Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland.
Department of Obstetrics and Gynecology, Ente Ospedaliere Cantonale, University of the Italian Switzerland, Lugano, Switzerland.
Chin Clin Oncol. 2021 Apr;10(2):22. doi: 10.21037/cco-20-224.
Endometrial cancer care has undergone major changes in the past 30 years. In 1988, staging transitioned from clinical to surgical. Moreover, the surgical approach of choice is no longer open surgery, but minimally invasive surgery. An improvement in terms of nodal evaluation followed. Full systematic lymphadenectomy has been continuously replaced by sentinel lymph node mapping. Although sentinel lymph node mapping with a cervical injection of indocyanine green dye is rapidly gaining clinical acceptance, we lack consistent recommendations on a well-defined procedure that accurately and indolently assesses the lymph node status. Such recommendations are indispensable, as nodal status is the most important predictive factor of survival and is essential for tailoring adjuvant treatment to the risk of recurrence. This paper focuses on transitions in endometrial cancer care and highlights current data on sentinel lymph node mapping in endometrial cancer. We demonstrate that sentinel lymph node mapping is a safe and accurate strategy for nodal status evaluation with appropriate sensitivity, false-negative rate and negative predictive value in high- as well as low-risk settings. Furthermore, we elaborate on type and dose of tracer, site of injection, number of sentinel lymph nodes to be removed, sentinel lymph node mapping learning curve, operation mode and sentinel lymph node ultrastaging. In the future, guidelines with consistent recommendations on the above outlined features of sentinel lymph node mapping should be established to allow for a uniform and wide-spread application of the sentinel lymph node mapping procedure.
在过去的 30 年中，子宫内膜癌的治疗发生了重大变化。1988 年，分期从临床转变为手术。此外，首选的手术方法不再是开放性手术，而是微创手术。随后淋巴结评估也有所改善。完整的系统淋巴结切除术不断被前哨淋巴结绘图术取代。尽管经宫颈注射吲哚菁绿染料的前哨淋巴结绘图术迅速获得临床认可，但我们缺乏关于准确且温和评估淋巴结状态的明确程序的一致建议。这些建议是必不可少的，因为淋巴结状态是生存的最重要预测因素，对于根据复发风险定制辅助治疗至关重要。本文重点介绍子宫内膜癌治疗的转变，并强调子宫内膜癌中前哨淋巴结绘图术的最新数据。我们证明，前哨淋巴结绘图术是一种安全且准确的策略，可用于评估淋巴结状态，在高风险和低风险环境中具有适当的敏感性、假阴性率和阴性预测值。此外，我们详细阐述了示踪剂的类型和剂量、注射部位、要切除的前哨淋巴结数量、前哨淋巴结绘图术的学习曲线、手术方式和前哨淋巴结超分期。未来，应制定具有前哨淋巴结绘图术上述特征的一致建议指南，以实现该程序的统一和广泛应用。
