Application Value Of Sentinel Lymph Node Mapping In Endometrial Cancer Surgery

Objective:To select methylene blue as a lymph node tracer for sentinel lymph node(SLN)mapping in endometrial cancer surgery,and to explore the application value of SLN mapping technology in endometrial cancer surgery and the feasibility of using methylene blue as a lymph node tracer,so as to provide reference for primary hospitals to carry out SLN mapping technology in endometrial cancer surgery.Methods:From October 1,2018 to December 31,2020,40 patients with endometrial cancer diagnosed by pathology in the Department of Gynecology,people’s Hospital of Guangxi Zhuang Autonomous Region were selected.All patients underwent standard staging surgery through laparoscopic approach.After general anesthesia,2.5ml diluted methylene blue solution was injected at 3and 9 points of the cervix for SLN tracing.The area and number of SLN were explored during the operation,and then all the other pelvic lymph nodes were sent for pathological examination.Statistical analysis was used to describe the detection rate,accuracy,sensitivity and negative predictive value of SLN.T test,rank sum test and X~2test were used for different types of data;Kappa test was used to test the consistency of transfer,and the test level was set as P<0.05.Results:1.Among the 40 patients with endometrial cancer,31 patients could detect at least one SLN,and the total detection rate of SLN was 77.5%.SLN could be detected simultaneously in 19 patients with bilateral pelvis,and the bilateral detection rate of SLN was 47.5%.SLN was detected only in one pelvis in 12 patients,and the unilateral detection rate of SLN was 30.0%.2.Postoperative pathological examination showed that SLN was positive in3 of 31 patients with endometrial carcinoma,and pelvic lymph node was positive in 1 patient.The positive rate of SLN was 9.68%,the accuracy was96.77%,the sensitivity was 75%,and the negative predictive value was 96.43%.3.A total of 87 SLNs were detected in 40 patients with endometrial cancer,41.38%of which were located in the external iliac artery region,40.23%in the obturator region,and the rest were located in the common iliac region,the internal iliac region,and the presacral region.4.Kappa test was used to evaluate SLN and pelvic lymph node metastasis in patients with endometrial cancer,and the results were highly consistent(kappa=0.839,P<0.001).Conclusions:1.Methylene blue has high accuracy and negative predictive value in SLN tracing of endometrial carcinoma;2.SLN was mainly distributed in the external iliac artery and obturator area;3.In the form of Medical Union,it is safe and feasible for primary hospitals to use methylene blue to carry out SLN mapping technology of endometrial cancer.