| Objective:Detecting the effect of carbon nanoparticles tracking sentinel lymph node(SLN)during the operation of uterine cancer.To study the predictive value of the technology what the sentinel lymph node was trackd by carbon nanoparticles(CNP)for lymph node metastasis in patients with uterine cancer(cervical cancer and endometrial cancer),so as to explore the feasibility of this technology in the guidance of intraoperative lymphadenectomy in patients with uterine cancer.Method:84 patients who were admitted to the gynaecology of the First Affiliated Hospital of Dalian Medical University,and confirmed pathologically as uterine cancer from October 2016 to January 2020.Including 59 cases of cervical cancer and 25 cases of endometrial cancer.After general anesthesia,all patients were injected 0.5ml of carbon nanoparticles suspension into the cervix by transvaginal.During the operation,the operation field of pelvic and abdominal cavity was explored.The locations of sentinel lymph nodes were recorded,and all sentinel lymph nodes and non sentinel lymph nodes were examined pathologically during and/or after operation to further confirm the presence of carbon nanoparticles stained lymph nodes and cancer metastasis.The statistical analysis software SPSS 25.0 was used to analyze the data.The detection rate,false negative rate,negative predictive value of sentinel lymph nodes were statistically described.Count date were expressed by rate.Logistic regression analysis was used in univariate analysis.The comparison of the rates was by Chi-square(?~2)test or Fisher's accurate probability method,and paralleling consistency Kappa test,P < 0.05 was considered statistically significant.Results:1.In all 59 cases of cervical cancer,pelvic lymphadenectomy was performed,and only 7 cases underwent para-aortic lymphadenectomy at the same time.The number of SLN cases with carbon nanoparticles staining and confirmed by postoperative pathology was41,the total detection rate was 69.49%(41/59),in which the detection rate of pelvic SLN was 69.49%(41/59),and the detection rate of para-aortic SLN was 42.86%(3/7).Similarly,pelvic lymphadenectomy was performed in 25 patients with endometrial cancer,and only 9 patients underwent para-aortic lymphadenectomy at the same time.The number of SLN cases with carbon nanoparticles staining and confirmed by postoperative pathology was 16,the total detection rate was 64%(16/25),the detection rate of pelvic SLN was 64%(16/25),and the detection rate of para-aortic SLN was55.56%(5/9).2.Confirming by pathology,1802 lymph nodes were resected in 59 patients with cervical cancer,with an average of 30.54 lymph nodes per person.1306 lymph nodes were resected in 41 cases of successful carbon nanoparticles imaging,of which 505 were SLNs,accounting for 38.67%(505/1306),and the average SLN per person was12.32(505/41).It was mainly located in the region of obturator,internal iliac(34.65%)and external iliac(33.27%).A total of 532 lymph nodes were removed from 25 patients with endometrial cancer,with an average of 21.28 lymph nodes per person.410 lymph nodes were resected in 16 patients of successful imaging with carbon nanoparticles,of which 151 were SLNs,accounting for 36.83%(151/410),and the SLN per person was9.44(151/16),It was mainly located in the common iliac region(29.14%)and the external iliac region(28.48%).3.Confirming by pathology,among 41 cases of cervical cancer successfully traced by carbon nanoparticles,8 cases had lymph node metastasis,of which 6 cases had SLN metastasis.So the negative predictive value of sentinel lymph node biopsy in cervical cancer patients was 94.29% [33/(2+33)],the false negative rate was 25%(2/8),and the accuracy was 95.12% [(6+33)/41].In 16 cases of endometrial carcinoma successfully traced by carbon nanoparticles,only one case had lymph node metastasis,which occurred in SLNs.So,the negative predictive value of sentinel lymph node biopsy in endometrial cancer patients was 100%(15/15),the false negative rate was 0(0/16),and the accuracy was 100%(16/16).4.Analyze the consistency of SLN and pelvic cavity and abdominal cavity lymph node metastasis in cervical cancer patients,the Kappa value was 0.828,P<0.001.Therefore,SLN of cervical cancer was highly consistent with lymph node metastasis in pelvic and abdominal cavity.Analyze the consistency of SLN and lymph node metastasis in patients with endometrial cancer,the Kappa value was 1.000,P<0.001.Therefore,The SLN of endometrial carcinoma was identical with the lymph node metastasis of pelvic cavity and abdominal cavity.Conclusions:1.Cervical injection of carbon nanoparticles suspension to trace the sentinel lymph nodes in patiens with cervical cancer and endometrial cancer has a high detection rate and accuracy,and its clinical application is safe,effective and feasible.2.Sentinel lymph nodes of cervical cancer patients and are endometrial cancer patients mostly located in the region of obturator,internal iliac,external iliac and general iliac.It is highly consistent with the real status of retroperitoneal lymph node metastasis.3.Sentinel lymph node detection has a good predictive value for the retroperitoneal lymph node metastasis in patients with uterine cancer. |
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