前哨淋巴结活检技术在子宫内膜癌中的应用价值及示踪技巧的探讨  

The application and tracing skills of sentinel lymph node biopsy in endometrial cancer

作　　者：王甜 孙培松[1] 胡元晶[1] WANG Tian;SUN Peisong;HU Yuanjing(Department of Obstetrics and Gynecology,Tianjin Central Hospital of Gynecology Obstetrics,Tianjin 300100,China)

机构地区：[1]天津市中心妇产科医院妇产科,300100

出　　处：《中国妇产科临床杂志》2020年第4期340-344,共5页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨前哨淋巴结活检技术(sentinel lymph node biopsy, SLNB)中吲哚菁绿(indocyanine green, ICG)示踪在子宫内膜癌患者中应用的可行性及临床价值。方法收集2016年8月至2020年3月在天津市中心妇产科医院住院行前哨淋巴及手术分期治疗的子宫内膜癌患者176例,术前将ICG于宫颈3点及9点进行注射,术中观察并切除示踪的前哨淋巴结(SLN),再根据美国国立综合癌症网络(NCCN)指南行子宫切除及腹膜后淋巴结切除,术后经病理检查判断SLN及腹膜后淋巴结转移情况,计算SLN的检出率、敏感度、阴性预测值及假阴性率等。结果 176例患者的SLN总检出率为91%(160/176),双侧SLN检出率为78%(138/176)。ICG荧光显影技术检测和识别SLN阴性预测值为98.1%(157/160),敏感度为90.3%(28/31),假阴性率为9.7%(3/31)。按NCCN推荐SLN实施法则计算,阴性预测值为98.3%(173/176),敏感度为91.9%(34/37),假阴性率为8.1%(3/37)。子宫内膜癌的SLN主要位于髂外淋巴结(39%,116/298)和闭孔淋巴结(38%,113/298)。其中SLN的识别与脉管癌栓有关(P=0.000)。结论 ICG荧光显影技术下识别子宫内膜癌SLN具有较高的检出率、敏感性及阴性预测值,多条淋巴结通路同时显影及隐匿部位淋巴结的识别可降低假阴性率,提高SLNB的临床应用价值。Objective To investigate the feasibility and clinical value of sentinel lymph node biopsy(SLNB)with indocyanine green(ICG)tracing in patients with endometrial cancer.Methods A total of 176 patients with endometrial cancer who were hospitalized in Tianjin Central Hospital of Gynecology Obstetrics from August 2016 to March 2020 for sentinel lymphatic and surgical staging were collected.ICG was injected into the cervix at 3 o’clock and 9 o’clock before surgery,intraoperative observation and removal of the traced sentinel lymph node(SLN),and then hysterectomy and retroperitoneal lymph node resection were conducted according to the National Comprehensive Cancer Network(NCCN)guidelines.Postoperative pathological examination was performed to determine SLN and retroperitoneal lymph node metastasis,the detection rate,sensitivity,negative predictive value and false negative rate of SLN were calculated.Results The total SLN detection rate of 176 patients was 91%(160/176),and detection rate of bilateral SLN was 78%(138/176).The negative predictive value was 98.1%(157/160),the sensitivity was 90.3%(28/31),and the false negative rate was 9.7%(3/31).According to the NCCN recommended SLN implementation rule,the negative predictive value is 98.3%(173/176),the sensitivity is 91.9%(34/37),and the false negative rate is 8.1%(3/37).The SLN of endometrial cancer is mainly located in extrailiac lymph nodes(39%,116/298)and obturator lymph nodes(38%,113/298).The recognition of SLN is related to lymphovascular space invasion(LVSI)(P=0.00).Conclusions The detection rate,sensitivity and negative predictive value of SLN in endometrial cancer were higher with ICG fluorescence imaging.Simultaneous visualization of multiple lymph node pathways and identification of hidden node lymph nodes can reduce the false negative rate and improve the clinical application of SLNB value.

关 键 词：子宫内膜癌 前哨淋巴结 吲哚菁绿 

分 类 号：R737.33[医药卫生—肿瘤]