Intraoperative sentinel node identification in early stage cervical cancer using a combination of radiolabeled albumin injection and isosulfan blue dye injection
Intraoperative sentinel node identification in early stage cervical cancer using a combination of radiolabeled albumin injection and isosulfan blue dye injection
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DOI：
10.1016/j.ygyno.2003.11.028
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发表时间：
2004-03-01
影响因子：
4.7
通讯作者：
Xercavins, J
中科院分区：
文献类型：
--
作者：
Martínez-Palones, JM;Gil-Moreno, A;Xercavins, J
目标.我们研究了在接受广泛子宫切除术和盆腔淋巴结切除术治疗早期宫颈癌的患者中，使用放射性同位素淋巴显像（99 m标记的人血清白蛋白和异硫蓝染料注射液）识别前哨淋巴结的可行性。在2000年9月至2002年10月期间，25例宫颈癌FIGO I期（n = 24）或II期（n = 1）患者接受了前哨淋巴结检测，术前淋巴结造影（肿瘤周围注射锝-99m胶体白蛋白）和术中淋巴结标测，使用蓝色染料和手持式或腹腔镜伽马探针。所有病例均采用开放手术或腹腔镜手术完成盆腔或腹主动脉旁淋巴结清扫。在23例可评估的患者中，淋巴结造影共检测到51个前哨淋巴结（平均每例患者2.21个淋巴结）。术中发现前哨淋巴结61个，平均每例患者2.52个淋巴结，平均每例患者1.94个淋巴结。40%的前哨淋巴结位于髂动脉区，25%位于髂外区。在12%的病例中证实了显微镜下淋巴结转移（4个淋巴结）。所有这些淋巴结以前都被检测为前哨淋巴结。其余419个盆腔淋巴结切除后组织学阴性。用锝-99m标记的纳米胶体结合蓝色染料注射进行前哨淋巴结识别是可行的，并且显示出100%的阴性预测值，并且可能识别出可以避免淋巴结清扫的女性。(C)2004年爱思唯尔公司All rights reserved.
Objectives. We investigated the feasibility of sentinel lymph node identification using radioisotopic lymphatic mapping with technetium-99m-labeled human serum albumin and isosulfan blue dye injection in patients undergoing radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer.Methods. Between September 2000 and October 2002, 25 patients with cervical cancer FIGO stage I (n = 24) or stage II (n = 1) underwent sentinel lymph node detection with preoperative lymphoscintigraphy (technetium-99m colloid albumin injection around the tumor) and intraoperative lymphatic mapping with blue dye and a handheld or laparoscopic gamma probe. Complete pelvic or paraaortic lymphadenectomy was performed in all cases by open surgery or laparoscopic surgery.Results. In 23 evaluable patients, a total of 51 sentinel lymph nodes were detected by lymphoscintigraphy (mean 2.21 nodes per patient). Intraoperatively, 61 sentinel lymph nodes were identified, with a mean of 2.52 nodes per patient by gamma probe and a mean of 1.94 nodes per patient after isosulfan blue injection. Forty percent of sentinel nodes were found in the interiliac region and 25% in the external iliac area. Microscopic nodal metastases (four nodes) were confirmed in 12% of cases. All these lymph nodes were previously detected as sentinel lymph nodes. The remaining 419 nodes after pelvic lymphadenectomy were histologically negative.Conclusions. Sentinel lymph node identification with technetium-99m-labeled nanocolloid combined with blue dye injection is feasible and showed a 100% negative predictive value, and potentially identified women in whom lymph node dissection can be avoided. (C) 2004 Elsevier Inc. All rights reserved.