| Objective: The aim of this study is to investigate the feasibility of SLN(sentinel lymph node)mapping and its distribution in cervical and uterine malignant tumors by cervical injection of different doses of ICG(Indocyanine Green)or methylene blue.The correlations between the detection of SLN and clinicopathologic characteristics are analyzed and the clinical value of SLN ultrastaging is also evaluated.Materials and Methods: Ninety patients with cervical and uterine malignant tumor were assessed for eligibility.A total of 2 ml or 4 ml of1.25 mg/ml ICG or 1% methylene blue was injected to uterine cervix at 3and 9 o'clock respectively.A laparoscopic system was used to identify the SLN,or the dye can be observed with the naked eye,and the developing time and distribution areas of SLN were recorded.Radical hysterectomy or hysterectomy plus systematic bilateral pelvic lymphadenectomy were performed in all patients.Then the number of total lymph nodes,the number of SLN and SLN detection rate were calculated according to H&E staining after operation.The sensitivity,negative predictive valueand its relationships with clinicopathologic features were analyzed as well.Finally,49 cases with negative SLN were randomly selected to examine by ultrastaging,including serial sectioning,H&E staining and IHC(Immunohistochemistry)with CK,Ki-67 and P16 as antibodies.Results: The average developing time of SLN was 5.2±0.9min.The mean number of lymph nodes was 24.9±7.3,and the average amount of SLNs was 3.7±2.4.The mean number of SLNs for group of ICG(4.6±2.3)was more than that of methylene blue(3.0±2.3),p<0.01,and their degree of dispersion were similar.The average amount of SLNs of group for 2ml(2.6±1.5)was lesser than that of 4ml(4.8±2.7),p<0.01,but the discrete degree was higher for group of 4ml instead.The lymph node metastasis rate was 13.6%(6/44)in cervical cancer and 4.3%(2/46)in uterine neoplasms.The total,bilateral and unilateral SLN detection rate were82.9%(149/180),72.2%(65/90)and 93.3%(84/90),respectively.Calculated on a per side basis,the sensitivity of SLN biopsy was 100%(8/8),the specificity was 92.7%(76/82),the accuracy was 100%(82/82),the false negative rate was 0%(0/0),the negative predictive value was100%(76/76),the positive predictive value was 100%(8/8).Among all the detected sites of SLN,the most common SLN was distributed in the external iliac lymph node 57.0%(85/149),followed by the obturator20.8%(31/149),the internal iliac 16.8%(25/149)and the total iliac lymph node 6.7%(10/149).Two patients had the para-aortic SLN,andone patient had a prescral SLN.The outcomes of SLN detection were not affected by learning curve,surgical approach,disease groups,risk factors,or junction of the lower uterine segment and endocervix involvement and tumor size in cervical malignant tumor,all p>0.05.In selected 49 patients with negative routine H&E staining SLN,the results of ultrastaging showed negative IHC staining in all cases and no micrometastasis or isolated tumor cells were found,its detection rate was 0%.Conclusions: SLN mapping in cervical and uterine malignant tumor is feasible and safety.SLN detection rate is significantly higher using ICG fluorescence compared with methylene blue staining.Injection with2 ml tracer is more suitable for obtaining SLN than 4ml,which suggests that appropriate dose of tracer may control the tracer diffuse to next lymph node station.Ultrastaging in patients with negative routine H&E staining SLN does not increase the detection rate of micrometastasis and isolated tumor cells.The most common distribution of SLN is the external iliac,the obturator and the internal iliac lymph node.No associations between outcomes of SLN detection and clinicopathologic characteristics were found. |
PDF Full Text Request