共查询到20条相似文献,搜索用时 15 毫秒
1.
Gökhan Demirayak Cihan Comba İsa Aykut Özdemir 《Journal of minimally invasive gynecology》2018,25(5):776
Study Objective
To demonstrate the feasibility of sentinel lymph node (SLN) biopsy using a laparoendoscopic single-site (LESS) approach in endometrial cancer (EC).Design
A step-by-step video demonstration of the surgical procedure (Canadian Task Force Classification III).Setting
The satisfaction of patients who undergo LESS hysterectomy is greater than that reported by patients who undergo multiport laparoscopic hysterectomy, owing to better cosmesis and reduced postoperative analgesic requirements [1]. SLN biopsy is associated with significantly lower estimated blood loss, shorter operation time, and less morbidity compared with systematic lymphadenectomy [2]. LESS surgery can be more feasible and safer with the use of SLN biopsy compared with complete lymphadenectomy in patients with early-stage EC.Interventions
This 69-year-old woman with grade 2 endometrioid EC underwent SLN mapping followed by LESS SLN biopsy, total hysterectomy, and bilateral salpingo-oophorectomy. Before the umbilical incision was made, 1.25?mg/mL of indocyanine green was injected into the cervical stroma at the 3 o'clock and 9 o'clock positions to both deep and superficial levels. A 10-mm 30° standard-length optical camera for near-infrared fluorescence imaging was used. The total operative time was 75 minutes, and the estimated blood loss was 20?mL. SLNs were detected bilaterally between proximal parts of the external iliac arteries and veins. After SLN resection, total hysterectomy and bilateral salpingo-oophorectomy were performed. No postoperative complications occurred. The patient was discharged at 30 hours after surgery. In the final pathology, stage 1A G2 EC was detected.Conclusion
LESS SLN biopsy and TLH-BSO is a feasible procedure and sentinel lymph node concept may increase the use of LESS in EC. 相似文献2.
Fabio Martinelli Antonino Ditto Giorgio Bogani Mauro Signorelli Valentina Chiappa Domenica Lorusso Edward Haeusler Francesco Raspagliesi 《Journal of minimally invasive gynecology》2017,24(1):89-93
Study Objective
To report the detection rate (DR) of sentinel lymph nodes (SLNs) in endometrial cancer (EC) patients after hysteroscopic injection of indocyanine green (ICG) and laparoscopic near-infrared (L-NIR) fluorescence mapping.Design
Prospectively collected data (Canadian Task Force classification II-2).Setting
Gynecologic oncology referral center.Patients
Consecutive patients with apparent early-stage endometrioid EC scheduled for surgical treatment: total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, SLN mapping.Interventions
The mapping technique consisted in an intraoperative hysteroscopic peritumoral injection of 5 mg ICG followed by L-NIR fluorescence mapping. Evaluations of the SLN DR and sites of mapping were performed.Measurements and Main Results
A total of 57 procedures was performed. Patient mean age was 60 years (range, 28–80) and mean body mass index was 28.2 kg/m2 (range, 19–43). At least 1 SLN was detected in 89.5% of the whole population (51/57). After the first 16 cases, L-NIR camera technical improvement led to a 95% DR (39/41). The mean number of harvested SLNs was 4.1 (range. 1–8), and in 47% of cases SLNs mapped to aortic nodes (24/51). Bilateral pelvic mapping was found in 74.5% of cases (38/51). Three patients had SLN metastases: 1 in the pelvic area only, 1 both in the pelvic and aortic area, and 1 presented with 2 metastatic aortic SLNs with negative pelvic SLNs. Overall, 2 of 3 node-positive patients (67%) had aortic SLN involvement. No adverse events were reported.Conclusions
Laparoscopic SLN mapping after the hysteroscopic injection of ICG has comparable DRs with both radioactive tracer series and ICG series with cervical injection, overcoming the need for radioactive substances. Hysteroscopic injection leads to a higher mapping in the aortic area compared with cervical injection. Further investigation is warranted on this topic. 相似文献3.
4.
