Intraoperative clinical evaluation of lymph nodes in women with gynecologic cancer
Intraoperative clinical evaluation of lymph nodes in women with gynecologic cancer
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DOI：
10.1067/mob.2001.113128
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发表时间：
2001-05-01
影响因子：
9.8
通讯作者：
Eltabbakh, GN
中科院分区：
文献类型：
--
作者：
Eltabbakh, GN
目的：本研究旨在确定妇科肿瘤患者术中淋巴结系统临床评估的准确性，并探讨影响其准确性的因素。研究设计：前瞻性记录178例连续行淋巴结切除术的女性淋巴结转移的特征和术中临床印象。总体临床印象和淋巴结特征（肿大、坚硬和粘附）与最终的组织病理学诊断相关。结果：总体临床印象与最终组织病理诊断吻合良好（kappa = 0.753），但假阴性率较高（25.8%）。扩大和坚固的组合具有最高的总体准确性（93.3%）。临床评价的准确性因肿瘤类型、淋巴结阳性程度、阳性淋巴结占总淋巴结数的比例而有显著差异。结论：经过训练的外科医生对淋巴结进行系统的术中临床评估，虽然总体准确率较高，与最终的组织病理诊断相关性较好，但其假阴性率较高，不能替代组织病理检查。
OBJECTIVE: This study was undertaken to determine the accuracy of systematic intraoperative clinical evaluation of lymph nodes in women with gynecologic cancers and to examine the factors affecting such accuracy.STUDY DESIGN: The characteristics and overall intraoperative clinical impression of lymph node metastases were prospectively recorded for 178 consecutive women undergoing lymphadenectomy. The overall clinical impression and lymph node characteristics (enlargement, firmness, and adherence) were correlated with the final histopathologic diagnosis.RESULTS: The overall clinical impression showed excellent agreement with the final histopathologic diagnosis (kappa = 0.753) but had a high false-negative rate (25.8%). The combination of enlargement and firmness had the highest overall accuracy (93.3%). Accuracy of clinical evaluation varied significantly according to the type of cancer, node positivity, and the proportion of positive nodes with respect to the total number of nodes.CONCLUSION: Although systematic intraoperative clinical evaluation of lymph nodes by a trained surgeon has high overall accuracy and correlates well with the final histopathologic diagnosis, it has a high false-negative rate and cannot substitute for histopathologic examination.