Application Of Carbon Nanoparticles Tracing Of Sentinel Lymph Nodes In Endometrial Cancer With High Risk Factors

purpose:To evaluate the detection rate（DR）,sensitivity（SEN）,specificity（SPE）,negative prediction（NPV）,and false-negative rate（FNR）of carbon nanoparticles cervical injection in the detection of sentinel lymph nodes（SLN）in endometrial cancer with high-risk factors,and to study the predictive value of sentinel lymph node biopsy on pelvic lymph node status in endometrial cancer patients with high-risk factors.Methods:Thirty patients with high-risk factors who attended the Department of Gynecology,Second Hospital of Jilin University for surgical treatment of endometrial malignancy from December 2020 to December 2021 were selected.Before the start of the procedure,3 and 9 points of the cervix are selected as injection points and 1 ml of nanocarbon suspension is injected superficially（1-3 mm）combined with deep（1-2cm）in the cervix.all enrolled patients underwent full staging surgery.The posterior peritoneum is opened.the black stained lymph nodes are regarded as sentinel lymph nodes and the non-black stained lymph nodes as Non-sentinel lymph nodes（NSLN）.The number and location of the SLNs are recorded and sent for pathological examination separately,while the rest of the specimens are sent for routine examination.Results:1.A total of 30 patients with a mean age of 56.77±8.99 years（29-74）and a median body mass index（BMI）of 24.76 kg/m2（20.28-33.38）were included in this study.Pelvic Lymph Node Dissection（PLND）was performed in all 30 patients.In addition,10 patients with specific pathological types（plasmacytoma in 5 cases,carcinosarcoma in 3 cases,clear cell carcinoma in 1 case and undifferentiated carcinoma in 1 case）underwent para-aortic lymph node dissection（PALND）.According to the International Federation of Gynecology and Obstetrics（FIGO）2018endometrial cancer staging,there were 4 cases of stage IA,8 cases of stage IB,3cases of stage II,3 cases of stage IIIA,2 cases of stage IIIB and 10 cases of stage IIIC1.According to the pathological findings,There were 20 cases of endometrioid carcinoma,of which 12 were highly differentiated,3 were moderately differentiated and 5 were hypofractionated and there were 9 cases of interstitial cervical infiltration,12 cases of lymphatic vascular infiltration,22 cases with a tumour diameter of 2 cm and 24 cases of deep muscular infiltration.2.Of the 30 patients included,SLN was successfully visualized in 27 cases,with a DR of 90.0%（27/30）for SLN,3 cases of failed visualization,4 cases of unilateral visualization,13.3%（4/30）for unilateral DR,and 23 cases of bilateral visualization,76.7%（23/30）for bilateral DR.11 pelvic lymph node metastases in 30 patients,including 10 SLN metastases and one unsuccessful visualization but postoperative confirmation of pelvic lymph node metastases.Of the 10 patients with SLN metastases,5 had SLN metastases only and 5 had both SLN and NSLN metastases;17had no metastases in either SLN or NSLN.The SLN predicted pelvic lymph nodes with a Sensitivity（Sen）of 90.9%（10/11）,Specificity（Spe）of 89.5%（17/19）,Accuracy（Ac）of 100.0%（10+17/27）,Negative predictive value（NPV）100%（17/17）and false-negative rate（FNR）0%.The magnetic resonance prediction of the depth of myxomatous infiltration of endothelial carcinoma was 91.6% for Sen,100% for Spe,and 75.0% for NPV.3.A total of 758 pelvic lymph nodes were detected,of which 138（18.2%）were SLN and 620（81.8%）were NSLN.The SLNs were distributed in 36（26.08%）in the foramen occulta,27（19.57%）in the internal iliac region,56（40.58%）in the external iliac region and 19（13.77%）in the common iliac region,with no anterior abdominal aortic sentinel lymph nodes visualized.4.SLN visualization failure was associated with cervical infiltration（p=0.021）,but not with age,BMI,tumor size,myxomatous infiltration,or lymph-vascular space invasion（LVSI）（p>0.05）.Lymph node metastasis was correlated with LVSI（p=0.009）and there was no correlation with high risk factors such as depth of myxomatous infiltration,degree of differentiation,size of tumor,histology,age,and cervical infiltration（p>0.05）.Conclusion:1.Nanocarbon is safe and feasible in endometrial cancer with high-risk factors2.SLN visualization failure was shown to be associated with cervical infiltration in this study.Lymph node metastasis was correlated with LVSI.SLN is most commonly seen in the closed foramen and external iliac lymph nodes.3.SLN status had high concordance with pelvic lymph node status.SLN has a high clinical value for assessing pelvic lymph node status in endometrial cancer with high risk factors.4.Combination of 3 or more high risk factors predisposes to pelvic lymph node metastases...