Erken evre serviks kanseri hastalarında mavi boya kullanılarak sentinel lenf nodu tespiti

Abstract

Amaç: Bu çalışmada, radikal histerektomi ve pelvik lenfadenektomi uygulanan erken evre invaziv serviks kanserli hastalarda intraoperatif mavi boya uygulaması ile lenfatik haritalama kullanılarak sentinel lenf nodu (SLN) tespitinin uygulanabilirliğini belirlemek amaçlanmıştır. Yöntemler: Haziran 2009 ile Aralık 2010 tarihleri ​​arasında, erken evre serviks kanseri (evre IA1, IB1) ​​nedeniyle radikal histerektomi operasyonu yapılacak olan 16 hastaya SLN'nin tanımlanması için lenf nodu haritalaması önerildi. SLN haritalaması, ameliyat öncesi, anestezi altında, intraservikal izosülfan mavisi enjeksiyonu uygulanarak yapıldı. Tüm hastalara laparotomi ile SLN tanımlanması, ardından pelvik ve paraaortik lenf nodu diseksiyonu ve radikal histerektomi operasyonu uygulanmıştır. Bulgular: Hastaların ortanca yaşı 47 idi (aralık 36-68 yıl). Histolojik tipler arasında skuamöz hücreli karsinom (12 vaka), adenoskuamöz karsinom (3 vaka) ve adenokarsinom (1 vaka) vardı. Hastaların FIGO evrelemesi 5 vakada Ia1 ve 11 vakada Ib1 olarak belirlendi. 16 hastadanıSLN'ler dahil olmak üzere toplam 417 lenf nodu (minimum 12, maksimum 51) eksize edildi. 5 hastada toplam 8 SLN belirlendi: 3 hastada 1, 1 hastada 2 ve 1 hastada 3. Tüm SLN'ler tek taraflı olarak tesbit edildi. İşlemin teknik başarısızlık oranı, SLN'yi belirleyememe olarak tanımlandı, ve %68,8 olarak (11/16) ve toplam SLN tespit oranı %31,2 olarak (5/16) saptandı İmmünohistokimyasal incelemelerde SLN'lerin hiçbirinde metastaz saptanmadı. Ultrastaging ile de SLN'lerin hiçbirinde mikrometastaz saptanmadı. Ayrıca, SLN'lerinde metastaz bulunmayan hastaların non-sentinel lenf nodlarında da metastaz saptanmadı. Sonuç olarak, yanlış negatiflik oranı belirlenemedi. Sonuç: Ön çalışmamıza göre, mavi boya ile SLN haritalaması düşük maliyetli, ulaşılabilir ve kolay uygulanabilir bir yöntem olmasına rağmen, SLN tespit oranı düşüktür.

Keywords

• serviks kanseri
• sentinel lenf nodu
• lenfatik metastaz

Sentinel lymph node detection using blue dye in patients with early stage cervical cancer: a pilot study

Abstract

Aims: This study aimed to determine the feasibility of sentinel lymph node (SLN) detection using lymphatic mapping with intraoperative isosulfan blue dye application in patients with earlystage invasive cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy. Methods: From June 2009 to December 2010, 16 patients undergoing radical hysterectomy for early-stage cervical cancer (stage IA1, IB1) were offered lymph node mapping for identification of the SLN. The SLN mapping was done after intracervical isosulphane blue injection preoperatively. All patients underwent SLN identification via laparotomy followed by a complete pelvic and paraaortic lymph node disection and radical hysterectomy. Results: The median age of the patients was 47 years (range: 36-68 years). The histological types identified included squamous cell carcinoma (12 cases), adenosquamous carcinoma (3 cases), and adenocarcinoma (1 case). The FIGO staging for the patients revealed Ia1 in 5 cases and Ib1 in 11 cases. A total of 417 lymph nodes (minimum 12, maximum 51), including SLNs, were removed from 16 patients. A total of 8 SLNs were identified in 5 patients: 1 in 3 patients, 2 in 1 patient, and 3 in 1 patient. All SLNs were unilateral. The technical failure rate of the procedure, defined as the inability to identify an SLN, was 68.8% (11/16), and the total SLN detection rate was 31.2% (5/16). Immunohistochemical examinations found no metastases in any of the SLNs. Ultrastaging also did not identify micrometastasis in any of the SLNs. Additionally, there were no metastases detected in the non- SLN s of patients who did not exhibit metastasis in the SLNs. Consequently, the false-negative rate could not be determined. Conclusion: According to our preliminary study, although SLN mapping with blue dye is a low-cost, accessible, and easy-to perform method, it has a low detection rate of SLN.

Keywords

• Cervical cancer
• sentinel lymph node
• lymphatic metastasis

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