Update on sentinel node mapping in uterine cancer: 10-year experience at Memorial Sloan-Kettering Cancer Center
Update on sentinel node mapping in uterine cancer: 10-year experience at Memorial Sloan-Kettering Cancer Center
复制标题
DOI：
10.1111/jog.12227
复制
发表时间：
2014-02-01
影响因子：
1.6
通讯作者：
Abu-Rustum, Nadeem R.
中科院分区：
文献类型：
--
作者：
Abu-Rustum, Nadeem R.
子宫内膜癌是最常见的妇科恶性肿瘤。在大多数患者中，这种疾病会出现在早期，没有转移，预后良好。尽管早期子宫内膜癌患者的转移率很低，但标准的治疗方法仍然包括完全或选择性的盆腔和主动脉旁淋巴结切除术。尽管疾病局限于子宫，但许多患者将接受全面的淋巴结切除术，导致有害的副作用，包括下肢淋巴水肿。最近的研究，如《子宫内膜癌治疗研究》显示，对早期子宫内膜癌进行完全淋巴结切除术没有治疗益处，尽管需要进一步的研究来证实这些发现。在子宫内膜癌中使用前哨淋巴结（SLN）作图可以在完全淋巴结切除术和无淋巴结评估这两种思想流派之间提供一个适当的中间立场。SLN定位在许多癌症类型中得到越来越多的认可，它基于这样一个概念，即淋巴结转移是一个有序过程的结果，即淋巴以特定的模式远离肿瘤，因此如果SLN或第一个淋巴结为转移阴性，那么SLN之后的淋巴结也应该是阴性的。我们在此介绍纪念斯隆-凯特琳癌症中心在子宫癌SLN定位方面的经验，这是我们在2003年首次使用的一种技术，多年来不断改进。
Endometrial cancer is the most common gynecologic malignancy. In the majority of patients, the disease will present at an early stage, without metastasis, and with an excellent prognosis. Although the rate of metastasis in patients with early stage endometrial cancer is low, the standard of treatment still includes a complete or selective pelvic and para-aortic lymphadenectomy for staging. Many patients will undergo a comprehensive lymphadenectomy despite having disease confined to the uterus, resulting in detrimental side-effects, including lower extremity lymphedema. Recent studies, such as A Study in the Treatment of Endometrial Cancer', have shown that there is no therapeutic benefit to a complete lymphadenectomy in early stage endometrial cancer, although further study is needed to confirm these findings. The use of sentinel lymph node (SLN) mapping in endometrial cancer may provide an appropriate middle ground between the two schools of thought of complete lymphadenectomy versus no nodal evaluation. SLN mapping, which is gaining ever-increasing acceptance in many cancer types, is based on the concept that lymph node metastasis is the result of an orderly process, that is, the lymph drains in a specific pattern away from the tumor, and therefore if the SLN, or first node, is negative for metastasis, then the nodes after the SLN should also be negative. We present here the Memorial Sloan-Kettering Cancer Center experience with SLN mapping in uterine cancer, a technique we first began using in 2003 and have improved over the years.