前哨淋巴结在子宫内膜癌中应用的研究进展

Research Progress of Sentinel Lymph Node in Endometrial Carcinoma

前哨淋巴结(SLN)绘图作为一项能显示可疑转移淋巴结的新技术,目前在子宫内膜癌的治疗中有良好的应用前景,通过回顾现有的子宫内膜癌SLN的文献,了解SLN的背景、多种识别技术、应用价值及微转移等,并分析其与系统性淋巴结切除术对患者生存质量、期别、预后的影响,尚存在的争议及未来发展方向等相关问题。总结目前的观点如下:吲哚菁绿(ICG)宫颈注射能够准确地评估盆腔和部分腹主动脉旁淋巴结状态,假阴性率可达到<5%;SLN为腹主动脉旁的检测率约为<5%,发生腹主动脉旁淋巴结跳跃式转移的概率约为0.8%~1%,Ⅱ型子宫内膜癌及高级别患者转移概率为3%;SLN通过病理学超分期能很好地预测淋巴结的小体积转移(单独细胞转移及微转移),小体积转移患者有较好的预后,经辅助治疗后无进展生存发生率与未发生转移患者相似;SLN可改善患者生存质量,低级别子宫内膜样癌可仅行SLN切除,而高危因素患者行SLN切除是合理的但安全性有待商榷。

Sentinel lymph nodes(SLN) mapping as a new technology can show suspicious metastasis of lymph nodes, the current treatment of endometrial carcinoma has a good application prospect, this paper reviews the existing literature of endometrial cancer sentinel lymph node, understanding the background of the sentinel lymph node and multiple recognition technology, application value and micrometastases, etc., and analyzes it with systematic lymphadenectomy for patients survival quality, the influence of the period, prognosis, is the future development direction of dispute and related problems. Conclusion:indoline green(ICG) cervical injection can accurately assess the state of pelvic and partial abdominal aortic lymph nodes, and the false negative rate can reach < 5%. The detection rate of the sentinel lymph node at the abdominal aorta was about <5%, and the probability of the metastasis of the abdominal aortic lymph node was about 0.8%-1%, and the metastasis probability of the patients with endometrial cancer and the high level was 3%. SLNS through pathology staging detection can well predict the small volume of lymph node metastasis(ITCs and micrometastases), small volume transfer patients have better prognosis, after treatment with auxiliary progression-free survival(should get rid of the word) incidence similar to not shift patients. SLN can improve the survival quality of patients, and low-grade endometrial carcinoma can only be resected with SLN, while patients with high risk factors are reasonable in SLN removal, but the safety is open to discussion.