Application Of Carbon Nanoparticles In Sentinel Lymph Node Mapping In Endometrial Carcinoma Surgery

ObjectiveUsing carbon nanoparticles as sentinel lymph node(SLN)tracer,to analyze the sentinel lymph node(SLN)distribution of endometrial carcinoma,and the detection rate,sensitivity and negative predictive value(NPV)of SLN mapping in endometrial carcinoma surgery.To explore the feasibility and effectiveness of SLN mapping technique,and the application value of carbon nanoparticles in the identification of SLN in endometrial carcinoma surgery.Methods35 endometrial carcinoma patients with uterine-confined disease hospitalized in Qilu Hospital of Shandong University from September 2016 to August 2017 were included in this study.All patients were diagnosed with endometrial carcinoma through endometrial biopsy from diagnostic curettage or hysteroscopy.All patients received comprehensive clinical evaluation before surgery.The cervix was injected with a total of 2 mL of diluted carbon nanoparticles at 3,6,9and 12 o’clock.The retroperitoneum was explored and the first black-dyed lymph nodes were removed and defined as SLNs.Then all patients underwent comprehensive staging surgery.All SLNs were sent for routine hematoxylin and eosin(H-E)staining and pathological examination.Negative SLNs under H-E staining received cytokeratin(CK)immumohistochemical(IHC)staining afterwards.The clinical characteristic of 35 patients,the SLN number and distribution rule,the detection rate,sensitivity and NPV of SLN mapping were analyzed.Results1.Among the 35 patients,the median age was 53 years and median body mass index(BMI)was 25.3kg/m.23(65.71%)patients received laparoscopic surgery and 12(34.29%)patients received laparotomy.32(91.43%)cases were endometrioid adenocarcinoma,2(5.71%)cases were serous carcinoma,1(2.86%)case was endometrioid adenocarcinoma with mucinous adenocarcinoma.In 32 cases of endometrioid adenocarcinoma,17(53.12%)cases were G1,11(34.38%)cases were G2,and 4(12.50%)cases were G3.According to the surgical pathological staging of Federation of International Gynecology and Obstetrics(FIGO)2014 version,24(68.58%)cases were stage IA,4(11.43%)cases were stage IB,2(5.71%)cases were stage ⅢA,3(8.57%)cases were stage ⅢC1 and 2(5.71%)cases were stage ⅢC2.32(91.43%)cases were without LVSI,3(8.57%)cases were with LVSI.27(77.14%)cases were with depth of myometrial invasion(DMI)<50%and 8(22.86%)cases were with DMI ≥50%.2.At least one SLN was detected in 31 patients,and no SLN was detected in 4 patients.The total SLN detection rate was 88.57%(31/35).The bilateral SLN detection rate was 51.43%(18/35)and the unilateral SLN detection rate was 22.86%(8/35).The detection rate of para-aortic and presacral SLN was 14.29%(5/35).3.The SLN detection rate was significantly higher in patients with DMI<1/2 than in patients with DMI>1/2(p=0.030).No significant difference was found in detection rates between surgical approaches,histology types,histological grades and patients with or without LVSI(P>0.05).4.A total of 186 SLNs were detected and the median SLN number was 5 per patient(range,1-14).There were 93(50.00%)external iliac SLNs,61(32.80%)obturator SLNs,14(7.53%)para-aortic SLNs,11(5.91%)common iliac SLNs,4(2.15%)internal iliac SLNs and 3(1.61%)presacral SLNs.5.A total of 12 positive SLNs was identified in 4 patients of endometrioid adenocarcinoma,including 5 right external iliac SLNs,4 left obturator SLNs,1 left external iliac SLN,1 right obturator SLN and 1 right internal iliac SLN.Among the 4 patients with positive SLN,two patients were stage ⅢC1 and two patients were stageⅢC2.6.26 patients had negative SLNs and negative pelvic/para-aortic lymph nodes(PLNs),4 patients had positive SLNs and positive PLNs,1 patients had negative SLNs and positive PLNs.Overall,the sensitivity and NPV of the SLN mapping was 80.00%and 96.30%respectively.7.There was no cervical injection related or tracer related adverse events,such as fever,allergy and injuries of blood vessels,nerves and organs.Conclusions1.Carbon nanoparticles suspension is a kind of safe and effective SLN tracer for endometrial carcinoma.Cervical injection owns high success rate and reproducibility,it is useful and validated mapping technique.2.The number,distribution and metastasis of SLN reflect the main lymphatic drainage pattern of endometrial carcinoma.3.SLN mapping in endometrial carcinoma surgery has relatively high SLN detection rate,sensitivity and NPV.SLN mapping can effectively predict the lymph nodes status and owns safety and feasibility.