| ObjectiveThis study was designed to investigate the use of indolecyanine as a tracer in sentinel lymph nodes in laparoscopic surgery for common early uterine malignancies(cervical cancer and endometrial carcinoma).To explore the method and feasibility of using sentinel lymph node biopsy in retroperitoneal lymph node resection of early uterine malignant tumor,to evaluate the forecasts accuracy of the SLN for retroperitoneal lymph node status for early uterine malignancy.MethodsTwenty-one cases of early uterine malignancies were selected,including 13 cases of early cervical cancer and 8 cases of endometrial carcinoma.At the beginning of the operation,a cervical injection with indocyanine green was injected at 3 and 9 o'clock.The earliest high-level fluorescent signal lymph nodes as SLN under the direct vision of laparoscope and removed,to send frozen and routine pathological examination.Continue to laparoscopic(radical)hysterectomy + bilateral salpingo/oophorectomy+ retroperitoneal lymphadenectomy ± omentumectomy.The location,time,number,frozen and conventional pathological results of SLN were recorded in all patients.The location,number and pathological results of all retroperitoneal lymph nodes were recorded.Results1.Twenty-one patients of early uterine malignancies were removed a total of 889 retroperitoneal lymph nodes,with an average of 42.3 cases each excision.2.Of the 21 patients with early uterine malignancy,20 patients had successfully detected at least one SLN,and 36 sides were detected,with a total detection rate of 85.7%(36/42).Of the 20 patients who had successfully detected SLN,94 SLNs were detected and 1-6 of SLN were detected on one side.On average,2.6 SLNs were detected on each side.In patients with cervical cancer,SLN was distributed in 26 cases of obturator lymph nodes,accounting for 40.1%(26/65);21 external iliac lymph nodes,accounting for 32.3%(21/65);9 iliac common lymph nodes,accounting for 13.8%(9/65)and 9 internal iliac lymph nodes,accounting for 13.8%(9/65).In patients with endometrial carcinoma,SLN was distributed in 13 cases of external iliac lymph nodes,accounting for 44.8%(13/29);12 iliac common lymph nodes,accounting for 41.4%(12/29)and 4 internal iliac lymph nodes,accounting for 13.8%(4/29).94 SLNs were sent in the frozen pathological examination,including two SLNs positive,one for the endometrial serous adenocarcinoma of the external iliac lymph nodes,one for the cervical squamous cell carcinoma of the iliac common lymph nodes.The results of frozen pathology were consistent with those of conventional pathological results.3.Of the 20 patients successfully diagnosed with SLN,the SLN development time was 2-19 minutes,averaging 8.9 minutes.4.In this study,the accuracy of SLN detection was 100.0%(20/20),the false negative rate was 0,the sensitivity was 100.0%(2/2),the specificity was 94.7%(18/19),the positive predictive value was 100.0%(2/2)and the negative predictive value was 100.0%(18/18).5.There was no significant correlation between the detection rate of sentinel lymph nodes and the diameter of the tumor,the depth of the invasion,the type of pathology,the degree of histodifferentiation and whether invasion of vascular tumor thrombus.Conclusions1.Early uterine malignancy after a cervical injection with indocyanine green tracer laparoscopic sentinel lymph node mapping has a high detection rate and accuracy,is a more safe and feasible method.2.Sentinel lymph nodes in cervical cancer often appear in the obturator and external iliac lymph nodes.Endometrial carcinoma sentinel lymph nodes most often appear in the external iliac lymph nodes.The true metastatic status of retroperitoneal lymph nodes has a high consistency,for the diagnosis of lymph node metastasis of the higher diagnostic performance.3.There was no significant correlation between the detection rate of sentinel lymph nodes and the diameter of the tumor,the depth of the invasion,the type of pathology,the degree of histodifferentiation and whether invasion of vascular tumor thrombus. |
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