目的:系统评价前哨淋巴结活组织检查术(SLNB)用于宫颈癌早期盆腔淋巴结转移诊断的临床价值。方法:计算机全面检索Pub Med、Embase、Medline数据库及中国知网、万方、维普数据库,检索2001~2013年国内外关于SLNB确定早期宫颈癌盆腔淋巴结的研究,用Meta分析的相关软件Meta Disc1.4进行统计学处理。结果:筛选出文献11篇,患者共581例。最后合并的早期宫颈癌SLNB的敏感度为0.86(95%CI 0.78~0.91),特异度为0.98(95%CI 0.97~0.99)。结论:合并后早期宫颈癌SLNB的敏感度、特异度较高,其对诊断宫颈癌淋巴结转移是可靠的。 相似文献
5.
《Journal of minimally invasive gynecology》2014,21(4):540-545
Lymph node status is the most important prognosticator of survival in women with early stage cervical cancer. Thus many patients with cervical cancer will undergo pelvic lymphadenectomy as part of the treatment. This procedure is associated with substantial morbidity. Use of the sentinel lymph node technique in women with cervical cancer has the potential to decrease this morbidity. Multiple studies have suggested that sentinel lymph node mapping in these patients is feasible, with excellent detection rates and sensitivity. This review examines the current body of literature about sentinel lymph node biopsy in women with cervical cancer. 相似文献
6.
宫颈癌前哨淋巴结定位和检测 总被引:1,自引:0,他引:1
目的:使用亚甲蓝作为示踪剂检测宫颈癌前哨淋巴结,观察其安全性和可行性。方法:2006年3月至2007年3月,采用亚甲蓝检测25例ⅠB~ⅡB期宫颈癌前哨淋巴结。根据术后病理判断用前哨淋巴结预测盆腔淋巴结转移的准确性和假阴性率。结果:25例中,19例成功定位出前哨淋巴结36枚,总检出率为76.00%。最多见检出部位为闭孔淋巴结。准确率为100.00%,假阴性率为0。结论:染料法宫颈癌前哨淋巴结定位是安全可行的,检出部位以闭孔窝最多见。 相似文献
7.
王朝红 《国际妇产科学杂志》2010,37(5):318
淋巴结转移是宫颈癌肿瘤细胞转移的最早特征,宫颈癌患者局部淋巴结状况直接影响患者的预后并决定着辅助治疗方案的制定。然而对患者盆腔所有淋巴结进行评估是一件十分繁杂的事情,前哨淋巴结(SLN)能反映整个盆腔淋巴结的转移状况,其研究使大多数早期宫颈癌患者避免不必要的盆腔淋巴结清扫术。目前常用的淋巴结识别方法有染料法、放射性核素示踪法及联合法。淋巴结微转移检测法(如:免疫组化法、连续切片法、鳞状细胞癌抗原检测及淋巴结HPV检测法等)能提高SLN的诊断准确性。 相似文献
8.
Luca Montanelli Claudio Reato Stefania Mauro Sofia Meregalli Marianna Spallino Alessandro Buda 《Journal of minimally invasive gynecology》2018,25(3):537-540
Endometrial cancer is the most common malignancy in some developed countries, with an estimated 102?423 new cases reported in 2015. Isolated mediastinal lymph node recurrence has not been reported previously in this setting. We report a 78-year-old woman with an isolated lymph node recurrence in the mediastinal aortic region detected 5 years after her initial surgical treatment and postoperative adjuvant chemotherapy. Following curative radiotherapy with volumetric-modulated arc therapy at 60?Gy, the recurrence disappeared. To our knowledge, this is the first reported case of recurrent endometrial cancer with isolated mediastinal recurrence. 相似文献
9.
