The Clinical Significance Of Sentinel Lymph Node In Early Cervical Cancer

Objectives: Cervical cancer is the most common malignancy in gynecology.In recent years,the incidence of cervical cancer has gradually increased and it has become younger.The concept of sentinel lymph node has promoted the new progress in the diagnosis and treatment of early cervical cancer.This study aims to explore the feasibility and accuracy of SLN detection in the tracing of SLN by using methylthioninium chloride as a lymph tracer and to investigate the distribution regulations and clinical value of SLN pelvic cavity in early cervical cancer.Methods: From July 2016 to July 2017,the Department of Obstetrics and Gynecology of yijishan Hospital,Wannan Medical College was selected to perform laparoscopic extensive hysterectomy and pelvic lymph node dissection(and para-aortic lymph node dissection).Of the 49 patients with early cervical squamous cell carcinoma,FIGO stage was IA2 to IIA2.After successful general anesthesia,1.0 ml of methylthioninium chloride was injected into the cervix at 3,6,9 and 12 o'clock popsitions,respectively.Routine laparoscopic surgery was performed after the injection.The lateral and posterior peritoneum were opened after the operation.The blue-stained lymph nodes were identified as SLNs,and the labeling sites were bagged,followed by systematic pelvic lymphadenectomy(and para-aortic lymph nodes dissection).and extensive hysterectomy.Then the specimens were removed for examination of routine pathology.The SLN detection rate,accuracy,sensitivity,false-negative rate and negative predictive value were calculated according to SLN intraoperative identification and postoperative pathological conditions,and statistical analysis was performed.Results: In 49 cases of early cervical squamous cell carcinoma,1,718 lymph nodes were completely removed,of which 40 cases(81.63%,40/49)successfully detected at least one SLN,321 in total.Among them,30 cases(61.22%,30/49)successfully detected bilateral SLN,and 10 cases(20.41%,10/49)detected unilateral SLN.Among the SLN cases detected,1 case had pathological metastasis of SLN,NSLN also had metastasis,5 cases had SLN metastasis,and NSLN had no metastasis.Among the cases without SLN,there were 3 cases of pelvic lymph node pathology metastasis.Therefore,The specificity of SLN detection was 85%(34/40),sensitivity was 66.67%(6/9),accuracy was 100%(6+34/40),false negative rate was 33.33%(3/9),the negative predictive value was 91.89%(34/37)and the positive predictive value was 100%(6/6).The most common site of SLN is in obturator area,accounting for 55.45%(178/321),followed by external iliac area(20.25%,65/321),common iliac area(14.02%,45/321)and internal iliac area(6.85%).(22/321),rare in the inguinal region(1.87%,6/321)and in the parametrium(1.56%,5/321).Among 49 cases,8 cases received NACT before operation,3 cases successfully were detected SLN,and the detection rate was 37.50%.Among 41 cases without NACT,SLN was detected in 37 cases.The rate is 90.24%.The detection rate of SLN without NACT was significantly higher than the SLN detection rate after NACT,P <0.05.It was considered statistically significant.Preoperative NACT could affect SLN detection rate,and NACT decreased the detection rate of SLN.Of the 49 patients,there were 32 cases with FIGO stage Less than or equal to IB2 stage,of which 27 cases successfully detected SLN,the SLN detection rate was 84.38%(27/32),17 cases with FIGO stage> IB2 stage,13 cases were successfully examined.So the detection rate of SLN was 76.47%(13/17),that is,the detection rate of SLN in FIGO stage Less than or equal to IB2 was higher than that in FIGO stage over IB2 stage,but P is over 0.05,the statistical analysis was performed between them.no statistical significance.It is considered that FIGO staging of cervical cancer has no effect on the detection of SLN.Among all the 49 cases,there were 27 cases with tumor diameter Less than or equal to Less than or equal to 2cm,and SLN was successfully detected in 24 cases.here were 22 cases with tumor diameter over 2cm,The detection rate was 88.89%.SLN was successfully detected in 16 cases.72.73%,so the tumor diameter over 2cm reduce the detection rate of SLN,but the statistical processing between the two detection rates,P is over 0.05,no statistical significance.It is believed that the size of the tumor has no effect on the detection rate of SLN.Of the 40 SLN cases detected,6 had SLN pathological metastases,1 had NSLN metastases,and the remaining 5 had no metastasis.SLNs In the case of pelvic lymph node metastasis,the SLN were all metastasized,and SLN could predict the pelvic lymph node metastasis.Among the 9 cases without SLN detected,3 cases showed pelvic lymph node metastasis.The 3 cases all were FIGO stage over IB2 stage and the tumor diameter were over 2 cm.Of the 49 patients,9 were in the high-risk group,of which 6 were found to have SLN.The detection rate of SLN was 66.67%(6/9).In the intermediate-risk group,12 cases were detected.SLN was detected in 10 cases.The detection rate was 83.33.%(13/17),There were 28 cases in the low-risk group,and SLN was detected in 24 cases.The detection rate was 85.71%(24/28).Therefore,the detection rate of SLN in the low-risk group was the highest,and the detection rate of SLN in the high-risk group was the lowest.Statistical analysis was performed among the three detection rates,P>0.05.There was no statistical significance.The risk factors of cervical cancer had no effect on the detection rate of SLN.Conclusion: In patients with early cervical squamous cell carcinoma,methylene blue was used as a lymph tracer.The detection rate was 81.63%,and the specificity were 85.00%,,sensitivity were 66.67%,,and accuracy were 100%,.the false negative rate was 33.33%,and the negative predictive value was 91.89%,positive predictive value was 100%.The main distribution site of SLN was obturator,followed by external iliac area and common iliac area and internal iliac area.It was rare in inguinal region and parametrium tissue.About the detection of SLN in early cervical cancer,NACT reduced its detection rate,with statistical significance;FIGO staging is less IB2 phase,tumor diameter Less than or equal to 2cm is conducive to the detection of SLN,and lower risk factors are conducive to the detection of SLN but statistically meaningless.In clinical application,SLN tracing can be used to predict pelvic lymph node metastasis and determine the individualized surgical treatment plan.