Sentinel node dissection in vulvar cancer.
Sentinel node dissection in vulvar cancer.
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DOI：
10.1007/s11864-006-0043-4
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发表时间：
2006-03-01
影响因子：
4.3
通讯作者：
Terada, Keith Y
中科院分区：
文献类型：
--
作者：
Hakim, Amy A;Terada, Keith Y
外阴癌是一种罕见但毁灭性的疾病。除根治性外阴切除术外，大多数患者还需要腹股沟股淋巴结切除术，这通常会导致伤口感染、伤口破裂和慢性水肿。在过去，早期病变的金标准是根治性外阴切除术和双侧腹股沟-股淋巴结清扫术。这导致了低复发率，但毁灭性的毁容和高并发症发生率。因为只有大约20%的外阴癌患者在就诊时淋巴结阳性，所有患者的腹股沟-股淋巴结切除术的传统方法导致许多患者经历了病态的手术，没有任何真实的益处。前哨淋巴结清扫术，通过只切除含有转移的最高风险的淋巴结，提供了一种病态程度低得多的选择。此外，由于仅切除一个或两个淋巴结，因此这些淋巴结可以进行比传统的完全淋巴结切除术更彻底的组织病理学分析。这包括连续切片和细胞角蛋白抗原的免疫组化染色。非常小的转移，称为微转移，可以用这种方式检测。因此，前哨淋巴结连续切片和免疫组化染色可能提供了一个更准确的评估区域淋巴结的发病率较低。前哨淋巴结阳性的患者可能会接受额外的治疗。前哨淋巴结阴性的患者理论上转移的风险非常低，不需要任何额外的治疗。
Vulvar cancer is an uncommon but devastating disease. In addition to radical vulvectomy, most patients require inguinofemoral lymphadenectomy, which often results in wound infection, wound breakdown, and chronic lymphedema. In the past, the gold standard for early lesions was radical vulvectomy with complete bilateral inguinal-femoral lymphadenectomy. This resulted in a low rate of recurrence but devastating disfigurement and high complication rates. Because only approximately 20% of patients with vulvar cancer have positive lymph nodes upon presentation, the traditional approach of inguinal-femoral lymphadenectomy for all patients resulted in many patients undergoing a morbid procedure without any real benefit. Sentinel node dissection, by removing only the nodes with the highest risk of containing metastases, offers a much less morbid alternative. In addition, because only one or two lymph nodes are removed, these can be subjected to a more thorough histopathologic analysis than conventional complete lymphadenectomy. This involves serial sectioning and immunohistochemical staining for cytokeratin antigen. Very small metastases, termed micrometastases, can be detected in this fashion. Therefore, sentinel node dissection with serial sectioning and immunohistochemical staining potentially offers a more accurate assessment of the regional nodes with less morbidity. Patients with positive sentinel nodes may then undergo additional therapy. Patients with negative sentinel nodes are theoretically at very low risk for metastases and should not require any additional treatment.