Hawez Tabayi, Bollino Michele, Lönnerfors Celine, Persson Jan
Division of Gynaecologic Oncologic Surgery, Department of Obstetrics and Gynaecology, Skåne University Hospital Lund, 22185 Lund, Sweden.
Department of Clinical Sciences, Obstetrics and Gynaecology, Faculty of Medicine, Lund University, 22185 Lund, Sweden.
Cancers (Basel). 2024 Dec 18;16(24):4215. doi: 10.3390/cancers16244215.
BACKGROUND/OBJECTIVES: Given the risk of a progression, or an undiagnosed endometrial cancer (EC), the treatment of choice is hysterectomy in women with endometrial intraepithelial neoplasia (EIN). The risk of metastatic disease and whether sentinel node (SLN) biopsy should be performed remains unclear. The primary aim of this prospective study was to determine the overall incidence of concurrent EC and the impact of the diagnostic tool used and the type of endometrial lesion. The secondary aim was to investigate the risk of metastatic SLNs.
Between July 2019 and May 2024, 98 consecutive women with EIN deemed suitable for robotic surgery and SLN dissection were included in the study. Ultrastaging and immunohistochemistry were performed on all SLNs.
In total, 47% of women with preoperative EIN had EC on final histology; 13% of these had metastatic SLNs and the overall risk of metastases was 6.3%. Women who obtained their diagnosis by an endometrial biopsy had 65% risk of EC. All women with metastatic SLNs had non-polypoid lesions and five out of six obtained their diagnosis through endometrial biopsy.
The overall risk of SLN metastases was 6.3%, all in women with a general endometrial thickening and/or a diagnosis of EIN by office endometrial biopsy, suggesting that SLN detection should be offered particularly to women with EIN who fulfill these preoperative criteria.
背景/目的：鉴于存在病情进展或未诊断出子宫内膜癌（EC）的风险，对于患有子宫内膜上皮内瘤变（EIN）的女性，首选治疗方法是子宫切除术。转移性疾病的风险以及是否应进行前哨淋巴结（SLN）活检仍不明确。这项前瞻性研究的主要目的是确定同时存在EC的总体发生率以及所用诊断工具和子宫内膜病变类型的影响。次要目的是调查转移性SLN的风险。
在2019年7月至2024年5月期间，98名连续的被认为适合机器人手术和SLN清扫术的EIN女性被纳入研究。对所有SLN进行超分期和免疫组织化学检查。
总体而言，术前EIN的女性中有47%最终组织学检查显示患有EC；其中13%有转移性SLN，转移的总体风险为6.3%。通过子宫内膜活检获得诊断的女性患EC的风险为65%。所有有转移性SLN的女性均有非息肉样病变，六分之五是通过子宫内膜活检获得诊断的。
SLN转移的总体风险为6.3%，所有这些女性均有一般子宫内膜增厚和/或通过门诊子宫内膜活检诊断为EIN，这表明尤其应向符合这些术前标准的EIN女性提供SLN检测。