Amanika Kumar Sumer A. Wallace William A. Cliby Gretchen E. Glaser Andrea Mariani Mario M. Leitao Michael Frumovitz Carrie L. Langstraat 《Journal of minimally invasive gynecology》2019,26(4):727-732
Study Objective
We sought to estimate the impact of sentinel nodes in gynecologic oncology on fellowship training and discuss potential solutions.Design
Retrospective multi-institution cohort (Canadian Task Force classification II-2).Setting
Three tertiary cancer referral cancer centers.Patients
Patients with endometrial and vulvar cancer undergoing lymph node evaluation.Interventions
Patient history and fellow case volumes were evaluated retrospectively for type of lymph node assessment.Measurements and Main Results
Minimally invasive endometrial cancer and vulvar cancer fellow case volumes in 3 large institutions were reviewed and average annual volumes calculated for each clinical gynecologic oncology fellow. For vulvar cancer, probabilities of sentinel lymph node mapping and laterality of lesions were estimated from the literature. For endometrial cancer, estimates of lymphadenectomy rates were determined using probabilities calculated from our historic database and from review of the literature. Modeling the approaches to lymphadenectomy in endometrial cancer (full, selective, and sentinel), 100% versus 68% versus 24%, respectively, of patients would require complete pelvic lymphadenectomy and 100% versus 34% versus 12% would require para-aortic lymphadenectomy. In vulvar cancer, rates of inguinal femoral lymphadenectomy are expected to drop from 81% of unilateral groins to only 12% of groins.Conclusions
Sentinel lymph node biopsy for endometrial and vulvar cancer will play an increasing role in practice, and coincident with this will be a dramatic decrease in pelvic, para-aortic, and inguinal femoral lymphadenectomies. The declining numbers will require new strategies to maintain competency in our specialty. New approaches to surgical training and continued medical education will be necessary to ensure adequate training for fellows and young faculty across gynecologic surgery. 相似文献10.
淋巴结转移与否是判断早期宫颈癌患者预后的独立危险因素和术后是否需要辅助治疗的依据。早期宫颈癌淋巴结转移率较低,大多数患者因无盆腔淋巴结转移而不能从全盆腔淋巴结清扫术中受益。若通过前哨淋巴结(sentinel lymph node,SLN)检测来准确评估早期宫颈癌盆腔淋巴结转移状态,则可以用SLN活检技术替代系统淋巴结清扫术减少手术并发症。虽然目前由于各种原因该项技术未能被临床广泛应用,但纳米炭(carbon nanoparticle,CNP)的出现为其提供了新的契机。CNP具有淋巴系统趋向性和吸附抗癌药物等特点,能在淋巴管、淋巴结高密度且长时间聚集,有利于指导恶性肿瘤的淋巴结清除及淋巴化疗。综述运用CNP混悬液在术前标记早期宫颈癌SLN的可行性,使SLN活检技术替代系统淋巴结清扫术成为可能。 相似文献
11.
Clare J. Reade Waldo Jimenez Daria O’Reilly Al Covens 《Journal d'obstetrique et gynecologie du Canada》2012,34(11):1053-1065
ObjectiveInguinofemoral lymphadenectomy for vulvar cancer is associated with a high incidence of groin wound complications and lymphedema. Sentinel lymph node biopsy (SLNB) is a morbidity-reducing alternative to lymphadenectomy. The objective of this health technology assessment was to determine the clinical effectiveness, costeffectiveness, and organizational feasibility of SLNB in the Canadian health care system.MethodsA review of the English-language literature published from January 1992 to October 2011 was performed across five databases and six grey-literature sources. Predetermined eligibility criteria were used to select studies, and results in the clinical, economic, and organizational domains were summarized. Included studies were evaluated for methodologic quality using the Newcastle-Ottawa Scale.ResultsOf 825 reports identified, 88 observational studies met the eligibility criteria. Overall study quality was poor, with a median Newcastle-Ottawa Scale score of 2 out of 9 stars. Across all studies, the detection rate of the sentinel lymph node was 82.2% per groin and the false-negative rate was 6.3%. The groin recurrence rate after negative SLNB was 3.6% compared with 4.3% after negative lymphadenectomy, and complications were reduced after SLNB. No economic evaluations were identified comparing SLNB to lymphadenectomy. Safe implementation of SLNB requires appropriate patient selection, detection technique, and attention to the learning curve.ConclusionAlthough study quality is poor, the available data suggest implementation of SLNB may be safe and feasible in Canadian centres with adequate procedural volumes, assuming that implementation includes careful patient selection, careful technique, and ongoing quality assessment. Cost-effectiveness has yet to be determined. 相似文献
12.
