Lecointre Lise, Lodi Massimo, Faller Émilie, Boisramé Thomas, Agnus Vincent, Baldauf Jean-Jacques, Gallix Benoît, Akladios Chérif
Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France.
I-Cube UMR 7357-Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie, Université de Strasbourg, 67081 Strasbourg, France.
J Clin Med. 2020 Nov 28;9(12):3874. doi: 10.3390/jcm9123874.
To assess the value of sentinel lymph node (SLN) sampling in high risk endometrial cancer according to the ESMO-ESGO-ESTRO classification.
We performed a comprehensive search on PubMed for clinical trials evaluating SLN sampling in patients with high risk endometrial cancer: stage I endometrioid, grade 3, with at least 50% myometrial invasion, regardless of lymphovascular space invasion status; or stage II; or node-negative stage III endometrioid, no residual disease; or non-endometrioid (serous or clear cell or undifferentiated carcinoma, or carcinosarcoma). All patients underwent SLN sampling followed by pelvic with or without para-aortic lymphadenectomy.
We included 17 original studies concerning 1322 women. Mean detection rates were 89% for unilateral and 68% for bilateral. Pooled sensitivity was 88.5% (95%CI: 81.2-93.2%), negative predictive value was 96.0% (95%CI: 93.1-97.7%), and false negative rate was 11.5% (95%CI: 6.8; 18.8%). We noted heterogeneity in SLN techniques between studies, concerning the tracer and its detection, the injection site, the number of injections, and the surgical approach. Finally, we found a correlation between the number of patients included and the SLN sampling performances.
This meta-analysis estimated the SLN sampling performances in high risk endometrial cancer patients. Data from the literature show the feasibility, the safety, the limits, and the impact on surgical de-escalation of this technique. In conclusion, our study supports the hypothesis that SLN sampling could be a valuable technique to diagnose lymph node involvement for patients with high risk endometrial cancer in replacement of conventional lymphadenectomy. Consequently, randomized clinical trials are necessary to confirm this hypothesis.
根据欧洲肿瘤内科学会（ESMO）-欧洲妇科肿瘤学会（ESGO）-欧洲放射肿瘤学会（ESTRO）分类评估前哨淋巴结（SLN）取样在高危子宫内膜癌中的价值。
我们在PubMed上进行了全面检索，以查找评估高危子宫内膜癌患者SLN取样的临床试验：Ⅰ期子宫内膜样癌，3级，肌层浸润至少50%，无论有无脉管间隙浸润；或Ⅱ期；或淋巴结阴性的Ⅲ期子宫内膜样癌，无残留病灶；或非子宫内膜样癌（浆液性或透明细胞或未分化癌，或癌肉瘤）。所有患者均接受SLN取样，随后进行盆腔淋巴结清扫，可联合或不联合腹主动脉旁淋巴结清扫。
我们纳入了17项涉及1322名女性的原始研究。单侧SLN的平均检出率为89%，双侧为68%。合并敏感度为88.5%（95%置信区间：81.2 - 93.2%），阴性预测值为96.0%（95%置信区间：93.1 - 97.7%），假阴性率为11.5%（95%置信区间：6.8；18.8%）。我们注意到各研究之间在SLN技术方面存在异质性，涉及示踪剂及其检测、注射部位、注射次数和手术方式。最后，我们发现纳入患者数量与SLN取样性能之间存在相关性。
这项荟萃分析评估了高危子宫内膜癌患者的SLN取样性能。文献数据显示了该技术的可行性、安全性、局限性以及对手术降期的影响。总之，我们的研究支持这样一种假设，即SLN取样可能是一种有价值的技术，可用于诊断高危子宫内膜癌患者的淋巴结受累情况，以替代传统的淋巴结清扫术。因此，有必要进行随机临床试验来证实这一假设。
