Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands.
Int J Gynecol Cancer. 2021 May;31(5):744-753. doi: 10.1136/ijgc-2020-001964. Epub 2020 Nov 13.
Sentinel lymph node mapping has emerged as an alternative to lymphadenectomy in evaluating the lymph node status in endometrial cancer. Several pathological methods to examine the sentinel lymph node are applied internationally. The aim of this study was to determine the value of ultrastaging and to assess the ultrastaging method with the highest detection rate of metastases.
A systematic review was conducted. Inclusion criteria were: pathologically-confirmed endometrial cancer with sentinel lymph node mapping, report of the histological outcomes, metastases found by hematoxylin and eosin staining and metastases found by ultrastaging were separately mentioned, and description of the ultrastaging method. The primary outcome was the detection of metastases found by ultrastaging that were not detected by routine hematoxylin and eosin staining. The secondary outcome was the difference in detection rate of metastases between several ultrastaging methods. Random effects meta-analyses were conducted.
Fifteen studies were selected, including 2259 patients. Sentinel lymph nodes were examined by routine hematoxylin and eosin staining. Subsequently, multiple ultrastaging methods were used, with differences in macroscopic slicing (bread-loaf/longitudinal), number of microscopic slides, and distance between slides, but all used immunohistochemistry. A positive sentinel lymph node was found in 14% of patients. In 37% of these, this was detected only by ultrastaging. Using more ultrastaging slides did not result in a higher detection rate. Bread-loaf slicing led to a higher detection rate compared with longitudinal slicing (mean detection rates 53% and 33%, respectively).
Pathological ultrastaging after routine hematoxylin and eosin staining in endometrial cancer patients has led to an increased detection rate of sentinel lymph node metastases. Different ultrastaging methods are used, with a preference for bread-loaf slicing. However, due to the large heterogeneity of the studies, assessing which ultrastaging method has the highest detection rate of sentinel lymph node metastases was not possible.
前哨淋巴结活检术已成为子宫内膜癌淋巴结状态评估的一种替代方法。目前国际上有多种病理方法用于检测前哨淋巴结。本研究旨在确定超微结构检查的价值，并评估转移率最高的超微结构检查方法。
进行了系统评价。纳入标准为：经病理证实的子宫内膜癌患者行前哨淋巴结活检术，报告组织学结果，分别提及苏木精-伊红染色和超微结构检查发现的转移灶，以及超微结构检查方法的描述。主要结局是检测苏木精-伊红染色未发现的超微结构检查发现的转移灶。次要结局是几种超微结构检查方法检测转移灶的检出率差异。进行随机效应荟萃分析。
选择了 15 项研究，共纳入 2259 例患者。前哨淋巴结通过常规苏木精-伊红染色检查。随后，使用多种超微结构检查方法，在宏观切片（面包状/纵向）、显微镜切片数量和切片之间的距离上存在差异，但均使用免疫组织化学。14%的患者发现前哨淋巴结阳性。在这些患者中，37%仅通过超微结构检查发现。使用更多的超微结构切片并不能提高检出率。面包状切片比纵向切片的检出率更高（分别为 53%和 33%）。
子宫内膜癌患者在常规苏木精-伊红染色后进行病理超微结构检查，提高了前哨淋巴结转移灶的检出率。不同的超微结构检查方法被应用，其中面包状切片更为流行。然而，由于研究之间存在很大的异质性，无法评估哪种超微结构检查方法对前哨淋巴结转移灶的检出率最高。
