Gynecology Department, University Hospital, University of Lausanne, Lausanne, Switzerland.
Gynecology Department, University Hospital, University of Lausanne, Lausanne, Switzerland.
Gynecol Oncol. 2020 Sep;158(3):576-583. doi: 10.1016/j.ygyno.2020.05.043. Epub 2020 Jun 25.
We aimed to assess the diagnostic value of frozen-section pathologic examination (FSE) of sentinel lymph nodes (SLN) in patients with early-stage cervical cancer.
Two French prospective multicentric database on SLN biopsy for cervical cancer (SENTICOL I and II) were analysed. Patients with IA to IIA1 2018 FIGO stage, who underwent SLN biopsy with both FSE and ultrastaging examination were included.
Between 2005 and 2012, 313 patients from 25 centers fulfilled the inclusion criteria. Metastatic involvement of SLN was diagnosed in 52 patients (16.6%). Macrometastases, micrometastases and isolated tumor cells (ITCs) were found in 27, 12 and 13 patients respectively. Among the 928 SLNs analysed, FSE identified 23 SLNs with macrometastases in 20 patients and 5 SLNs with micrometastases in 2 patients whereas no ITCs were identified. Ultrastaging of negative SLNs by FSE found macrometastases, micrometastases and ITCs in additional 7, 11 and 17 SLNs. Ultrastaging increased significantly the rate of patients with positive SLN from 7% to 16.6% (p < 0.0001). The sensitivity and the negative predictive value of FSE were 42.3% and 89.7% respectively or 56.4% and 94.1% if ITCs were excluded. False-negative cases were more frequent with tumor size ≥ 20 mm (OR = 4.46, 95%IC = [1.45-13.66], p = 0.01) and preoperative brachytherapy (OR = 4.47, 95%IC = [1.37-14.63], p = 0.01) and less frequent with patients included in higher volume center (>5 patients/year) (OR = 0.09, 95%IC = [0.02-0.51], p = 0.01).
FSE of SLN had a low sensitivity for detecting micrometastases and ITCs and a high negative predictive value for SLN status. Clinical impact of false-negative cases has to be assessed by further studies.
我们旨在评估早期宫颈癌患者前哨淋巴结（SLN）冷冻切片病理检查（FSE）的诊断价值。
对两项法国前瞻性 SLN 活检宫颈癌多中心数据库（SENTICOL I 和 II）进行分析。纳入了接受 SLN 活检且同时进行 FSE 和超微检查的 2018 年 FIGO 分期为 IA 至 IIA1 的患者。
2005 年至 2012 年，25 个中心的 313 名患者符合纳入标准。52 名患者（16.6%）诊断为 SLN 转移受累。27 名、12 名和 13 名患者分别发现大转移、微转移和孤立肿瘤细胞（ITC）。在分析的 928 个 SLN 中，FSE 在 20 名患者的 23 个 SLN 中发现了大转移，在 2 名患者的 5 个 SLN 中发现了微转移，而未发现 ITC。FSE 对阴性 SLN 的超微检查发现，在另外 7、11 和 17 个 SLN 中发现了大转移、微转移和 ITC。超微检查使 SLN 阳性患者的比例从 7%显著增加到 16.6%（p<0.0001）。FSE 的灵敏度和阴性预测值分别为 42.3%和 89.7%，如果排除 ITC，则分别为 56.4%和 94.1%。肿瘤大小≥20mm（OR=4.46，95%CI=[1.45-13.66]，p=0.01）和术前近距离放疗（OR=4.47，95%CI=[1.37-14.63]，p=0.01）的假阴性病例更为常见，而在纳入高容量中心（>5 名患者/年）的患者中（OR=0.09，95%CI=[0.02-0.51]，p=0.01）假阴性病例则较少。
FSE 对检测微转移和 ITC 的灵敏度较低，对 SLN 状态的阴性预测值较高。假阴性病例的临床影响需要进一步研究评估。
