宫颈癌前哨淋巴结活检的潜在风险：单中心初步研究。
Potential risks in sentinel lymph node biopsy for cervical cancer: a single-institution pilot study.
机构信息
Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, East Dongfeng Road 651, Guangzhou, 510060, China.
State Key Laboratory of Oncology in South China, Guangzhou, 510060, China.
出版信息
World J Surg Oncol. 2020 Jun 18;18(1):133. doi: 10.1186/s12957-020-01905-9.
BACKGROUND
Sentinel lymph node (SLN) biopsy is an attractive technique that is widely performed in many oncological surgeries. However, the potential risks in SLN biopsy for cervical cancer remains largely unclear.
METHODS
Seventy-five patients with histologically confirmed cervical cancer were enrolled between May 2014 and June 2016. SLN biopsies were performed followed by pelvic lymphadenectomies and all resected nodes were labeled according to their anatomic areas. Only bilateral detections of SLNs were considered successful. Patients' clinicopathologic feature, performance of SLN detection, and distributions of lymph node metastases were analyzed.
RESULTS
Of the 75 enrolled patients, at least one SLN was detected in 69 (92.0%), including 33 in bilateral and 36 in unilateral. SLNs were most detected in the obturator area (52 of 69 patients, 75.4%) and 26 (37.7%) patients presented SLNs in more than one area of hemipelvis. Lymphovascular invasion was found to be the only factor that adversely influenced SLN detection, while the tumor diameter, growth type, histological grade, deep stromal invasion, and neoadjuvant chemotherapy showed no significant impacts. Patients with lymphovascular invasion showed a significantly higher rate to have unsuccessful detection (90.9% versus 41.5%, P < 0.001) and lymph node metastasis (40.9% versus 3.8%, P < 0.001) compared with those without. Nodal metastases were confirmed in 11 patients, of whom 9 (81.8%) had lymphovascular invasion and 7 (63.6%) had non-SLN metastasis. The most frequently involved SLNs were obturator nodes (9/11, 81.8%). In addition, the parametrial nodes also have a high rate to be positive (4/11, 36.4%), although they were relatively less identified as SLNs. Besides, 3 patients showed metastases in the laterals without SLN detected.
CONCLUSIONS
In cervical cancer, lymphovascular invasion is a significant factor for unsuccessful SLN detection. The risk of having undetected metastasis is high when SLN is positive; therefore, further lymphadenectomy may be necessary for these patients.
背景
前哨淋巴结（SLN）活检是一种广泛应用于许多肿瘤外科的有吸引力的技术。然而，宫颈癌 SLN 活检的潜在风险在很大程度上仍不清楚。
方法
2014 年 5 月至 2016 年 6 月期间，共纳入 75 例经组织学证实的宫颈癌患者。行 SLN 活检后行盆腔淋巴结清扫术，所有切除的淋巴结均根据其解剖区域进行标记。仅双侧检测到 SLN 被认为是成功的。分析患者的临床病理特征、SLN 检测结果和淋巴结转移分布。
结果
在 75 例入组患者中，至少有 1 例 SLN 被检出的患者有 69 例（92.0%），其中 33 例为双侧，36 例为单侧。SLN 最常被检测到的区域是闭孔区（52 例患者中有 52 例，75.4%），26 例患者（37.7%）有超过一个半骨盆区域的 SLN。淋巴管血管侵犯被发现是唯一对 SLN 检测有不利影响的因素，而肿瘤直径、生长类型、组织学分级、深肌层浸润和新辅助化疗均无显著影响。有淋巴管血管侵犯的患者其 SLN 检测不成功的比例显著更高（90.9%比 41.5%，P < 0.001），且淋巴结转移的比例也显著更高（40.9%比 3.8%，P < 0.001）。11 例患者证实存在淋巴结转移，其中 9 例（81.8%）有淋巴管血管侵犯，7 例（63.6%）有非 SLN 转移。最常受累的 SLN 是闭孔淋巴结（9/11，81.8%）。此外，宫旁淋巴结也有较高的阳性率（4/11，36.4%），尽管它们作为 SLN 被识别的比例相对较低。此外，3 例患者在没有检测到 SLN 的情况下出现了侧方转移。
结论
在宫颈癌中，淋巴管血管侵犯是 SLN 检测不成功的重要因素。当 SLN 阳性时，存在未检出转移的风险较高；因此，这些患者可能需要进一步行淋巴结清扫术。
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