Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania.
Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania.
Medicina (Kaunas). 2022 May 26;58(6):712. doi: 10.3390/medicina58060712.
Systematic pelvic lymphadenectomy (LND) is an essential part of lymph-node status evaluation in endometrial cancer (EC) patients to tailor the adjuvant treatment. However, it is associated with the post-operative lymphatic complications and does not improve the outcomes of the disease. Indocyanine green (ICG) mapped sentinel lymph-node biopsy (SLB) has recently been introduced into the clinical practice as an alternative for the surgical lymph-node evaluation in EC patients with the potential to decrease LND related complications. The aim of our study was to evaluate the feasibility of ICG mapped SLB in low, intermediate, and high-risk EC patients in a center with no previous experience on endoscopic SLB procedure. : The prospective study was performed. 170 patients with histologically confirmed EC were included. Sentinel lymph-nodes (SLs) were mapped with ICG dye and removed ahead of the total laparoscopic hysterectomy. Low-risk patients received only SLB, while SLB and LND were performed for intermediate and high-risk patients. : The overall detection rate of SLs was 88.8%. Bilateral mapping was achieved in 68.2% of the patients. The overall detection rate for low-risk patients was 93.7%, 85.0% for the intermediate-risk group, and 100% for high-risk patients ( = 0.232). The most common anatomical sites of SLs were the external iliac (45.8% on the right and 46.6% on the left) and obturator regions (20.9% and 25.6%, respectively). Positive lymph-nodes were found in 8 (4.7%) patients. The sensitivity of SLB was 75.0% and negative predictive value (NPV)-97.2%. : Even in the center with no previous experience, sentinel lymph-node biopsy using ICG mapping is feasible. However, the favorable outcomes might be associated with the learning process of newly established method.
系统盆腔淋巴结清扫术（LND）是评估子宫内膜癌（EC）患者淋巴结状态的重要组成部分，有助于制定辅助治疗方案。然而，LND 与术后淋巴并发症相关，并且不能改善疾病的结局。吲哚菁绿（ICG）示踪前哨淋巴结活检（SLB）最近已被引入临床实践，作为 EC 患者手术淋巴结评估的替代方法，具有降低 LND 相关并发症的潜力。我们的研究目的是评估在一个没有内镜 SLB 经验的中心，ICG 示踪 SLB 在低、中、高危 EC 患者中的可行性。
这是一项前瞻性研究。共纳入 170 例经组织学证实的 EC 患者。使用 ICG 染料对前哨淋巴结（SLs）进行定位，并在全腹腔镜子宫切除术之前进行切除。低危患者仅接受 SLB，而中高危患者则进行 SLB 和 LND。
SLs 的总体检出率为 88.8%。68.2%的患者实现了双侧定位。低危患者的总体检出率为 93.7%，中危组为 85.0%，高危组为 100%（=0.232）。SLs 最常见的解剖部位是髂外（右侧 45.8%，左侧 46.6%）和闭孔区（分别为 20.9%和 25.6%）。8 例（4.7%）患者发现阳性淋巴结。SLB 的灵敏度为 75.0%，阴性预测值（NPV）为 97.2%。
即使在没有既往经验的中心，使用 ICG 映射的前哨淋巴结活检也是可行的。然而，良好的结果可能与新建立的方法的学习过程有关。
