Department of Gynaecology, Klinikum Bremen-Nord, Bremen, Germany.
Department of Gynaecology, Charité Medical University Berlin, Berlin, Germany.
Cancer Rep (Hoboken). 2021 Aug;4(4):e1366. doi: 10.1002/cnr2.1366. Epub 2021 Mar 14.
In patients diagnosed with cervical cancer, the purpose of lymphadenectomy is the removal of lymph nodes for diagnosis and potential treatment of metastasized tumor cells. It is unclear if afferent lymphatic vessels harbor tumor cells and, thus, may pose additional risk for recurrence or progression if not removed.
In this feasibility study, we analyzed the lymphatic vessels afferent to sentinel lymph node (SLN) using a highly sensitive and specific molecular marker for cervical cancer cells.
Twenty patients diagnosed with cervical cancer of FIGO stage IA1 to IIB2 underwent laparoscopic SLN removal. Labeling was done using patent blue and the afferent lymphatic vessels were harvested from the parametric tissue and frozen at -80°C. HPV DNA type was evaluated in the primary tumor. Lymphatic vessels afferent to the sentinel lymph nodes were analyzed for the presence of viral oncogene transcripts of the respective HPV type. In one of 18 patients, all with tumor stage ≤IBI and pN0 by conventional histopathology, HPV mRNA could be detected in two of four lymphatic vessels, whereas at least one of the lymphatic vessel biopsies of both patients with tumors ˃4 cm and pN1 status was HPV mRNA positive. No clinical correlation with recurrence after a median follow-up of 9 years was noticed.
HPV mRNA indicative of disseminated tumor cells could be detected in lymphatic vessels. The relevance of harvesting lymphatic vessels afferent to SLN in order to increase oncologic safety will have to be investigated in a future prospective study.
在诊断为宫颈癌的患者中，淋巴结切除术的目的是为了诊断和治疗可能转移的肿瘤细胞而切除淋巴结。目前尚不清楚前向淋巴管是否存在肿瘤细胞，如果不切除这些细胞，是否会增加复发或进展的风险。
在这项可行性研究中，我们使用一种针对宫颈癌细胞的高度敏感和特异性的分子标志物来分析前哨淋巴结（SLN）的淋巴管。
20 例 FIGO 分期为 IA1 至 IIB2 的宫颈癌患者接受了腹腔镜 SLN 切除术。使用专利蓝进行标记，并从前哨淋巴结所在的参数组织中采集前向淋巴管，然后在-80°C 下冷冻。在原发性肿瘤中评估 HPV DNA 类型。分析前哨淋巴结的淋巴管中是否存在相应 HPV 型别的病毒癌基因转录本。在 18 例患者中，所有患者的肿瘤分期均为≤IBI 和常规组织病理学的 pN0，在 4 条淋巴管中的 2 条中可以检测到 HPV mRNA，而在肿瘤直径>4cm 和 pN1 状态的 2 例患者中，至少有一条淋巴管活检呈 HPV mRNA 阳性。中位随访 9 年后未发现与复发有关的临床相关性。
可以在前哨淋巴结的淋巴管中检测到 HPV mRNA，提示存在播散的肿瘤细胞。为了提高肿瘤学安全性，有必要在前瞻性研究中进一步研究采集前哨淋巴结前向淋巴管的相关性。
