Clinical Study Of Sentinel Lymph Nodes Detection Guided Radical Abdominal Trachelectomy For Stage â…  B1 Cervical Non Squamous Cell Carcinoma

Objectives:The aim of the study was to evaluate the clinical value of sentinel lymph nodes(SLN) in prediction of the pelvic lymph nodes status for stage Ⅰb1 cervical non squamous cell carcinoma and approach the clinical significance of SLN detection for guiding radical abdominal trachelectomy (RAT).Methods:The review analysis on 18 patients with FIGO stage Ⅰb1 cervical non squamous cell carcinoma in Shandong Cancer Hospital and Institute from June 2005 to June 2014. Isotope 99mTc-labeled phytate of 2ml was injected into cervix at 3、6、9、12 clock positions to mark pelvic lymph nodes before operation, The radioactivity reached 5 times higher than that in the ipsilateral nodes were determined SLN. SLN were identified by gamma detector and were excised in situ, and meanwhile, bilateral ovarian biopsy was performed in operation. SLN and resection of ovarian tissue were sent to frozen section pathological examination immediately in operation. After confirming pelvic lymph nodes and ovarian tissue no metastasis by utilizing fast frozen biopsy in operation, the RAT was performed. After operation, the pelvic lymph nodes and SLN were embedded using paraffin to make routine pathological examination and anti-cytokeratin immunohistochemistry examination.Finally, the amount of bleeding, operation time and complications were observed to assess the safety and reliability of RAT in patients with stage Ⅰb1 cervical non squamous cell carcinoma.Results:SLN were detected in all patients(100%,18/18). The number detected SLN was 66 with an average 3.7 per patient. SLN of 2 patients (11.1%) were positive on frozen sections and switched RH,the other16 patients with negative SLN underwent RAT successfully. The anti-cytokeration immunohistochemistry examination did not check out the missed micro metastasis foci by HE staining pathological examination in SLN and pelvic lymph nodes. The sensitivity, specificity, negative predictive value,the false negative rates were 100%,100%, 100%,0, respectively.The fast frozen pathology results all corresponded to that of postoperative pathological examination(18/18,100%). Preoperative and postoperative complications were seen in 7 cases. Preoperative complications occurred in 7 patients including 2 cases of uterine artery injury and 1 case of bladder injury. Pelvic lymphatic cyst was seen in 4 cases after operation.5 patients with procreative desire conceived 2 pregnancies (2spontaneous abortion) after surgery. Two relapses occurred and all died of tumor progression during follow-up. The recurrence rate was 12.5%. Overall survival was 32 months and 37 months, the other 14 patients were disease free survival during follow-up.Conclusions:SLN detection has a certain value for judging pelvic lymph nodes metastasis in patients with stage Ibl cervical non squamous cell carcinoma and RAT under the guidance of SLN detection is safe and reliable for the young patients who wish to keep the fertility ability.