| Objective: Analyze the clinical application value of sentinel lymph node mapping in early stage uterine malignant tumors with three-point and nine-point injection(cervical cancer uses shallow injections and endometrial cancer uses deep and shallow injections)of different tracers(methylene blue,indocyanine green(ICG)and nano-carbon suspension);Validation confirmed whether sentinel lymph node(SLN)can predict the accuracy of retroperitoneal lymph node tumor metastasis;explore whether sentinel lymph node biopsy(SLNB)can replace traditional systemic retroperitoneal lymph node resection,To provide data for the industry to formulate new standards;to explore relevant factors that affect the results of SLN detection.Methods: Strictly according to the inclusion and exclusion criteria,199 patients with uterine malignant tumors admitted to the Department of Gynecology,Guilin Medical College Affiliated Hospital from January 2018 to September 2020 were selected as the research objects.All patients were diagnosed by histopathology before surgery and operated through the approach.All selected laparoscopic extensive hysterectomy/total hysterectomy + bilateral salpingectomy ± bilateral oophorectomy + pelvic lymphadenectomy±abdominal aortic lymphadenectomy,randomized selection of tracer for SLN mapping,press use The tracers are divided into methylene blue group,ICG group and nano carbon group.During the operation,the tracer was injected at the 3 o’clock and 9 o’clock positions of the cervix(shallow injection for cervical cancer and combined deep and shallow injection for endometrial cancer),the dose was 1ml,and the developed SLN was taken and sent for separate biopsy.The pathological results are subject to the results of routine HE staining pathological examination and immunohistochemical examination(IHC)after surgery.Record the total number of lymph nodes resected,the number,location,imaging time and pathological results of sentinel lymph nodes,and determine the metastasis of sentinel lymph nodes to retroperitoneal lymph nodes by analyzing indicators such as sentinel lymph node visualization rate,sensitivity,false negative rate and negative predictive value The accuracy of the state assessment.At the same time,the relevant factors affecting the detection of SLN are analyzed.Results: Among 199 patients,a total of 168 patients had at least one SLN detected,with a total detection rate of84.4%,of which the unilateral detection rate was 54.2%,and the bilateral detection rate was 45.8%.A total of 567 SLNs were removed,with an average of The number of excisions in each patient was 2.9.The detection rates of SLN in the nanocarbon group and ICG group(95.7% and 95.5%)were higher than those in the methylene blue group(75.0%),and the number of SLN detected in the nanocarbon group and ICG group(3.0(2.0,4.0))And 4.0(3.0,6.0))were also more than the methylene blue group(2.5(1.0,4.0)).The development time of SLN ranged from 1 to 9.5 minutes,with an average of 5.5 minutes.There was no difference between the three groups.The lymph node metastasis rates of cervical cancer and endometrial cancer were 4.8%(4/84)and 7.0%(8/115),respectively.The sensitivity is 83.3%(10/12),the specificity is 84.0%(157/187),the accuracy is 99.4%(167/168),the false negative rate is 8.3%(1/12),and the negative predictive value is 99.4%(157/ 158),the positive predictive value is100%(10/10).The detection rate of SLN outside the iliac was 50.4%(286/567),18.9%(107/567)in the iliac,and 25.4%(144/567)obturator foramen.In addition,the detection rates of the total and parauterine iliac were 4.2%(24/567)and 1.1%(6/567).The detection of SLN has little correlation with the patient’s body mass index,menopausal status,disease type,primary tumor size,depth of myometrial invasion,pathological type,degree of differentiation,and lymphatic vascular space invasion(P>0.05).Conclusion:(1)SLNB has a high detection rate and accuracy in early cervical cancer and endometrial cancer,and has high negative and positive predictive values.It is a safe and reliable operation method.(2)ICG and nano-carbon tracing methods have higher detection rates of SLN than methylene blue tracing methods,and the number of detections of SLN is also higher than that of methylene blue.(3)In cervical cancer and endometrial cancer,SLN is most commonly distributed in the extra-iliac area,followed by the obturator and intra-iliac area.(4)The detection of SLN has little correlation with the patient’s body mass index,menopausal status,type of disease,primary tumor size,depth of muscle invasion,pathological type,degree of differentiation,and lymphatic vascular space invasion. |
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