子宫内膜癌前哨淋巴结定位 SENTINEL LYMPH NODE MAPPING FOR ENDOMETRIAL CANCER Z. Al-Talal, J. Gregoire, M.-C. Renaud, M. Roy, M. Plante Gynecologic Oncolo
SENTINEL LYMPH NODE MAPPING FOR ENDOMETRIAL CANCER
Z. Al-Talal, J. Gregoire, M.-C. Renaud, M. Roy, M. Plante
Gynecologic Oncology Division, Hôtel-Dieu de Québec, Québec, QC, Canada
Objectives: To evaluate detection rate, sensitivity and negative predictive value (NPV) of sentinel lymph node (SLN) mapping in endometrial cancer.
Methods: This single center study identified all patients undergoing hysterectomy, salpingo-oophorectomy, lymphadenectomy and SLN mapping for endometrial cancer between November 2010 and February 2012. Data was prospectively collected. Colorimetric and/or radio-isotopic detection with Patent Blue (PB) and Technetium (Tc99) were used to detect SLNs, followed by complete pelvic lymphadenectomy with or without para-aortic node sampling. Tc99 was injected on the morning of surgery, and PB after induction of anesthesia, at 3 and 9 o'clock. Intra-operative frozen section was optional. SLNs were ultra-staged for final pathology. Detection rate, sensitivity and NPV were calculated.
Results: Among 64 operated patients, SLNs were removed by laparoscopy in 62.5% of cases and laparotomy in 37.5%. At least 1 SLN was identified in 98.4% of PB cases (n=63) and 100% of Tc99 (n=32). Overall, 12.5% of patients had unilateral and 87,5% bilateral SLN identification. Fourteen patients (21.9%) had pelvic node metastasis including 10 macro-metastases, 2 micro-metastases and 2 isolated tumor cells (ITC). Concurrent metastatic para-aortic nodes were identified in 4 of those patients. Sensitivity of SLN mapping was 100% after ultra-staging (n=64) and 66.7% on frozen section (n=41), while NPV was 100 % and 91.4%, respectively.
Conclusion: SLN mapping in endometrial cancer appears promising. Detection rate is high. Although the sensitivity of intra-operative frozen section is limited, ultra-staging provides excellent sensitivity and NPV. Currently, the clinical significance and the management of micro-metastasis and ITC remains uncertain.
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