吲哚菁绿示踪时间对子宫内膜癌患者前哨淋巴结识别的影响研究

Effect of tracing time using indocyanine green on sentinel lymph node mapping in endometrial cancer

目的探讨吲哚菁绿(ICG)在子宫内膜癌患者前哨淋巴结(SLN)示踪时间与SLN检出情况及淋巴引流通路识别的关系。方法回顾性纳入北京大学人民医院自2016年3月至2021年11月行手术治疗并以ICG作为示踪剂、明确记录示踪时间、术前评估病灶局限于子宫体的子宫内膜癌患者104例。术中将ICG注射至患者子宫颈,观察荧光示踪的淋巴引流通路并切除示踪淋巴结,记录其位置及切除示踪淋巴结的数目及ICG示踪时间。术后石蜡病理检查判断淋巴结转移情况,以单侧盆腔为单位计算SLN的总检出率、SLN常见区域及淋巴引流通路的检出率,分析示踪时间是否影响SLN检出、淋巴引流通路的检出;按示踪时间四分位数分别将行系统性淋巴结切除术且有SLN检出的患者和单侧盆腔分组,分析示踪时间是否影响SLN检出的准确性。结果(1)在208侧盆腔中,SLN总检出率为75.96%,上子宫颈旁、下子宫颈旁、骨盆-漏斗韧带3条通路的检出率分别为72.60%、10.10%和4.33%;上子宫颈旁伴下子宫颈旁通路的检出率为6.25%;仅1侧盆腔同时检出3条通路。以患者为单位分析,SLN检测的敏感度为50.00%,阴性预测值为94.74%;以单侧盆腔为单位进行分析,SLN检测的敏感度为66.67%,阴性预测值为97.80%。(2)二元logistic回归分析显示SLN示踪时间与SLN检出率、各淋巴引流通路的检出均无明显相关性。(3)Fisher精确概率检验结果显示,按示踪时间四分位数分组,以患者和单侧盆腔为单位分别进行分析,各组阴性预测值均无显著性差异。结论以ICG作为示踪剂的示踪时长不会影响手术对SLN及淋巴引流通路的识别。

Objective To investigate the relationship between tracing time using indocyanine green(ICG)and the mapping of sentinel lymph node(SLN)as well as lymphatic drainage pathways in patients with endometrial cancer(EC).Methods Retrospective study of 104 women with EC whose lesions were limited to the uterine body were conducted in Peking University People's Hospital.All patients underwent SLN biopsy with tracer of ICG,the areas and number of SLN and tracing time were noted meticulously during surgery.All the lymph nodes were examined postoperatively by paraffin pathological examination to judge the metastasis of lymph nodes.The overall detection rate of SLN and the detection rates of common areas of SLN and lymphatic drainage pathways were calculated in the unit of unilateral pelvic cavity,and whether the tracing time affected the mapping of SLN as well as lymphatic drainage pathways were further analyzed.According to the quartiles of tracing time,patients and unilateral pelvic cavities that underwent systematic retroperitoneal lymphadenectomy and had SLN detected were divided into 4 groups respectively to analyze whether the tracing time affected the accuracy of SLN mapping.Results(1)The overall detection rate of SLNs was 75.96%;the detection rate of upper paracervical pathway(UPP),lower paracervical pathway(LPP)and infundibulo-pelvic pathway(IPP)was 72.60%,10.10%and 4.33%respectively;the detection rate of UPP+LPP pathway was 6.25%;only one patient's SLN was detected three pathways at the same time.When analyzed by patient,the sensitivity of SLN mapping was 50.00%,and the negative predictive value was 94.64%;when analyzed in the unit of unilateral pelvic cavity,the sensitivity was 66.67%,and the negative predictive value was 97.80%(89/91)(.2)There was no significant correlation between tracing time and mapping of SLN or lymphatic drainage pathways(.3)There was no significant difference in negative predictive value among groups divided according to the quartiles of tracing time,whether analyzed by patient or by unilateral pelvic cavity.Conclusion The tracing time using ICG will not affect the mapping of SLN or lymphatic drainage pathways.