Perioperative Algorithm as a Novel Method for Lymph Node Assessment in Stage I Endometrial Cancer

Hayam E. S. Atta, H. Hegab, O. Elashkar, M. Meleis, D. Abdallah
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Abstract

Background: The uterus has a complex lymphatic drainage consisting of many groups that are in danger of endometrial cancer (EC) spread. Lymph node metastasis is a genuine pointer of poor prognosis requiring adjuvant therapy. Lymphatic mapping surgically can be done by blue dye labeling and perioperative algorithm. Aim: To assess the role of perioperative sentinel lymph nodes (SLN) mapping algorithm in reducing the necessity of pelvic lymphadenectomy. Methods: Fifty patients with early stage I EC underwent surgical staging. Transcervical injection of methylene blue was used, laparotomy was done and retroperitoneal spaces were opened. All lymph nodes were histopathologically examined and the negative SLN were ultrastaged. Results: Methylene blue dye injection resulted in blue lymph nodes in 20 (40%) cases, suspicious in 2 (4%) and negative in 28 (56%). Histopathological examination of sampled lymph node showed metastases in 18/20 (90%) of blue nodes, 1/2 (50%) of suspicious nodes and 0/28 (0%) of negative nodes. There were no false negative cases in this study and the detection rate was 89%. Conclusion: Perioperative algorithm accuracy and simplicity make it a reliable approach for lymph node assessment in early stage EC.
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围手术期算法作为一期子宫内膜癌淋巴结评估的新方法
背景:子宫有一个复杂的淋巴引流系统,由许多有子宫内膜癌(EC)扩散危险的组织组成。淋巴结转移是预后不良的真正指标,需要辅助治疗。手术淋巴定位可通过蓝色染料标记和围手术期算法完成。目的:探讨围手术期前哨淋巴结(SLN)定位算法在减少盆腔淋巴结切除术必要性中的作用。方法:对50例早期ⅰ期EC患者进行手术分期。经宫颈注射亚甲蓝,开腹,打开腹膜后间隙。对所有淋巴结进行组织病理学检查,并对SLN阴性进行超分期。结果:亚甲基蓝染色致蓝色淋巴结20例(40%),可疑2例(4%),阴性28例(56%)。淋巴结组织病理学检查显示18/20(90%)蓝色淋巴结转移,1/2(50%)可疑淋巴结转移,0/28(0%)阴性淋巴结转移。本研究无假阴性病例,检出率为89%。结论:围手术期算法准确、简便,是早期EC淋巴结评估的可靠方法。
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8 weeks
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