宫颈癌前哨淋巴结活检的临床病理学意义

Clinical pathological significance of sentinel lymph node biopsy in cervical cancer patients

目的:用活性染料美兰定位进行子宫颈癌前哨淋巴结活检(Sentinel lymph node biopsy,SLNB),了解SLN的分布特点,探索SLN检测的可行性及其临床病理学意义。方法:对45例术前确诊宫颈癌、FIGO分期Ia2-Ⅱb的患者行经腹根治性子宫切除术加盆腔淋巴结清扫术加术中美兰识别SLN,将最先蓝染的淋巴结定为SLN,切除SLN送病理检查。SLN病理学评估包括连续切片中的病理诊断和广谱细胞角蛋白免疫组化检测证实。所有数据采用Stata7.0统计软件进行统计学分析,检验水准α=0.05。结果:①宫颈癌中识别和检获SLN41例占91.11(41/45),由SLN发现转移率的灵敏度为85.71(6/7);②闭孔淋巴结是宫颈癌SLN最常见部位,占检获SLN的55.04,其次髂内和髂外淋巴结分别为20.18和14.67;③癌转移SLN平均直径为(2.87±0.17)cm,显著大于无癌转移的SLN(1.57±0.05)cm;④SLN阳性检出率与宫颈癌FIGO分期、宫颈肌层浸润深度、颈管浸润呈显著正相关(均P<0.05)。结论:SLN能反映宫颈癌盆腔LN的转移情况与常见部位,并可作为确定手术范围的依据之一,有利于患者预后的评价。但染料注射时间、部位还需进一步探究与改进,以提高宫颈癌术中对SLN的判别检出率。宫颈癌根治术美兰定位检测SLN安全、可行。

Objective： To observe the distributing characteristics of sentinel lymph node （SLN） by natural dye methylene blue location, investigate the feasibility and the clinical pathological significance of the SLN detection. Methods： 45 patients diagnosed as cervical cancer preoperatively, FIGO stage Ⅰa2 - Ⅱ b, underwent radical hysterectomy and pelvic lymph nodes dissection and received SLN detection with methylene blue dye. The first blue dying lymph node for pathological detection was considered as SLN. Pathological assess of SLN included pathological diagnosis by serial sections and confirmation by broad - spectrum cytokeratin immunohistochemistry detection. The analysis was performed on Stata 7. 0 （ α = 0. 05） . Results： （1）SLNs were identified in 41 patients among 45 patients （91. 11% ）. The sensibility of lymphatic metastasis rate which detected by SLNs was 85. 71% （6/7）. （2）Cervical cancer SLN often occurred in obturator lymph nodes, accounting for 55. 04% among the detected SLNs, internal and external iliac lymph nodes made up of 20. 18% and 14. 67%, respectively. （3）Average diameter of cancerometastasis SLNs was significantly longer than that of non - cancerometastasis, （ 2 87 ± 0. 17） cm versus （1. 57 ±0. 05） cm respectively. （4）There was positive correlation between positive detection rate of SLNs, FIGO stage of cervical cancer, depth of myometrial invasion and canalis cervicis invasion （P 〈 0.05） . Conclusion： SLN biopsy can predict the metastasis and common position of pelvic lymph nodes correctly. It can he one of the evidences of standard to decide the operation range, which is more benefit to the evaluation of prognosis. Further investigation and improvement about stain injection time and position should be explored in future. It is safe and feasible to identify SLNs in cervical cancer radical correction with methylene blue staining.