子宫内膜癌前哨淋巴结检测及微转移的临床意义

虽然前哨淋巴结(Sentinel lymph node,SLN)检测在子宫内膜癌领域还属于探索阶段,但多项研究表明SLN检测在早期子宫内膜癌是可行的.蓝染和放射性胶体联合检测方法可以提高SLN检出率;子宫体多点注射法和经宫腔镜子宫内膜注射法较宫颈注射法比较,可以提高SLN检出率和主动脉旁SLN阳性率.此外SLN检出率还与示踪物剂量、注射到检测的间隔时间以及肿瘤浸润子宫肌层深度有关.连续切片及抗细胞角蛋白免疫组化方法的联合应用可以提高SLN微转移(MM)的检出率.SLN的重要意义不仅是替代淋巴结切除术,更多在于它能够检测出传统的病理学检查不能发现的MM.其"超"分期作用可以诊断出中危度子宫内膜癌患者并对其提供及时的辅助治疗,减少复发.

Sentinel Lymph Node Detection in Endometrial Cancer and Clinical Significance of Micrometastases

Sentinel lymph node (SLN) detection in endometrial cancer is still in the exploration stage. But a good many studies have confirmed the feasibility of SLN detection in patients with early endometrial cancer. Higher detection rate of SLN can be achieved by the combination of blue dye and radiocolloid. Compared with intracervical injection, more injections at different sites of the uterine corpus and hysteroscopic injection may improve SLN detection rate and para-aortic SLN detection rate. SLN detection rates are also related to some other factors such as the amount of tracers, the interval between injection and detection, and the depth of myometrium invasion. Serial-step section of SLN combined with immunohistochemistry staining with anti-cyto-keratin may improve the detection of micrometastasis (MM) in SLN. SLN procedure can detect MM which cannot be found by traditional pathological techniques. The ultrastaging will allow better stratification of patients at intermediate risk and can provide valuable informaiton for the selection of adjuvant therapy, thus decreasing the recurrent rate.