
In carefully selected patients with early cervical carcinoma, SLN biopsy alone appears to be a safe method for lymph node assessment of women undergoing surgical staging. Ultrastaging is an essential part of histologic examination of SLN.
前哨淋巴结（SLN）活检旨在通过降低手术发病率来评估淋巴结状态。本研究的目的是使用双技术（锝-99m（Tc-99m）纳米胶体和亚甲蓝染料注射）确定 SLN 活检在早期宫颈癌管理中的准确性和安全性。
这是一项 10 年的研究，于 2009 年 1 月至 2019 年 1 月期间在英国肯特郡梅德斯通的 West Kent 妇科肿瘤中心招募了 103 名连续接受手术治疗的早期宫颈癌患者，FIGO 2009 期 IA1（3 级和 2 级伴淋巴管血管空间侵犯）至 IB1（<2cm）。所有患者均选择接受盆腔淋巴结清扫术和 SLN 图谱或仅 SLN。所有患者均选择仅行 SLN。共有 97 例患者行腹腔镜 SLN 图谱。我们使用联合方法（Tc-99m 纳米胶体和/或亚甲蓝染料）。所有 SLN 均常规进行超微结构检查。
所有 103 例患者均至少使用一种联合方法（Tc-99m 纳米胶体或蓝色染料）检测到至少一个 SLN。85/103 例女性双侧均切除 SLN，双侧检出率为 83%。SLN 中位数为 2.3（范围 1-6）个。103 例患者中，7 例（6.7%）患者存在淋巴结受累。中位随访 53（范围 8-120）个月，无盆腔或主动脉旁淋巴结复发。阴性 SLN 的特异性和阴性预测值均为 100%。我们的 103 例患者均未报告下肢淋巴水肿。
在精心挑选的早期宫颈癌患者中，单独行 SLN 活检似乎是一种安全的方法，可用于评估接受手术分期的女性的淋巴结情况。超微结构检查是 SLN 组织学检查的重要组成部分。
