Asanoma Kazuo, Yahata Hideaki, Kodama Keisuke, Okugawa Kaoru, Yasunaga Masafumi, Onoyama Ichiro, Yagi Hiroshi, Maenohara Shoji, Hachisuga Kazuhisa, Isoda Takuro, Shimokawa Mototsugu, Ishigami Kousei, Oda Yoshinao, Kato Kiyoko
Department of Obstetrics and Gynecology, Kyushu University Hospital, Fukuoka, Fukuoka, Japan.
Department of Clinical Radiology, Kyushu University Hospital, Fukuoka, Fukuoka, Japan.
Asian J Endosc Surg. 2025 Jan-Dec;18(1):e70015. doi: 10.1111/ases.70015.
This study examined factors that affected sentinel lymph node (SLN) identification of patients with endometrial cancer having a preoperative estimation of low recurrent risk.
This study included 97 patients with endometrial cancer who attempted to identify SLN using a uterine cervical injection of technetium-99 m phytate under laparoscopic or robotic-assisted surgery at our institute. A preoperative single photon emission computed tomography (SPECT) and intraoperative gamma probe were used to detect hot nodes. Multiple clinical factors, including age, body mass index (BMI), and so on, were investigated for their association with SLN mapping failure.
Among 97 cases, SPECT failed to detect SLN unilaterally in 38 cases (39%) and on both sides in 9 cases (9%). Meanwhile, the gamma probe failed to detect SLN unilaterally in 23 cases (24%) and on both sides in 3 cases (3%). While only age was significantly associated with SLN detection failure using the SPECT detection system, both age and BMI were significantly associated with SLN detection failure using the gamma probe detection system. When limiting to the preoperative SLN detection failure cohort of 47 cases, there was a strong association between intraoperative SLN detection failure and BMI, but not age.
The SLN biopsy system was effectively applied to patients with endometrial cancer who underwent minimally invasive surgery (MIS). Attempts to improve SLN identification in older patients and those with obesity are warranted to obtain maximum benefits of MIS for low- or medium-risk cases.
本研究调查了影响术前预估复发风险较低的子宫内膜癌患者前哨淋巴结（SLN）识别的因素。
本研究纳入了97例子宫内膜癌患者，这些患者在我院接受腹腔镜或机器人辅助手术时，通过子宫颈注射99m锝植酸盐来尝试识别SLN。术前使用单光子发射计算机断层扫描（SPECT）和术中γ探测仪检测热点。研究了包括年龄、体重指数（BMI）等多种临床因素与SLN定位失败的相关性。
97例患者中，SPECT单侧未能检测到SLN的有38例（39%），双侧未能检测到的有9例（9%）。同时，γ探测仪单侧未能检测到SLN的有23例（24%），双侧未能检测到的有3例（3%）。使用SPECT检测系统时，只有年龄与SLN检测失败显著相关；而使用γ探测仪检测系统时，年龄和BMI均与SLN检测失败显著相关。将范围限定在术前SLN检测失败的47例患者队列中，术中SLN检测失败与BMI之间存在强相关性，但与年龄无关。
SLN活检系统有效地应用于接受微创手术（MIS）的子宫内膜癌患者。对于低风险或中等风险病例，有必要尝试提高老年患者和肥胖患者的SLN识别率，以最大程度地从MIS中获益。
