| Objective: The aim of this study was to analyze the distribution,detection rate and false negative rate of the Sentinel Lymph nodes(SLN)in early cervical cancer under laparoscopy,evaluate the sensitivity and negative predictive value of SLN,and explore the feasibility and value of SLN mapping technology in the application of early cervical cancer.Methods: 78 cases of cervical cancer patients were collected from July 1,2015 to December 31,2018 at the Fourth Hospital of Hebei Medical University.All the patients were injected with tracer materials into the cervix at 3 and 9 points after anesthesia.All patients including underwent SLN mapping followed by complete pelvic lymphadenectomy.Moreover,all the lymph nodes resected were stained with hematoxylin eosin staining(HE)pathological examination.Besides,the negative SLNs on hematoxylin-eosin staining were detected by immunohistochemistry cytokeratin staining(CK)micrometastasis.SPSS21.0 statistical software was applied.The detection rate and false negative rate were described.Enumeration data were analyzed by chi square test or Fisher exact probability method,and the consistency of Kappa test.P-values <0.05 were considered statistically significant.Results:1 The overall detection rate of SLN in cervical cancer was 98.7%(77/78),bilateral detection rate was 87.2%(68/78),sensitivity was 100%(14/14),accuracy was 100%(77/77),false negative rate was 0(0/14),and negative predictive value was 100%(63/63).2 A total of 1930 lymph nodes were resected in 78 patients with cervical cancer,with an average of 24.74 lymph nodes resected each person.SLN was detected in 77 patients,and a total of 494 SLNs were resected,accounting for 25.6%(494/1930)of the total lymph nodes,with an average of 6.33 SLNs resected each patient.A total of 1436 NSLNs were resected,accounting for 74.4%(1436/1930)of the total lymph nodes,and an average of 18.41 NSLNs were resected each person.3 SLN of cervical cancer was mainly distributed in the Obturator space of(61.5%,343/494),followed by External iliac(23.5%,131/494),Common iliac(7.3%,41/494),Parauterine(3.8%,21/494),Internal iliac(2.2%,12/494),Para abdominal aorta(1.3%,6/494)and Anterior sacral lymphatic drainage area(0.7%,4/494).4 Above all 78 patients with cervical cancer,there were 14 cases of lymph node metastasis,a total of 38 positive LNs,including 24 SLNs metastasis and 14 NSLNs metastasis.1 SLN was found to be isolated tumor cells(ITC),and 5 SLN was found to be Micrometastases(MIC).Only micrometastasis was detected in 2 cases,and the sensitivity increased from 85.7%(12/14)to 100%.Metastatic SLNs mainly distributed in the Obturator space(70.8%,17/24),Periuterine region(12.5%,3/24),Common iliac region(16.7%,4/24),and External iliac region(8.3%,2/24).5 The relationship between SLN and retroperitoneal lymph node metastasis in cervical cancer was analyzed.The kappa value was 1.000,P<0.001.Conclusions:1.Reliable SLN detection rate,sensitivity and negative predictive value were obtained by intraoperative SLN mapping recognition,and age,BMI,LVSI,tumor size,and preoperative neoadjuvant chemotherapy did not affect the SLN detection rate.2.SLN of cervical cancer is mainly located in the obturator region and the external iliac region,with a few cases of jump metastasis to the abdominal aorta region.3.The sensitivity of SLN micrometastasis was improved by pathologica ultra-staging detection.SLN mapping combined with pathologica ultra-staging detection can help to more accurately determine the status of pelvic lymph nodes.4.Intraoperative SLN mapping is safe and feasible for patients with early-stage cervical cancer. |
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