多部位示踪技术前哨淋巴结活检在早期子宫内膜癌中的应用

Application of Multi-Site Tracing Technique Sentinel Lymph Node Biopsy in Early Endometrial Cancer

目的探讨多部位示踪技术前哨淋巴结(SLN)活检在早期子宫内膜癌中的应用价值。方法选取我院收治的63例早期子宫内膜癌患者,随机平均分为宫颈注射组、宫体注射组、联合注射组,分别在相应部位注射吲哚菁绿,明确前哨淋巴结的部位及数量,将其切除后送病理检查,再行筋膜外全子宫切除术+双侧附件切除术+腹主动脉旁/盆腔淋巴结清扫术。比较三组SLN敏感度、准确度、假阴性率和阴性预测值。结果检出SLN的51例患者中有18例明确发生淋巴结转移(宫颈注射组3例,宫体注射组4例,联合注射组11例)。联合注射组有1例为腹主动脉旁区域淋巴结转移,属于早期高危型子宫内膜癌,为子宫内膜样癌。联合注射组敏感度、准确度高于宫颈组与宫体组,假阴性率低于宫颈组与宫体组(P<0.05)。结论联合宫颈与宫体作为注射部位能更有效识别盆腔区域SLN,且准确度更高,为术中淋巴结清扫提供积极的指导,对早期子宫内膜癌具有良好的应用价值。

Objective To explore the application value of multi-site tracing technique sentinel lymph node(SLN)biopsy in early endometrial cancer.Methods 63 patients with early endometrial cancer admitted to our hospital were randomly divided into intracervical injection group,intrauterine injection group and combined injection group equally.Indocyanine green was injected into corresponding areas to determine location and number of sentinel lymph nodes,which were resected and sent for pathology.The extrafascial hysterectomy,bilateral adnexectomy and para-aortic/pelvic lymphadenectomy were performed.The sensitivity,accuracy,false negative rate,and negative predictive value of SLN were compared among the three groups.Results Among 51 SLN patients,18 cases had lymph node metastasis(3 cases in intracervical injection group,4 cases in intrauterine injection group,1l cases in combined injection group).1 patient with para-aortic lymph node metastasis in combined injection group,which was an early high-risk type of endometrial cancer,endometrioid cancer.The sensitivity and accuracy of the combined injection group were higher than those of the intracervical injection group and intrauterine injection group,and the negative predictive rate was lower than that of the intracervical injection group and intrauterine injection group(P<0.05).Conclusions Intracervical and intrauterine injection sites can more effectively identify SLN in pelvic area with higher accuracy,providing positive guidance for intraoperative lymph node dissection and good application value for early endometrial cancer.