Diagnostic value of ICG for sentinel lymph node mapping in patients with stage I endometrial cancer

V. A. Alimov, S. Skugarev, D. N. Grekov, E. G. Novikova, D. S. Lantsov, A. M. Danilov, A. V. Sazhina, P. N. Afanasova
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Abstract

Background. Lymphatic spread is the main route of metastasis in early stage endometrial cancer. Considering its significance, three risk factors of lymph node metastasis were identified. At a high risk of lymph node metastasis in patients with stage I endometrial cancer, pelvic and lumbar lymph node dissection is recommended. In low-risk patients, lymph node dissection is not performed. Lymph node dissection in medium-risk patients is considered as a staging procedure. However, in patients with aggravating factors that prevent extended hysterectomy, lymph node biopsy with ICG mapping and subsequent microstaging may be an alternative to lymph node dissection. Purpose of the study: to analyze the effectiveness of surgical approaches for staging endometrial cancer at different risk factors for lymphatic metastasis.Material and Methods. The treatment outcomes were retrospectively analyzed in 565 patients with stage I endometrial cancer treated at the gynecological oncology department of Botkin City Clinical Hospital and at the gynecological oncology department of Kaluga Regional Clinical Oncology Center from 2021 to 2023. All women were divided into three groups according to the risk factors of lymph node metastasis. Patients underwent hysterectomy, hysterectomy combined with pelvic or pelvic and lumbar lymphadenectomy, as well as hysterectomy with ICG mapping and sentinel lymph node biopsy.Results. A total of 334 endometrial cancer patients underwent surgery at Botkin City Clinical Hospital. In the medium-risk group patients (n=94), who underwent hysterectomy with pelvic (n=36) and pelvic + lumbar lymphadenectomy (n=31), lymph node metastases were detected in 4 (11.1 %) and 6 (19.4 %) patients, respectively. In the high-risk group (n=50) with similar surgeries, metastatic lymph nodes were identified in 2 (10.5 %, n=19) and 6 (26.1 %, n=23) patients, respectively. At Kaluga Regional Oncology Center, 231 patients underwent hysterectomy with sentinel lymph node biopsy. The low-risk group, the medium-risk group, and the high-risk group showed lymph node metastases in 7 (5.47 %), 6 (10.2 %), and 6 (13.6 %) patients, respectively.Conclusion. In stage I endometrial cancer patients with a low risk of lymph node metastasis, hysterectomy with sentinel lymph node biopsy is recommended. For medium-and high-risk groups, hysterectomy with systemic lymphadenectomy is recommended. If it is not possible to remove the pelvic and lumbar lymph nodes, their biopsy with ICG mapping and microstaging can be recommended. A combination of systemic lymphadenectomy with sentinel lymph node biopsy is a promising technique that could hypothetically demonstrate better results in terms of disease staging.
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ICG 对 I 期子宫内膜癌患者前哨淋巴结绘图的诊断价值
背景。淋巴扩散是早期子宫内膜癌转移的主要途径。考虑到淋巴结转移的重要性,研究人员确定了淋巴结转移的三个风险因素。对于淋巴结转移风险较高的 I 期子宫内膜癌患者,建议进行盆腔和腰部淋巴结清扫。低风险患者不进行淋巴结清扫。中危患者的淋巴结清扫被视为一种分期手术。然而,对于有加重病情因素而无法进行扩大子宫切除术的患者,进行淋巴结活检并绘制 ICG 图谱,然后进行微分期,可能是淋巴结清扫术的替代方法。研究目的:分析不同淋巴转移风险因素下子宫内膜癌分期手术方法的有效性。对2021年至2023年期间在博特金市临床医院妇科肿瘤科和卡卢加地区临床肿瘤中心妇科肿瘤科接受治疗的565名I期子宫内膜癌患者的治疗结果进行回顾性分析。根据淋巴结转移的风险因素,所有妇女被分为三组。患者分别接受了子宫切除术、子宫切除术联合盆腔或盆腔和腰部淋巴结切除术,以及子宫切除术联合 ICG 图谱和前哨淋巴结活检。共有 334 名子宫内膜癌患者在博特金市临床医院接受了手术。中危组患者(94 人)接受了子宫切除术,并进行了盆腔淋巴结切除术(36 人)和盆腔+ 腰椎淋巴结切除术(31 人),其中分别有 4 人(11.1%)和 6 人(19.4%)发现淋巴结转移。在进行类似手术的高风险组(50 人)中,发现淋巴结转移的患者分别为 2 人(10.5%,19 人)和 6 人(26.1%,23 人)。在卡卢加地区肿瘤中心,231 名患者接受了子宫切除术,并进行了前哨淋巴结活检。低风险组、中风险组和高风险组分别有7例(5.47%)、6例(10.2%)和6例(13.6%)患者出现淋巴结转移。对于淋巴结转移风险较低的 I 期子宫内膜癌患者,建议在进行前哨淋巴结活检的同时进行子宫切除术。对于中、高危人群,建议进行子宫切除术,同时进行全身淋巴结切除术。如果无法切除盆腔和腰部淋巴结,则建议进行活检,并绘制 ICG 图谱和进行微分期。将全身淋巴结切除术与前哨淋巴结活检术结合起来是一种很有前景的技术,有可能在疾病分期方面取得更好的效果。
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来源期刊
Siberian journal of oncology
Siberian journal of oncology Medicine-Oncology
CiteScore
0.40
自引率
0.00%
发文量
117
审稿时长
8 weeks
期刊介绍: The main objectives of the journal are: -to promote the establishment of Russia’s leading worldwide positions in the field of experimental and clinical oncology- to create the international discussion platform intended to cover all aspects of basic and clinical cancer research, including carcinogenesis, molecular biology, epidemiology, cancer prevention, diagnosis and multimodality treatment (surgery, chemotherapy, radiation therapy, hormone therapy), anesthetic management, medical and social rehabilitation, palliative care as well as the improvement of life quality of cancer patients- to encourage promising young scientists to be actively involved in cancer research programs- to provide a platform for researches and doctors all over the world to promote, share, and discuss various new issues and developments in cancer related problems. (to create a communication platform for the expansion of cooperation between Russian and foreign professional associations).- to provide the information about the latest worldwide achievements in different fields of oncology The most important tasks of the journal are: -to encourage scientists to publish their research results- to offer a forum for active discussion on topics of major interest - to invite the most prominent Russian and foreign authors to share their latest research findings with cancer research community- to promote the exchange of research information, clinical experience, current trends and the recent developments in the field of oncology as well as to review interesting cases encountered by colleagues all over the world- to expand the editorial board and reviewers with the involvement of well-known Russian and foreign experts- to provide open access to full text articles- to include the journal into the international database- to increase the journal’s impact factor- to promote the journal to the International and Russian markets
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