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子宫内膜癌前哨淋巴结定位方法的评估

The Assessment of Sentinel Lymph Node Mapping Methods in Endometrial Cancer.

作者信息

Szatkowski Wiktor, Pniewska Karolina, Janeczek Maja, Ryś Janusz, Banaś Tomasz, Muzykiewicz Konrad, Iwańska Ewa, Jakubowicz Jerzy, Karolewski Kazimierz, Szadurska Agnieszka, Blecharz Paweł

机构信息

Department of Gynecological Oncology, Maria Skłodowska-Curie National Research Institute, Kraków Branch, 31-115 Kraków, Poland.

Departament of Pathology, Maria Skłodowska-Curie National Research Institute, Kraków Branch, 31-115 Kraków, Poland.

出版信息

J Clin Med. 2025 Jan 21;14(3):676. doi: 10.3390/jcm14030676.

Abstract

: Sentinel lymph node biopsy (SLNB) is a minimally invasive technique used to assess lymphatic involvement in endometrial cancer (EC), offering reduced surgical morbidity compared to routine lymphadenectomy. Despite its widespread use, the optimal combination of tracers for SLN detection remains a subject of debate. : This retrospective cohort study included 119 patients with early-stage EC treated at the Maria Skłodowska-Curie National Research Institute of Oncology between 2016 and 2021. SLNB was performed using technetium-99m (Tc99m), indocyanine green (ICG), Patent Blue, or combinations of these tracers. Detection rates for unilateral and bilateral SLNs and the accuracy of metastasis identification were analyzed. : The overall SLN detection rate was 97.5%. Individual tracer detection rates were 100% for ICG, 100% for Patent Blue, and 96% for Tc99m. Combined tracers achieved detection rates of 96.9% (Tc99m and ICG) and 97.3% (Tc99m and Patent Blue). Bilateral detection was highest with Tc99m and ICG (90.6%) and Patent Blue alone (91%). Metastases were identified in 12% of cases, with combined methods improving metastatic detection. Tc99m yielded no "empty nodes", compared to 1.7% with Patent Blue and 0.8% with ICG. : While combining Tc99m with dyes did not significantly improve overall SLN detection rates, it enhanced metastatic identification and reduced false-negative results. These findings suggest that combined tracer methods optimize SLNB accuracy in endometrial cancer. Prospective studies are needed to confirm these results.

摘要

前哨淋巴结活检(SLNB)是一种用于评估子宫内膜癌(EC)淋巴受累情况的微创技术,与常规淋巴结清扫术相比,手术发病率更低。尽管其应用广泛,但用于前哨淋巴结检测的示踪剂的最佳组合仍是一个有争议的话题。

这项回顾性队列研究纳入了2016年至2021年期间在玛丽亚·斯克洛多夫斯卡-居里国家肿瘤研究所接受治疗的119例早期子宫内膜癌患者。使用锝-99m(Tc99m)、吲哚菁绿(ICG)、专利蓝或这些示踪剂的组合进行前哨淋巴结活检。分析了单侧和双侧前哨淋巴结的检测率以及转移灶识别的准确性。

前哨淋巴结的总体检测率为97.5%。各示踪剂的检测率分别为:ICG为100%,专利蓝为100%,Tc99m为96%。联合示踪剂的检测率分别为:Tc99m与ICG组合为96.9%,Tc99m与专利蓝组合为97.3%。Tc99m与ICG联合使用时双侧检测率最高(90.6%),单独使用专利蓝时双侧检测率最高(91%)。12%的病例发现有转移,联合方法可提高转移灶的检测率。Tc99m未出现“空淋巴结”,而专利蓝为1.7%,ICG为0.8%。

虽然将Tc99m与染料联合使用并未显著提高前哨淋巴结的总体检测率,但它提高了转移灶的识别率并减少了假阴性结果。这些发现表明,联合示踪剂方法可优化子宫内膜癌前哨淋巴结活检的准确性。需要进行前瞻性研究来证实这些结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/34e1/11818588/635d6421719d/jcm-14-00676-g001.jpg

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