Cervical conization and sentinel lymph node mapping in the treatment of stage I cervical cancer: is less enough?
Cervical conization and sentinel lymph node mapping in the treatment of stage I cervical cancer: is less enough?
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DOI：
10.1097/igc.0000000000000034
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发表时间：
2014-01
期刊：
影响因子：
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通讯作者：
Abu-Rustum NR
中科院分区：
文献类型：
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作者：
Andikyan V;Khoury-Collado F;Denesopolis J;Park KJ;Hussein YR;Brown CL;Sonoda Y;Chi DS;Barakat RR;Abu-Rustum NR
确定宫颈锥切术和前哨淋巴结（SLN）定位作为治疗I期宫颈癌的生育保留策略的可行性，并估计实现宫颈无残留癌所需的肿瘤边缘状态。我们确定了2005年9月至2012年8月期间所有希望保留生育能力并接受SLN标测和宫颈锥切术治疗I期宫颈癌的患者。收集相关的人口统计学、临床和病理学信息。确定了10名患者。中位年龄为28岁（范围：18-36岁）。所有患者均未出现肉眼可见的肿瘤。浸润性癌的初步诊断是通过环形电切术（LEEP）或锥状活检进行的。所有患者均接受术前放射学评估（MRI和PET-CT）。影像学上无一例患者有明显肿瘤或疑似淋巴结转移的证据。分期分布包括：IA 1伴淋巴管浸润，7例（70%）;显微镜下IB 1，3例（30%）。组织学包括：鳞状细胞癌，8例（80%）;腺癌，1例（10%）;透明细胞癌，1例（10%）。9例患者接受了重复宫颈锥切术和SLN标测，1例患者接受了锥切术后宫颈活检和SLN标测。所有患者在最终标本上均未发现残留肿瘤。浸润癌距宫颈内边缘的中位距离为2.25mm，距宫颈外边缘的中位距离为1.9mm。所有收集的淋巴结均为转移阴性。中位随访17个月（范围1-83）后，无患者被诊断为疾病复发，3例患者（30%）妊娠。宫颈锥切术和前哨淋巴结定位似乎是一个可接受的治疗策略，为选定的小体积I期宫颈癌患者。肿瘤清除≥ 2 mm似乎与重复锥切无残留相关。需要更大的样本量和更长的随访时间来确定该手术的长期结局。
To determine the feasibility of cervical conization and sentinel lymph node (SLN) mapping as a fertility-sparing strategy to treat stage I cervical cancer and estimate the tumor margin status needed to achieve no residual carcinoma in the cervix. We identified all patients who desired fertility-preservation and underwent SLN mapping with cervical conization for stage I cervical cancer from 9/2005–8/2012. Relevant demographic, clinical, and pathological information was collected. Ten patients were identified. Median age was 28 years (range,18–36). None of the patients had a grossly visible tumor. The initial diagnosis of invasive carcinoma was made either on a loop electrosurgical excision procedure (LEEP) or cone biopsy. All patients underwent preoperative radiologic evaluation (MRI and PET-CT). None of the patients had evidence of gross tumor or suspicion of lymph node metastasis on imaging. Stage distribution included: IA1 with lymphovascular invasion, 7(70%); and microscopic IB1, 3(30%). Histology included: squamous cell carcinoma, 8(80%); adenocarcinoma, 1(10%); and clear cell carcinoma, 1(10%). Nine patients underwent repeat cervical conization with SLN mapping, and 1 patient underwent post-conization cervical biopsies and SLN mapping. None of the patients had residual tumor identified on the final specimen. The median distance from the invasive carcinoma to the endocervical margin was 2.25mm, and the distance from the invasive carcinoma to the ectocervical margin was 1.9mm. All collected lymph nodes were negative for metastasis. After a median follow-up of 17 months (range,1–83), none of the patients were diagnosed with recurrent disease and 3 patients (30%) achieved pregnancy. Cervical conization and SLN mapping appears to be an acceptable treatment strategy for selected patients with small-volume stage I cervical cancer. Tumor clearance of ≥2mm appears to correlate well with no residual on repeat conization. A larger sample size and longer follow-up is needed to establish the long-term outcomes of this procedure.