前哨淋巴结活检技术对早期宫颈癌腹腔淋巴结转移的评估价值  

Clinical value of sentinel lymph node biopsy in evaluating celiac lymph node metastasis in early cervical cancer

作　　者：宋丽华[1] 贾小林 刘宝刚[3] SONG Li-hua;JIA Xiao-lin;LIU Bao-gang(Department of Gynecology,the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,Shaanxi,CHINA;Department of Obstetrics and Gynecology,Fugu County Hospital of Traditional Chinese Medicine,Yulin 719499,Shaanxi,CHINA;Department of Cancer Radiotherapy,the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,Shaanxi,CHINA)

机构地区：[1]陕西中医药大学第二附属医院妇科,陕西咸阳712000 [2]榆林市府谷县中医医院妇产科,陕西榆林719499 [3]陕西中医药大学第二附属医院肿瘤放疗科,陕西咸阳712000

出　　处：《海南医学》2019年第16期2099-2101,共3页Hainan Medical Journal

摘　　要：目的分析前哨淋巴结活检术(SLNB)对早期宫颈癌中盆腔淋巴结转移判断的准确性、敏感性和特异性,评价SLNB对早期宫颈癌腹腔淋巴结转移的临床价值。方法将2014年6月至2017年6月陕西中医药大学第二附属医院妇二科诊断为ⅠA2~ⅡA1期的宫颈癌患者63例为研究对象,实施SLNB后均行双侧盆腔淋巴结清除术加广泛子宫切除术。术后将前哨淋巴结(SLN)和非前哨淋巴结(NSLN)送病理检查,记录其病理学检查结果并与之比较。结果手术共获得淋巴结1 853枚,其中SLN为192枚,NSLN为1 661枚;SLN主要分布在髂总、髂外和髂内闭孔,NSLN主要分布在髂总、髂外、髂内闭孔、腹主动脉旁以及腹股沟深;经病理组织学检查确诊有16例患者出现盆腔淋巴结转移,其转移率为25.40%;经放射性核素示踪法SLN检出率为93.65%(59/63),SLNB的准确性为98.31%(58/59),灵敏性为81.25%(13/16),假阴性率为6.25%(2/16);但不同临床分期、肿瘤大小患者的SLN阳性表达率比较差异均无统计学意义(P>0.05)。结论SLNB在早期宫颈癌中评估腹腔淋巴结转移是安全可行的,但国内学者需收集多中心大量样本的结果,以制订出符合国内的标准及临床规范化指南。Objective To analyze the accuracy,sensitivity and specificity of sentinel lymph node biopsy(SLNB)in the diagnosis of pelvic lymph node metastasis in early cervical cancer,and to evaluate the clinical diagnostic value of SLNB in the evaluation of abdominal lymph node metastasis in early cervical cancer.Methods From June 2014 to June 2017,63 patients with cervical cancer diagnosed asⅠA2-ⅡA1 in Second Department of Gynecology,the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine were enrolled in the study.After SLNB,bilateral pelvic lymphadenectomy and extensive hysterectomy were performed.SLN and non-sentinel lymph nodes(NSLN)were sent to pathological examination after surgery,and the results of pathological examination were recorded and compared.Results A total of 1 853 lymph nodes were obtained,192 were SLNs and 1 661 were NSLNs.SLN mainly in the total iliac,external iliac and internal iliac obturator.NSLN mainly in the total iliac,external iliac,internal iliac obturator,abdominal aorta and groin deep.Sixteen cases of pelvic lymph node metastasis were confirmed by pathological examination,tand he transfer rate was 25.40%.The detection rate of SLN by radionuclide tracer was 93.65%(59/63),the accuracy of SLNB was 98.31%(58/59),the sensitivity was 81.25%(13/16),and the false negative rate was 6.25%(2/16).However,the positive expression rate of SLN in different clinical stages and tumor sizes was not statistically significant(P>0.05).Conclusion It is safe and feasible for SLNB to assess celiac lymph node metastasis in early stage cervical cancer,which is worthy of clinical promotion.However,domestic scholars need to collect the results of a large number of multicentre samples and draw up guidelines that conform to national standards and clinical norms.

关 键 词：前哨淋巴结 活检技术 早期宫颈癌 淋巴结转移 评估价值 

分 类 号：R737.33[医药卫生—肿瘤]