Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic of Barcelona, Spain.
Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France.
J Gynecol Oncol. 2021 Jul;32(4):e52. doi: 10.3802/jgo.2021.32.e52. Epub 2021 Mar 20.
We aimed to evaluate the accuracy of sentinel lymph node (SLN) mapping with transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR) to detect lymph node (LN) metastases, in patients with intermediate and high-risk endometrial cancer (EC), focusing on its performance to detect paraaortic involvement.
Prospective study including women with preoperative intermediate or high-risk EC, according to ESMO-ESGO-ESTRO consensus, who underwent SLN mapping using the TUMIR approach. SLNs were preoperatively localized by planar and single photon emission computed tomography/computed tomography images, and intraoperatively by gamma-probe. Immediately after SLN excision, all women underwent systematic pelvic and paraaortic lymphadenectomy by laparoscopy.
The study included 102 patients. The intraoperative SLN detection rate was 79.4% (81/102). Pelvic and paraaortic drainage was observed in 92.6% (75/81) and 45.7% (37/81) women, respectively, being exclusively paraaortic in 7.4% (6/81). After systematic lymphadenectomy, LN metastases were identified in 19.6% (20/102) patients, with 45.0% (9/20) showing paraaortic involvement, which was exclusive in 15.0% (3/20). The overall sensitivity and negative predictive value (NPV) of SLNs by the TUMIR approach to detect lymphatic involvement were 87.5% and 97.0%, respectively; and 83.3% and 96.9%, for paraaortic metastases. After applying the MSKCC SLN mapping algorithm, the sensitivity and NPV were 93.8% and 98.5%, respectively.
The TUMIR method provides valuable information of endometrial drainage in patients at higher risk of paraaortic LN involvement. The TUMIR approach showed a detection rate of paraaortic SLNs greater than 45% and a high sensitivity and NPV for paraaortic metastases in women with intermediate and high-risk EC.
我们旨在评估经阴道超声引导肌内注射示踪剂（TUMIR）行前哨淋巴结（SLN）检测在中高危子宫内膜癌（EC）患者中检测淋巴结（LN）转移的准确性，重点关注其对检测腹主动脉旁受累的性能。
这是一项前瞻性研究，纳入了术前中高危 EC 患者，根据 ESMO-ESGO-ESTRO 共识，采用 TUMIR 方法进行 SLN 检测。术前通过平面和单光子发射计算机断层扫描/计算机断层扫描图像以及术中伽马探针定位 SLN。在切除 SLN 后，所有患者均通过腹腔镜进行系统的盆腔和腹主动脉旁淋巴结清扫术。
该研究纳入了 102 例患者。术中 SLN 检测率为 79.4%（81/102）。92.6%（75/81）和 45.7%（37/81）的患者观察到盆腔和腹主动脉旁引流，7.4%（6/81）的患者仅存在腹主动脉旁引流。在系统淋巴结清扫术后，19.6%（20/102）的患者发现 LN 转移，其中 45.0%（9/20）存在腹主动脉旁累及，15.0%（3/20）为腹主动脉旁累及。TUMIR 法检测 SLN 对淋巴受累的总体敏感性和阴性预测值（NPV）分别为 87.5%和 97.0%，对腹主动脉旁转移的敏感性和 NPV 分别为 83.3%和 96.9%。应用 MSKCC SLN 检测算法后，敏感性和 NPV 分别为 93.8%和 98.5%。
TUMIR 方法可提供高危患者子宫内膜引流的有价值信息，对中高危 EC 患者的腹主动脉旁 SLN 检测率较高，对腹主动脉旁转移具有较高的敏感性和 NPV。
