Uccella Stefano, Garzon Simone, Bosco Mariachiara, Porcari Irene, Lanzo Gabriele, Laganà Antonio Simone, Chiantera Vito, Cliby William A, Mariani Andrea, Franchi Massimo, Zorzato Pier Carlo
Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.
Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Health, ASL Biella, Biella, Italy.
Gynecol Obstet Invest. 2022;87(3-4):242-247. doi: 10.1159/000525126. Epub 2022 May 18.
In gynecologic oncology, the consolidated injection site for the pelvic sentinel lymph node mapping is the cervix. However, in apparent early-stage ovarian cancer, current trials map the pelvic area injecting the tracers in the utero-ovarian ligament. A different injection site is proposed based on a possible different lymphatic ovarian drainage through the utero-ovarian ligament and uterus and consequently a different pelvic sentinel lymph node mapping than the cervix; however, this was never proven. On that basis, this study aimed to investigate whether injecting the tracer in the utero-ovarian ligament map the same or a different pelvic sentinel lymph node than the cervix.
A prospective observational study was conducted.
All consecutive women undergoing primary surgery for gynecologic malignancy with planned pelvic sentinel lymph node mapping were enrolled. The cervical injection was performed at 3 and 9 o'clock injecting indocyanine green. Bilateral utero-ovarian ligament injection was performed by injecting methylene blue. The probability of detecting the same sentinel lymph node (concordance rate) and the probability of detecting a different sentinel lymph node (discordance rate) in each hemipelvis were compared using McNemar's exact test.
Out of 36 hemipelvis (18 patients), the overall detection rate with cervical indocyanine green injection was 86.1% (31/36) versus 52.8% (19/36) with utero-ovarian ligament methylene blue injection (p = 0.0004). Indocyanine green and methylene blue identified the same sentinel lymph node in all hemipelvis when sentinel lymph node mapping was obtained by both dyes (19/19; concordance rate 100%). No different or additional sentinel lymph nodes were identified by one of the two dyes (0/19; discordance rate 0%). The probability of detecting the same pelvic sentinel lymph node by the two injection sites was significantly higher than the probability of detecting a different pelvic sentinel lymph node (p < 0.0001).
The use of two different dyes with known different sentinel lymph node mapping performance impedes to evaluate differences in detection rate attributable to the two injection sites, limiting the comparison only in hemipelvis in which both dyes identified a sentinel lymph node.
The cervix and utero-ovarian ligament are two sites for the tracer injection that have a higher probability of detecting the same than a different pelvic sentinel lymph node. Given the higher technical challenge in performing the utero-ovarian ligament injection, these results suggest that the injection of the tracer into the cervix could be a more reliable alternative for the pelvic sentinel lymph node mapping in ovarian cancer.
在妇科肿瘤学中，盆腔前哨淋巴结 mapping 的联合注射部位是宫颈。然而，在明显的早期卵巢癌中，目前的试验通过在子宫卵巢韧带中注射示踪剂来对盆腔区域进行 mapping。基于子宫卵巢韧带和子宫可能存在不同的卵巢淋巴引流，进而可能存在与宫颈不同的盆腔前哨淋巴结 mapping，提出了一个不同的注射部位；然而，这从未得到证实。在此基础上，本研究旨在调查在子宫卵巢韧带中注射示踪剂与在宫颈注射相比，所 mapping 的盆腔前哨淋巴结是否相同或不同。
进行了一项前瞻性观察研究。
纳入所有计划进行盆腔前哨淋巴结 mapping 的妇科恶性肿瘤初次手术的连续女性患者。在宫颈的 3 和 9 点位置注射吲哚菁绿进行宫颈注射。通过注射亚甲蓝进行双侧子宫卵巢韧带注射。使用 McNemar 精确检验比较每个半盆腔中检测到相同前哨淋巴结的概率（一致性率）和检测到不同前哨淋巴结的概率（不一致率）。
在 36 个半盆腔（18 例患者）中，宫颈注射吲哚菁绿的总体检测率为 86.1%（31/36），而子宫卵巢韧带注射亚甲蓝的检测率为 52.8%（19/36）（p = 0.0004）。当通过两种染料都获得前哨淋巴结 mapping 时，吲哚菁绿和亚甲蓝在所有半盆腔中都识别出相同的前哨淋巴结（19/19；一致性率 100%）。两种染料中的任何一种都未识别出不同或额外的前哨淋巴结（0/19；不一致率 0%）。两个注射部位检测到相同盆腔前哨淋巴结的概率显著高于检测到不同盆腔前哨淋巴结的概率（p < 0.0001）。
使用两种已知具有不同前哨淋巴结 mapping 性能的不同染料妨碍了评估归因于两个注射部位的检测率差异，仅将比较限制在两种染料都识别出前哨淋巴结的半盆腔中。
宫颈和子宫卵巢韧带是两个示踪剂注射部位，它们检测到相同盆腔前哨淋巴结的概率高于检测到不同盆腔前哨淋巴结的概率。鉴于进行子宫卵巢韧带注射技术难度更高，这些结果表明在卵巢癌盆腔前哨淋巴结 mapping 中，将示踪剂注射到宫颈可能是一种更可靠的选择。
Zotero 插件