Application Of Sentinel Lymph Node Tracing In Early Endometrial Cancer

Objective:To systematically evaluate the feasibility and effectiveness of sentinel lymph node mapping(SLNM)technology in early endometrial cancer(EC).SLNM and comprehensive staging surgery were performed on patients with early endometrial cancer to evaluate the clinical significance of sentinel lymph node mapping technology in endometrial cancer,and pathological ultra-staging technology was used to further evaluate the clinical significance of sentinel lymph node(SLN)for clinical value of identifying metastatic lymph nodes.Method:(1)The databases Pub Med,Cochrane Library,Wanfang,CNKI were searched to retrieve prospective research studies on the application of SLN detection in diagnosis of lymph node metastasis in EC from incept to December 31,2019,and data were analyzed using Revman5.3 and Meta-Di Sc1.4.(2)Patients with early endometrial cancer who underwent laparoscopic staging surgery at the Department of Gynecology and Oncology,Liuzhou Workers’Hospital from February 2018 to December 2019 were selected as the research subjects.All patients were diagnosed by diagnostic curettage+pathological examination before operation.For all patients who met the inclusion criteria,carbon nanoparticles or(and)indocyanine green was used as a tracer injection in the cervix,followed by complete surgical staging.The influencing factors of the imaging effect were analyzed statistically.According to the intraoperative findings and postoperative pathology,the detection rate,accuracy,sensitivity,false negative rate,and negative predictive value were calculated in accordance with the University of Louisville standards.(3)Screening for high-risk factors inpatients with early endometrial cancer treated in the Department of Gynecology and Oncology of Liuzhou Workers’Hospital from March 2019 to December 2019,prospective studies were performed on these patients.High-risk factors including age≥60 years,deep muscular infiltration(>1/2),lymph-vascular invasion,the lesion larger than 2 cm in diameter,poor differentiation,and special pathological types(serous adenocarcinoma,clear cell adenocarcinoma and carcinosarcoma).All sentinel lymph nodes specimen were collected.Subsequent serial section+cytokeratin immunohistochemical staining histopathologically studied were performed.Calculate the detection rate,accuracy,sensitivity,false negative rate,negative predictive value and other indicators.Results:(1)35 Chinese and English literatures were included,and a total of 2746 patients with endometrial cancer were included.The total detection rate of sentinel lymph nodes in endometrial cancer did not have a threshold effect between the included studies,and there was moderate heterogeneity(I~2=47%).The heterogeneity caused by non-threshold effects was not statistically significant.The combined detection rate of combined analysis was 93%(95%CI 92%～94%),and the combined bilateral detection rate was 68%(95%CI 62%～74%).Combined sensitivity was 90%(95%CI 87%～93%),specificity was 100%(95%CI100%～100%),AUC=0.9958,Q*=0.9752.A subgroup analysis found that the detection rate of cervical injection and combined injection was significantly higher than that of uterine injection;the detection rate of sentinel lymph node combined with two or more tracers was not significantly different from that of single tracer.(2)The study finally included 103 patients,and 99 patients(96.12%)successfully detected at least one sentinel lymph node,of which 83.50%(86/103)were bilateral imaging and 12.62%(13/103)were unilateral imaging.96 cases(96.97%,96/103)were identified pelvic SLNs only.The imaging rate of para-aortic lymph nodes was 3.03%(3/103),and 3.88%(4/103)were both detected in pelvic and para-aortic lymph nodes.The most developed area was the obturator region.Age,BMI,pathological type,lesion size,depth of myometrial invasion,LVSI,tumor differentiation,type of tracer,and whether there were high-risk factors had no statistically significant differences on the detection rate(P>0.05).There were 3false negatives,false negative rate was 42.86%,the accuracy was 96.97%,the sensitivity was 57.1%,the specificity was 100%,and the negative predictive value was 96.84%.Combined with the ultrastaging results,the false negative rate can be reduced to 14.29%,the accuracy is 98.99%,and the negative predictive value is 98.92%.(3)A total of 29 patients were included.All cases successfully detected at least one sentinel lymph node.The detection rate was 100%,of which 82.76%(24/29)were bilateral imaging.The main development site is the obturator region.Pathological examination of 29 patients revealed a false negative pathology.The patient had metastatic lesions in the para-aortic lymph nodes,but the sentinel nodes were negative,that is,96.55%(28/29)patients with lymph node metastases could be correctly identified.After the ultrastaging pathological examination,the false negative rate dropped to 0,and the negative predictive value was 100%.Conclusion:Our study shows that sentinel lymph node technology is safe and effective in the evaluation of lymph nodes in early endometrial cancer.In particular,combined with ultrastaging technology can improve the detection rate of lymph node metastases in endometrial cancer.However,there is still a need to expand the sample size to further clarify the application of sentinel lymph node technology.