University Hospitals Giessen and Marburg Campus Giessen, Giessen, Hessen, Germany
Department of Gynecology, University of Cologne, Koln, Germany.
Int J Gynecol Cancer. 2024 May 6;34(5):675-680. doi: 10.1136/ijgc-2023-005206.
BACKGROUND: Lymphatic involvement is the most important prognostic factor in early-stage cervical cancer. Sentinel lymph node biopsy is a viable alternative to systematic lymphadenectomy and may identify metastases more precisely. OBJECTIVE: To compare two tracers (indocyanine green and patent blue) to detect sentinel nodes. METHODS: A single-center, retrospective study of women treated due to early-stage cervical cancer (International Federation of Gynecology and Obstetrics 2009 IA1 with lymphovascular invasion, IA2, and IB1). Location and tracer of all detected sentinel nodes had been documented for a prospective, multicenter trial (SENTIX trial). All sentinel nodes were sent to frozen section and final analysis through ultrastaging using a standard protocol. RESULTS: Overall, 103 patients were included. Bilateral detection rate for indocyanine green (93.2%) was significantly higher than for blue dye (77.7%; p=0.004). Their combined use significantly increased the bilateral detection to 99.0% (p=0.031). While 97.4% of all sentinel nodes were located below the common iliac vessels, no para-aortic nodes were labeled. Simultaneous bilateral detection with both tracers was found in 71.8% of the cases, of which the sentinel nodes were identical in 91.9%. Nine positive nodes were detected among seven patients (6.8%), all marked with indocyanine green while patent blue labeled six. Frozen section failed to detect one of three macrometastases and three of four micrometastases (sensitivity 43%; negative prediction value 96%). CONCLUSION: Anatomical distribution and topographic localization of the sentinel nodes obtained with these tracers were not different. Indocyanine green provided a significantly higher bilateral detection rate and had superior sensitivity to detect positive nodes compared with patent blue. Combining indocyanine green and blue dye increased the bilateral detection rate significantly.
背景:淋巴浸润是早期宫颈癌最重要的预后因素。前哨淋巴结活检是系统淋巴结清扫术的可行替代方法,并且可以更精确地识别转移。 目的:比较两种示踪剂(吲哚菁绿和专利蓝)来检测前哨淋巴结。 方法:对因早期宫颈癌(国际妇产科联合会 2009 年 2A1 期伴淋巴血管侵犯、2A2 期和 1B1 期)而接受治疗的女性进行单中心回顾性研究。前瞻性多中心试验(SENTIX 试验)记录了所有检测到的前哨淋巴结的位置和示踪剂。所有前哨淋巴结均通过冷冻切片进行送检,并通过使用标准方案进行超分期的最终分析。 结果:共纳入 103 例患者。吲哚菁绿的双侧检出率(93.2%)明显高于蓝色染料(77.7%;p=0.004)。两者联合使用显著提高了双侧检出率(99.0%;p=0.031)。虽然所有前哨淋巴结 97.4%位于髂总血管下方,但没有标记到腹主动脉旁淋巴结。两种示踪剂同时双侧检测发现 71.8%的病例,其中 91.9%的前哨淋巴结是相同的。7 例患者中有 9 个阳性淋巴结(6.8%),均由吲哚菁绿标记,而专利蓝标记了 6 个。冷冻切片未能检测到 3 个大转移灶和 4 个微转移灶中的 1 个(敏感性 43%;阴性预测值 96%)。 结论:这些示踪剂获得的前哨淋巴结的解剖分布和定位没有差异。吲哚菁绿提供了更高的双侧检出率,并且与专利蓝相比,对检测阳性淋巴结具有更高的敏感性。联合使用吲哚菁绿和专利蓝显著提高了双侧检出率。
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