UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS.
Università Cattolica del Sacro Cuore, Rome, Italy.
Curr Opin Oncol. 2024 Sep 1;36(5):412-417. doi: 10.1097/CCO.0000000000001058. Epub 2024 Jul 16.
The rationale on the use of sentinel lymph node (SLN) biopsy in the surgical staging of apparent early-stage ovarian cancer (OC) is supported by the fact that diagnostic and prognostic role of systematic staging lymphadenectomy has been determined but its therapeutic significance is still matter of controversy. Moreover, SLN biopsy represents an option to decrease intra- and postoperative morbidity. The present review aims to provide an overview on the current and future role of SLN in OC.
Most recent evidence shows that the overall mean per patient SLN detection rate in case of indocyanine green (ICG) alone was 58.6% compared with 95% in case of ICG + technetium, and with 52.9% in case of technetium alone or in combination with blue dye ( P < 0.001). Site of injection has been reported to be in both ovarian ligaments in majority of studies (utero-ovarian ligament and infundibulo-pelvic ligament), before or after ovarian mass removal, at time of primary or re-staging surgery and by minimally invasive or open approach. Cervical injection has been recently proposed to replace utero-ovarian injection. SLN detection rate in patients with confirmed ovarian malignancy varied across different studies ranging between 9.1% and 91.3% for the injection in the utero-ovarian ligament and migration to pelvic lymph nodes and between 27.3% and 100% for the injection in the infundibulo-pelvic ligament and migration to para-aortic lymph nodes. No intra- or postoperative complication could be attributed directly to SLN biopsy. The sensitivity and the accuracy of SLN in detecting lymphatic metastasis ranged between 73.3-100% and 96-100%, respectively. In up to 40% of positive SLNs, largest metastatic deposit was classified as micro-metastasis or isolated tumor cells, which would have been missed without ultrastaging protocol.
SLN biopsy represents a promising tool to assess lymph node status in apparent early-stage OC. The type and volume of injected tracer need to be considered as appear to affect SLN detection rate. Ultrastaging protocol is essential to detect low volume metastasis. Sensitivity and accuracy of SLN biopsy are encouraging, providing tracer injection in both uterine and ovarian ligaments.
前哨淋巴结（SLN）活检在明显早期卵巢癌（OC）的手术分期中的应用依据是，系统分期淋巴结切除术的诊断和预后作用已经确定，但它的治疗意义仍存在争议。此外，SLN 活检代表了降低围手术期发病率的一种选择。本综述旨在概述 SLN 在 OC 中的当前和未来作用。
最近的证据表明，单独使用吲哚菁绿（ICG）时，每位患者 SLN 的总平均检出率为 58.6%，而 ICG+锝的检出率为 95%，单独使用锝或与蓝色染料联合使用的检出率为 52.9%（P<0.001）。在大多数研究中，报道的注射部位都在卵巢韧带的两侧（子宫卵巢韧带和漏斗骨盆韧带），在卵巢肿块切除前后，在初次或再次分期手术时，通过微创或开放途径。最近提出了宫颈注射以替代子宫卵巢注射。在已证实患有卵巢恶性肿瘤的患者中，SLN 的检出率在不同研究中差异很大，从子宫卵巢韧带注射和向盆腔淋巴结转移的 9.1%到 91.3%不等，从漏斗骨盆韧带注射和向主动脉旁淋巴结转移的 27.3%到 100%不等。没有任何围手术期并发症可以直接归因于 SLN 活检。SLN 在检测淋巴转移中的灵敏度和准确性分别为 73.3-100%和 96-100%。在多达 40%的阳性 SLN 中，最大的转移灶被分类为微转移或孤立肿瘤细胞，如果没有超微分期方案，这些转移灶将被遗漏。
SLN 活检是评估明显早期 OC 淋巴结状态的一种很有前途的工具。需要考虑注射示踪剂的类型和体积，因为它们似乎会影响 SLN 的检出率。超微分期方案对于检测低体积转移是必不可少的。SLN 活检的灵敏度和准确性令人鼓舞，在子宫和卵巢韧带中注射示踪剂均能提供良好的效果。
