Jankulovska Anamarija, Stojanoski Sinisha, Stojcevski Sasho, Aluloski Igor, Jovanovic Rubens, Kunovska Slavica Kostadinova, Tanturovski Mile, Manevska Nevena, Petrusevska Gordana, Miladinova Daniela
University of "Ss. Cyril and Methodius" Faculty of Medicine, Institute of Pathophysiology and Nuclear Medicine, Skopje, Republic of North Macedonia.
University Clinic for Obstetrics and Gynecology, Skopje, Republic of North Macedonia.
Mol Imaging Radionucl Ther. 2023 Jun 20;32(2):103-111. doi: 10.4274/mirt.galenos.2022.36097.
Detection of a sentinel lymph node (SLN) in patients with endometrial cancer (EC) reduces the rate of unnecessary systemic lymph dissection. The aim of this study was to assess the SLN detection rate, accuracy of the method using Tc-99m-SENTI-SCINT and the rate of metastatic nodal involvement in patients with preoperative first stage EC.
A prospective study of SLN biopsy of 41 patients with stage I EC was conducted after cervical application of 4mCi Tc-99m-SENTI-SCINT. Planar lymphoscintigraphy and single-photon emission computed tomography/computed tomography (SPECT/CT) of the pelvis were performed, followed by site-specific lymphadenectomy in intermediate-risk patients if no SLN was detected per hemipelvis and pelvic lymphadenectomy in all high-risk patients.
Pre-operative detection rate of planar lymphoscintigraphy was 80.49 [95% confidence interval (CI): 68.36-92.62] and of SPECT/CT 95.12 (95% CI: 88.52-101.7). The total intraoperative SLN detection rate was 95.12 (95% CI: 88.52-101.7) per patient and 26.83 (95% CI: 19.91-33.75) bilaterally. The average number of SLNs removed was 1.6±0.8. The most common anatomical location of SLN was the right external iliac region. The SLN metastatic rate was 17%. Both sensitivity and negative predictive value regarding metastatic involvement were 100%.
The SLN detection rate, sensitivity and negative predictive value using Tc-99m-SENTI-SCINT in patients with EC in our study were high. The application of ultra-staging in the histopathological analysis of SLN increases the detection of nodal metastases and improves the staging in these patients.
检测子宫内膜癌（EC）患者的前哨淋巴结（SLN）可降低不必要的系统性淋巴结清扫率。本研究旨在评估术前I期EC患者的SLN检测率、使用锝-99m- SENTI - SCINT方法的准确性以及淋巴结转移累及率。
对41例I期EC患者在宫颈应用4mCi锝-99m- SENTI - SCINT后进行SLN活检的前瞻性研究。进行盆腔平面淋巴闪烁显像和单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT），如果每个半骨盆未检测到SLN，则对中危患者进行特定部位淋巴结清扫，对所有高危患者进行盆腔淋巴结清扫。
平面淋巴闪烁显像的术前检测率为80.49[95%置信区间（CI）：68.36 - 92.62]，SPECT/CT的检测率为95.12（95%CI：88.52 - 101.7）。每位患者术中SLN的总检测率为95.12（95%CI：88.52 - 101.7），双侧检测率为26.83（95%CI：19.91 - 33.75）。切除的SLN平均数量为1.6±0.8。SLN最常见的解剖位置是右髂外区域。SLN转移率为17%。关于转移累及的敏感性和阴性预测值均为100%。
在我们的研究中，使用锝-99m- SENTI - SCINT检测EC患者的SLN检测率、敏感性和阴性预测值都很高。在SLN的组织病理学分析中应用超分期可增加淋巴结转移的检测并改善这些患者的分期。
