Lago Víctor, Rey Iria, Arnáez Marta, Padilla-Iserte Pablo, Matute Luis, Gurrea Marta, Moner Sara, Bello Pilar, Domingo Santiago
Gynecologic Oncology Unit, University Hospital La Fe, Avinguda de Fernando Abril Martorell, 106, Tower F, 3rd Floor, 46026, Valencia, Spain.
Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, Spain.
Arch Gynecol Obstet. 2025 May;311(5):1407-1414. doi: 10.1007/s00404-025-07984-x. Epub 2025 Apr 5.
In early-stage ovarian cancer, sentinel lymph node (SLN) mapping using double injection into the utero-ovarian and infundibulo-pelvic ligaments has been postulated. Cervical injection, commonly used in other gynaecologic tumors, may provide a simpler alternative to utero-ovarian injection for pelvic-SLN detection. This study aims to demonstrate whether cervical and utero-ovarian injections drain to the same pelvic SLN using different tracers for each injection site: technetium-99m (Tc) at cervix and indocyanine green into the utero-ovarian ligament.
This prospective trial enrolled endometrial cancer patients scheduled for SLN biopsy from July 2023 to May 2024. Each hemipelvis was considered a case. Tc was injected at the cervix preoperatively. If Tc migration occurred, indocyanine green was injected into the utero-ovarian ligament intraoperatively. Concordance of migration was determined in those hemipelvis with both Tc-cervical and indocyanine green utero-ovarian migration.
Seventeen patients (34 hemipelvis) were included. Migration from both injection sites occurred in 17 hemipelvis, identifying the same pelvic-SLN in all cases, being the concordance rate of 100%. Migration of Tc or indocyanine green from cervical injection was detected in 91.2% (95% CI 81.6-100%), whereas migration of indocyanine green injection from the utero-ovarian ligament was detected in 73.9% (95% CI 56-91.9%); these detection rates were not significantly different (p = 0.077).
Lymphatic migration from the cervix to the pelvis seems to be comparable to the migration from the utero-ovarian ligament to the pelvis, with both pathways converging at the same SLN.
在早期卵巢癌中，有人提出通过向子宫卵巢韧带和漏斗骨盆韧带双重注射来进行前哨淋巴结（SLN）定位。在其他妇科肿瘤中常用的宫颈注射，可能为盆腔SLN检测提供一种比子宫卵巢注射更简单的替代方法。本研究旨在通过在每个注射部位使用不同的示踪剂来证明宫颈注射和子宫卵巢注射是否引流至同一盆腔SLN：宫颈注射锝-99m（Tc），子宫卵巢韧带注射吲哚菁绿。
这项前瞻性试验纳入了2023年7月至2024年5月计划进行SLN活检的子宫内膜癌患者。每个半骨盆视为一个病例。术前在宫颈注射Tc。如果出现Tc迁移，则术中在子宫卵巢韧带注射吲哚菁绿。在同时有Tc宫颈迁移和吲哚菁绿子宫卵巢迁移的半骨盆中确定迁移的一致性。
纳入17例患者（34个半骨盆）。17个半骨盆出现了两个注射部位的迁移，在所有病例中均识别出相同的盆腔SLN，一致率为100%。宫颈注射的Tc或吲哚菁绿迁移检出率为91.2%（95%CI 81.6-100%），而子宫卵巢韧带注射吲哚菁绿的迁移检出率为73.9%（95%CI 56-91.9%）；这些检出率无显著差异（p = 0.077）。
从宫颈到骨盆的淋巴迁移似乎与从子宫卵巢韧带到骨盆的迁移相当，两条途径在同一前哨淋巴结处汇合。
