Endometrial İntraepitelyal Neoplazi Cerrahisinde Sentinel Lenf Nodu Haritalaması: Tek Merkez Deneyimi

Öz

Amaç: Endometrial intraepitelyal neoplazi (EIN), endometrium kanserinin (EK) iyi tanımlanmış prekürsör lezyonu olup önemli oranda eş zamanlı kanser riski taşımaktadır. EIN tanısı alan hastalarda lenf nodu değerlendirmesinin gerekliliği tartışmalıdır. Bu çalışmada preoperatif EIN tanısı olan hastalarda sentinel lenf nodu (SLN) haritalamasının uygulanabilirliği, cerrahi sonuçları ve eş zamanlı endometrium kanseri ile ilişkili klinik parametrelerin değerlendirilmesi amaçlandı.

Gereç ve Yöntemler: Ocak 2024 – Şubat 2026 tarihleri arasında merkezimizde preoperatif EIN tanısı ile opere edilen ve en az histerektomi ile birlikte SLN haritalaması uygulanan 33 hasta retrospektif olarak incelendi. Hastalar nihai patoloji sonuçlarına göre EK ve EIN/benign patoloji olarak iki gruba ayrıldı. Klinik, patolojik ve cerrahi parametreler karşılaştırıldı.

Sonuçlar: Toplam 33 hastanın 10’unda (%30.3) eş zamanlı EK saptandı. Bilateral SLN saptama oranı %66.7, unilateral saptama oranı %27.2 idi. Hiçbir hastada lenf nodu metastazı izlenmedi. EK saptanan olguların tamamı düşük dereceli endometrioid histolojide olup derin myometrial invazyon ve lenfovasküler alan invazyonu saptanmadı. İki hastada Mayo kriterlerine göre lenf nodu diseksiyonu gerektirebilecek patolojik özellikler mevcuttu. Preoperatif patolojide invaziv hastalık şüphesi ve yüksek CA-125 düzeyi eş zamanlı kanser ile anlamlı olarak ilişkili bulundu (p<0.05).Perioperatif komplikasyon oranı %15.2 idi ve sadece bir hastada cerrahi müdahele gerektirecek komplikasyon izlendi.

Tartışma: Preoperatif EIN tanısı olan hastalarda SLN haritalaması uygulanabilir ve güvenli bir yöntemdir. EIN olgularında eş zamanlı EK oranının yüksek olması, hastalarda SLN değerlendirmesinin cerrahi evreleme açısından katkı sağlayabileceğini düşündürmektedir. Özellikle invaziv hastalık şüphesi bulunan hastalarda SLN haritalaması daha fazla önem kazanabilir.

Anahtar Kelimeler

• Atipili endometrial hiperplazi
• Endometrial intraepitelyal neoplazi
• Endometrium kanseri
• Sentinel lenf nodu

Sentinel Lymph Node Mapping in the Surgical Management of Endometrial Intraepithelial Neoplasia: A Single-Center Experience

Öz

Objective: Endometrial intraepithelial neoplasia (EIN) is a well-defined precursor lesion of endometrial cancer (EC) and is associated with a substantial risk of concurrent malignancy. The necessity of lymph node assessment in patients diagnosed with EIN remains controversial. This study aimed to evaluate the feasibility of sentinel lymph node (SLN) mapping, surgical outcomes, and clinical parameters associated with concurrent EC in patients with a preoperative diagnosis of EIN.

Material and Method: Thirty-three patients who underwent hysterectomy with SLN mapping for a preoperative diagnosis
of EIN between January 2024 and February 2026 at our center were retrospectively analyzed. According to final pathology results, patients were divided into two groups as EC and EIN/benign pathology. Clinical, pathological, and surgical parameters were compared between the groups.

Results: Concurrent EC was detected in 10 of 33 patients (30.3%). The bilateral SLN detection rate was 66.7%, and unilateral SLN detection was achieved in 27.2% of patients. No lymph node metastasis was identified. All EC cases had low-grade endometrioid histology without deep myometrial invasion or lymphovascular space invasion. Two patients had pathological features indicating lymph node dissection according to Mayo criteria. Suspicion of invasive disease in preoperative pathology and higher CA-125 levels were significantly associated with concurrent EC (p<0.05). The perioperative complication rate was 15.2%, with only one complication requiring surgical intervention.

Conclusion: SLN mapping appears to be a feasible and safe approach in patients with a preoperative diagnosis of EIN. The considerable rate of concurrent EC suggests that SLN evaluation may contribute to surgical staging, particularly in patients with suspicion of invasive disease.

Anahtar Kelimeler

• Atypical Endometrial Hyperplasia
• Endometrial intraepithelial neoplasia
• Endometrium Cancer
• Sentinel Lymph Nodes

Kaynakça

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