Laparoscopic sentinel node mapping in early-stage cervical cancer
Laparoscopic sentinel node mapping in early-stage cervical cancer
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DOI：
10.1016/j.ygyno.2003.08.024
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发表时间：
2003-12-01
影响因子：
4.7
通讯作者：
Roy, M
中科院分区：
文献类型：
--
作者：
Plante, M;Renaud, MC;Roy, M
目标。我们的目的是确定哨兵节点（SN）制图的可行性和准确性，以及它预测区域节点盆地状态的能力。2000年10月至2002年9月，对70例接受根治性手术的早期宫颈癌（IA期、IB期和IIA期）患者进行了淋巴结测绘，以确定前哨淋巴结。所有患者均在腹腔镜下进行SN识别，然后进行完整的腹腔镜盆腔淋巴结和参数解剖。所有病例均在宫颈内注射蓝色染料后进行SN定位，并结合术前宫颈内注射Tc-99淋巴显像和术中小型腹腔镜伽玛探头检测SN 29例（42%）。单纯蓝色染色技术（n = 70）在61例（87%）患者中发现至少1例SN。解剖侧SN检出率为74%，左侧70%，右侧77%。60%的病例发现双侧SN。在联合技术组（n = 29）中，SN检出率从79%上升到93% （P = 0.04）。加入淋巴显像后，双侧SN检出率由55%提高至72% （P = 0.03）。在该系列的后15例中，SN检出率达到93%(14/15)，与前55例的检出率相比有统计学意义（P < 0.01）。共发现135个SN，其中大多数（88%）位于三个主要部位：外髂、闭孔和分叉。36例（51%）有2个SN， 16例（24%）有3个或以上SN。12例（17%）患者淋巴结阳性。在这些病例中，腹腔镜下淋巴结正常的患者每侧淋巴结的SN检出率为75%，而淋巴结宏观受累的患者仅为56% （P = NS）。假阴性率为0。联合技术对SN标测的阴性预测值为100%，灵敏度为93%。2例患者对蓝色染料过敏（3%）。结合蓝染技术和淋巴显像对宫颈癌患者前哨淋巴结的定位在腹腔镜下是可行的，而且准确度很高。随着经验的积累和淋巴显像术的使用，检出率显著提高。(C) 2003 Elsevier Inc.版权所有。
Objective. We aimed to determine the feasibility and accuracy of sentinel node (SN) mapping and its ability to predict the status of the regional nodal basin.Methods. From October 2000 to September 2002, 70 patients undergoing radical surgery for early-stage cervical cancer (stage IA, IB, and IIA) were offered lymph node mapping for identification of the sentinel node. All patients underwent SN identification laparoscopically followed by a complete laparoscopic pelvic node and parametrial dissection. The SN mapping was done after intracervical blue dye injection in all cases and was combined with preoperative lymphoscintigraphy following intracervical Tc-99 injection and intraoperative SN detection with a miniaturized laparoscopic gamma probe in 29 cases (42%).Results. The blue dye technique alone (n = 70) identified at least I SN in 61 (87%) of the patients. The rate of SN detection by side of dissection was 74%, 70% on the left side and 77% on the right side. Bilateral SN were identified in 60% of cases. In the subgroup of patients who had the combined technique (n = 29), the rate of SN detection increased from 79 to 93% (P = 0.04). The bilateral SN detection rate increased from 55 to 72% when adding lymphoscintigraphy (P = 0.03). In the last 15 cases of the series, the SN detection rate reached 93% (14/15) and this was statistically significant compared to the detection rate of the first 55 cases (P < 0.01). A total of 135 SN were identified, with the majority (88%) being located at three main sites: the external iliac, obturator, and bifurcation. Thirty-six patients (51%) had 2 SN identified, and 16 (24%) had 3 SN or more. Twelve (17%) patients had positive lymph nodes. In those cases, the rate of SN detection per side of dissection in patients with normal appearing nodes at laparoscopy was 75%, whereas it was only 56% in patients with macroscopically involved lymph nodes (P = NS). The false negative rate was 0. The negative predictive value of SN mapping was 100% and the sensitivity was 93% with the combined technique. Two patients had allergic reactions to the blue dye (3%).Conclusion. Sentinel node mapping with the combined blue dye technique and lymphoscintigraphy in patients with cervical cancer is laparoscopically feasible and is highly accurate. The detection rate improves significantly with experience and with the use of lymphoscintigraphy. (C) 2003 Elsevier Inc. All rights reserved.