Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Division of Gynecologic Oncology, University Health Network/Sinai Health Systems, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
Gynecol Oncol. 2023 Jun;173:41-48. doi: 10.1016/j.ygyno.2023.04.004. Epub 2023 Apr 18.
The study aimed to define the accuracy of intraoperative frozen section (FS) for the detection of metastases in sentinel lymph node biopsy (SLNB) and describe the pattern of lymph node (LN) spread and relation to molecular classifiers in patients with high-grade endometrial cancer (EC).
We performed a secondary outcome of clinicopathologic data from the Sentinel Lymph Node Biopsy versus Lymphadenectomy for Intermediate- and High-Grade Endometrial Cancer Staging (SENTOR) prospective cohort study evaluating SLNB in patients with clinical stage I high-grade EC (ClinicalTrials.gov ID: NCT01886066). The primary outcome was the sensitivity of FS of the sentinel lymph node (SLN) specimen, compared to a standardized ultrastaging protocol. Secondary outcomes included the pattern and characteristics of LN spread.
There were 126 patients with high-grade EC with a median age of 66 years (range:44-86) and a median Body Mass Index (BMI) of 26.9 kg/m (range:17.6-49.3). FS was performed on surgical specimens from 212 hemipelves; SLNs were identified in 202 specimens (95.7%) and fatty tissue alone was identified in 10 specimens (4.7%). Of the 202 hemipelves in which SLNs were identified, 24 were positive for metastatic disease on final pathology. Initial FS correctly identified only 12, yielding a sensitivity of 50% (12/24, 95% CI 29.6-70.4) and a negative predictive value of 94% (178/190, 95% CI 89-96.5). A total of 24 patients (19%) had LN metastases: 16 (13%) had isolated pelvic metastases, 7 (6%) had both pelvic and para-aortic metastases and 1 (0.8%) had an isolated para-aortic metastasis.
Intraoperative FS of SLNs in high-grade EC patients has poor sensitivity. Since isolated para-aortic metastases are rare, para-aortic lymphadenectomy may be omitted in patients in which SLNs were successfully mapped to the pelvis.
本研究旨在定义术中冷冻切片（FS）检测前哨淋巴结活检（SLNB）中转移的准确性，并描述高级别子宫内膜癌（EC）患者中淋巴结（LN）播散的模式及其与分子分类器的关系。
我们对 Sentinel Lymph Node Biopsy versus Lymphadenectomy for Intermediate- and High-Grade Endometrial Cancer Staging（SENTOR）前瞻性队列研究的临床病理数据进行了二次分析，该研究评估了临床 I 期高级别 EC 患者（ClinicalTrials.gov ID：NCT01886066）的 SLNB。主要结局是 FS 检测 SLN 标本的敏感性，与标准化超分期方案进行比较。次要结局包括 LN 播散的模式和特征。
共有 126 名高级别 EC 患者，中位年龄为 66 岁（范围：44-86 岁），中位体重指数（BMI）为 26.9kg/m²（范围：17.6-49.3）。对 212 半骨盆的手术标本进行了 FS 检查；在 202 个标本中识别出 SLN（95.7%），10 个标本中仅识别出脂肪组织（4.7%）。在识别出 SLN 的 202 个半骨盆中，24 个最终病理证实有转移性疾病。初始 FS 仅正确识别出 12 个，敏感性为 50%（12/24，95%CI 29.6-70.4），阴性预测值为 94%（178/190，95%CI 89-96.5）。共有 24 名患者（19%）发生 LN 转移：16 名（13%）仅为盆腔转移，7 名（6%）为盆腔和腹主动脉旁转移，1 名（0.8%）为孤立性腹主动脉旁转移。
高级别 EC 患者 SLN 的术中 FS 敏感性较差。由于孤立性腹主动脉旁转移罕见，因此在成功将 SLN 映射至骨盆的患者中，可以省略腹主动脉旁淋巴结清扫术。
