Wang J, Wang H X, Xu M M, Wang N, Zhao W H, Yang D, Du N Y, Zhao W, Zhang H B, Wang Y X, Liu Y P, Ding Y, Zhang L L, Wang X, Zhang Z M
Department of Gynecology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China.
Department of Gynecology, Shijiazhuang People's Hospital, Shijiazhuang 050011, China.
Zhonghua Fu Chan Ke Za Zhi. 2022 Nov 25;57(11):821-829. doi: 10.3760/cma.j.cn112141-20220723-00479.
To investigate the application of sentinel lymph node biopsy (SLNB) in early-staged cervical cancer by laparoscopy. It was a prospective, single-arm, single-center clinical study. Seventy-eight cases of cervical cancer patients were collected from July 2015 to December 2018 at the Fourth Hospital of Hebei Medical University. All the patients were injected with tracer into the disease-free block of cervical tissue after anesthesia by the same surgeon who learned sentinel lymph node (SLN) mapping technique in Memorial Sloan-Kettering Cancer Center, and underwent SLN mapping followed by complete pelvic lymphadenectomy. Moreover, all the dissected lymph nodes were stained with hematoxylin eosin staining (HE) pathological examination. Besides, the negative SLN on hematoxylin-eosin staining were detected by immunohistochemistry cytokeratin staining micro-metastasis. To analyze the distribution, detection rate, false negative rate the sensitivity and negative predictive value of the SLN in early-staged cervical cancer by laparoscopy, and explore the value of SLN mapping in predicting the lymph nodes metastasis in early-staged cervical cancer. The overall detection rate of SLN in cervical cancer was 99% (77/78), bilateral detection rate was 87% (68/78). The average of 12.4 lymph node (LN) and 3.6 SLN were dissected for each patients each side. SLN of cervical cancer were mainly distributed in the obturator space (61.5%, 343/558), followed by external iliac (23.5%, 131/558), common iliac (7.3%, 41/558), para-uterine (3.8%, 21/558), internal iliac (2.2%, 12/558), para abdominal aorta (1.1%, 6/558), and anterior sacral lymphatic drainage area (0.7%, 4/558). Fourteen cases of LN metastasis were found among all 78 cases. There were a total of 38 positive LN, including 26 SLN metastasis and 12 none sentinel LN metastasis. Through immunohistochemical staining and pathological ultra-staging, 1 SLN was found to be isolated tumor cells (ITC), and 5 SLNs were found to be micro-metastases (MIC), accounting for 23% (6/26) of positive SLN. SLN mapping with pathological ultra-staging improved the prediction of LN metastasis in cervical cancer (2/14). Metastatic SLN mainly distributed in the obturator space (65%, 17/26), peri-uterine region (12%, 3/26), common iliac region (15%, 4/26), and external iliac region (8%, 2/26). The consistency of the diagnosis of lymph node metastasis by SLN biopsy and postoperative retroperitoneal lymph node metastasis showed that the Kappa value was 1.000 (<0.001), indicated that the metastasis status of SLN and retroperitoneal lymph node were completely consistent. The sensitivity, specificity, accuracy, false-negative rate, and negative predictive value of SLN biopsy in the diagnosis of lymph node metastasis were 100%, 100%, 100%, 0, and 100%, respectively. SLN in early-staged cervical cancer patients were mainly distributed in the obturator and external iliac space, pathalogical ultra-staging of SLN could improve the prediction of LN metastasis. Intraoperative SLN mapping is safe, feasible and could predict the state of retroperitoneal LN metastasis in early-staged cervical cancer. SLNB may replace systemic pelvic lymphadenectomy.
探讨腹腔镜下前哨淋巴结活检（SLNB）在早期宫颈癌中的应用。这是一项前瞻性、单臂、单中心临床研究。2015年7月至2018年12月在河北医科大学第四医院收集了78例宫颈癌患者。所有患者在麻醉后由同一位在纪念斯隆凯特琳癌症中心学习过前哨淋巴结（SLN）定位技术的外科医生将示踪剂注入宫颈组织的无病区域，然后进行SLN定位，随后进行全盆腔淋巴结清扫术。此外，所有切除的淋巴结均进行苏木精伊红染色（HE）病理检查。此外，对苏木精 - 伊红染色阴性的SLN进行免疫组织化学细胞角蛋白染色检测微转移。分析腹腔镜下早期宫颈癌SLN的分布、检出率、假阴性率、敏感性和阴性预测值，探讨SLN定位在预测早期宫颈癌淋巴结转移中的价值。宫颈癌SLN的总体检出率为99%（77/78），双侧检出率为87%（68/78）。每位患者每侧平均切除12.4个淋巴结（LN）和3.6个SLN。宫颈癌的SLN主要分布在闭孔间隙（61.5%，343/558），其次是髂外（23.5%，131/558）、髂总（7.3%，41/558）、子宫旁（3.8%，21/558）、髂内（2.2%，12/558）、腹主动脉旁（1.1%，6/558）和骶前淋巴引流区（0.7%，4/558）。78例患者中发现14例LN转移。共有38个阳性LN，包括26个SLN转移和12个非前哨LN转移。通过免疫组织化学染色和病理超分期，发现1个SLN为孤立肿瘤细胞（ITC），5个SLN为微转移（MIC），占阳性SLN的23%（6/26）。SLN定位结合病理超分期提高了宫颈癌LN转移的预测（2/14）。转移的SLN主要分布在闭孔间隙（65%，17/26）、子宫周围区域（12%，3/26）、髂总区域（15%，4/26）和髂外区域（8%，2/26）。SLN活检诊断淋巴结转移与术后腹膜后淋巴结转移诊断的一致性显示Kappa值为1.000（<0.001），表明SLN和腹膜后淋巴结的转移状态完全一致。SLN活检诊断淋巴结转移的敏感性、特异性、准确性、假阴性率和阴性预测值分别为100%、100%、100%、0和100%。早期宫颈癌患者的SLN主要分布在闭孔和髂外间隙，SLN的病理超分期可提高LN转移的预测。术中SLN定位安全、可行，可预测早期宫颈癌腹膜后LN转移状态。SLNB可能取代系统性盆腔淋巴结清扫术。
