Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy.
Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy.
Int J Environ Res Public Health. 2022 Mar 21;19(6):3716. doi: 10.3390/ijerph19063716.
In endometrial carcinoma (EC) patients, sentinel lymph node (SLN) biopsy has shown the potential to reduce post-operative morbidity and long-term complications, and to improve the detection of low-volume metastasis through ultrastaging. However, while it has shown high sensitivity and feasibility in low-risk EC patient groups, its role in high-risk groups is still unclear.
To assess the role of SLN biopsy through the cervical injection of indocyanine green (ICG) in high-risk groups of early-stage EC patients.
Seven electronic databases were searched from their inception to February 2021 for studies that allowed data extraction about detection rate and accuracy of SLN biopsy through the cervical injection of ICG in high-risk groups of early-stage EC patients. We calculated pooled sensitivity, false negative (FN) rate, detection rate of SLN per hemipelvis (DRh), detection rate of SLN per patients (DRp), and bilateral detection rate of SLN (DRb), with 95% confidence interval (CI).
Five observational cohort studies (three prospective and two retrospective) assessing 578 high risk EC patients were included. SLN biopsy sensitivity in detecting EC metastasis was 0.90 (95% CI: 0.03-0.95). FN rate was 2.8% (95% CI: 0.6-11.6%). DRh was 88.4% (95% CI: 86-90.5%), DRp was 96.6% (95% CI: 94.7-97.8%), and DRb was 80% (95% CI: 75.4-83.9).
SLN biopsy through ICG cervical injection may be routinely adopted instead of systematic pelvic and para-aortic lymphadenectomy in surgical staging for high-risk groups of early-stage EC patients, as well as in low-risk groups.
在子宫内膜癌（EC）患者中，前哨淋巴结（SLN）活检已显示出降低术后发病率和长期并发症的潜力，并通过超分期提高了低容量转移的检测能力。然而，尽管在低危 EC 患者组中显示出高敏感性和可行性，但在高危组中的作用仍不清楚。
通过宫颈注射吲哚菁绿（ICG）评估 SLN 活检在早期高危 EC 患者中的作用。
从各数据库建立至 2021 年 2 月，检索了允许提取高危早期 EC 患者通过宫颈注射 ICG 进行 SLN 活检检测率和准确率数据的研究。我们计算了 SLN 活检检测 EC 转移的敏感性、假阴性（FN）率、半骨盆 SLN 检测率（DRh）、患者 SLN 检测率（DRp）和双侧 SLN 检测率（DRb），置信区间（CI）为 95%。
纳入了 5 项评估 578 例高危 EC 患者的观察性队列研究（3 项前瞻性和 2 项回顾性）。SLN 活检检测 EC 转移的敏感性为 0.90（95%CI：0.03-0.95）。FN 率为 2.8%（95%CI：0.6-11.6%）。DRh 为 88.4%（95%CI：86-90.5%），DRp 为 96.6%（95%CI：94.7-97.8%），DRb 为 80%（95%CI：75.4-83.9%）。
高危早期 EC 患者的手术分期以及低危患者可常规采用 ICG 宫颈注射 SLN 活检替代系统盆腔和腹主动脉淋巴结切除术。
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