Dioun Shayan, Chen Ling, Melamed Alexander, Gockley Allison, St Clair Caryn M, Hou June Y, Tergas Ana I, Khoury-Collado Fady, Hur Chin, Hershman Dawn L, Wright Jason D
Columbia University College of Physicians and Surgeons, the Joseph L. Mailman School of Public Health, Columbia University, the Herbert Irving Comprehensive Cancer Center, and New York Presbyterian Hospital, New York, New York.
Obstet Gynecol. 2021 May 1;137(5):924-934. doi: 10.1097/AOG.0000000000004352.
To examine the utilization, morbidity, and cost of sentinel lymph node mapping in women undergoing hysterectomy for complex atypical endometrial hyperplasia.
Women with complex atypical endometrial hyperplasia who underwent hysterectomy from 2012 to 2018 in the Perspective database were examined. Perioperative morbidity, mortality, and cost were examined based on performance of sentinel lymph node mapping, lymph node dissection or no nodal evaluation.
Among 10,266 women, sentinel lymph node mapping was performed in 620 (6.0%), lymph node dissection in 538 (5.2%), and no lymphatic evaluation in 9,108 (88.7%). Use of sentinel lymph node mapping increased from 0.8% in 2012 to 14.0% in 2018, and the rate of lymph node dissection rose from 5.7% to 6.4% (P<.001). In an adjusted model, residence in the western United States, treatment by high-volume hospitals and use of robotic-assisted hysterectomy were associated with sentinel lymph node mapping (P<.05 for all). The complication rates were similar between the three groups. The median cost for sentinel lymph node mapping ($9,673) and lymph node dissection ($9,754) were higher than in those who did not undergo nodal assessment ($8,435) (P<.001).
Performance of sentinel lymph node mapping is increasing rapidly for women with complex atypical endometrial hyperplasia but is not associated with increased perioperative morbidity or mortality.
研究在因复杂性非典型子宫内膜增生接受子宫切除术的女性中前哨淋巴结定位的应用情况、发病率及成本。
对2012年至2018年在Perspective数据库中因复杂性非典型子宫内膜增生接受子宫切除术的女性进行研究。根据前哨淋巴结定位、淋巴结清扫或未进行淋巴结评估的情况，对围手术期发病率、死亡率及成本进行研究。
在10266名女性中，620名（6.0%）进行了前哨淋巴结定位，538名（5.2%）进行了淋巴结清扫，9108名（88.7%）未进行淋巴结评估。前哨淋巴结定位的应用比例从2012年的0.8%增至2018年的14.0%，淋巴结清扫率从5.7%升至6.4%（P<0.001）。在调整模型中，居住在美国西部、由大型医院治疗以及使用机器人辅助子宫切除术与前哨淋巴结定位相关（均P<0.05）。三组的并发症发生率相似。前哨淋巴结定位（9673美元）和淋巴结清扫（9754美元）的中位成本高于未进行淋巴结评估的患者（8435美元）（P<0.001）。
对于患有复杂性非典型子宫内膜增生的女性，前哨淋巴结定位的应用正在迅速增加，但与围手术期发病率或死亡率增加无关。