淋巴结转移作为宫颈癌和子宫内膜癌的主要转移途径,是影响其预后的重要因素。在治疗前和治疗过程中如何检测和评估这2种恶性肿瘤的盆腔淋巴结状态仍处于初步探索阶段。目前检测淋巴结状态的方法有超声检查、计算机断层扫描、磁共振成像(MRI)、正电子发射计算机断层显像(PET-CT)和前哨淋巴结活检定位等。不同检查方法的原理不同,其敏感度、特异度和准确度等方面各有优劣。随着影像学技术及显像生物制剂的发展,淋巴结状态检测已由单纯形态学向功能学转变。彩色多普勒超声、弥散加权成像及PET-CT等均在传统影像学技术上进一步提高了敏感度和特异度,其中PET-CT和功能性MRI在检测的敏感度、特异度和准确度等方面尤其具有优势;显像生物制剂通过不断发展,已逐渐细化为针对淋巴结内肿瘤细胞代谢、血管和淋巴回流等三方面的特异性淋巴造影剂。 相似文献
13.
Alessandro Buda Giampaolo Di Martino Elena De Ponti Paolo Passoni Federica Sina Claudio Reato Francesca Vecchione Daniela Giuliani 《Journal of minimally invasive gynecology》2018,25(1):93-98
Study Objective
The goal of this study was to evaluate the intraoperative and perioperative surgical outcomes of 2 different florescence systems commonly used for sentinel lymph node (SLN) mapping in women with early-stage cervical cancer or endometrial cancer.Design
Case-control study (Canadian Task Force classification II-2).Setting
The Gynecology Oncology Surgical Unit of the San Gerardo Hospital, Italy.Patients
Thirty-four consecutive women with early stage-cervical cancer (stage IA-1B1) or apparent confined stage I endometrial cancer were included in the study.Interventions
Between October 2016 and May 2017, 34 patients underwent laparoscopic surgery with SLN mapping using indocyanine green dye: 22 women were mapped with the Storz 1S system (Karl Storz Endoscopy, Tuttlingen, Germany; Group A), whereas 12 women underwent planned surgery with the Novadaq PinPoint system (Novadaq, Mississauga, Ontario, Canada; Group B).Measurement and Main Results
We compared the surgical and perioperative outcomes of Group A and Group B. Patients in Group B had a shorter duration of the SLN mapping time than those in Group A (p?=?.0003). The median number of SLNs removed was 2 (range, 0–5) in Group A and 2 (range, 1–3) in Group B (p?=?.501). Bilateral mapping was 77.3% in Group A and 83.3% in Group B (p?=?.334), respectively. No differences were recorded in terms of body mass index, length of hospital stay, type of tumor, bilateral mapping, or number of lymph nodes removed. Body mass index was found to have no impact on the duration of the mapping (p?=?.353).Conclusion
From our preliminary experience we can conclude that both fluorescence systems are valid and applicable for SLN detection in the case of early-stage cervical or endometrial cancer. The PinPoint system seems to allow surgeons easier and faster identification of the SLNs, particularly in endometrial cancer patients. 相似文献14.
Julian Di Guilmi Maria Cecilia Darin Maria Toscano Gustavo Maya 《Journal of minimally invasive gynecology》2018,25(3):378-379
Study Objective
To demonstrate the initial experience in Argentina using the iSpies indocyanine green (ICG) platform in sentinel lymph node mapping in patients with early-stage cervical cancer.Design
Step-by-step demonstration of the technique using a video and pictures (educative video) (Canadian Task Force classification III).Setting
Laparoscopic and robotic sentinel lymph node mapping using ICG has been shown to be safe and feasible; however, in developing countries, the opportunities to use fluorescent imaging through a minimally invasive approach are very limited, given the cost restrictions of acquiring the near-infrared technology and the fluorescent dyes.Intervention
A 47-year-old woman presented with a stage IB1 squamous cervical cancer. Physical examination revealed a 1.5-cm tumor without evidence of parametrial involvement. Magnetic resonance imaging did not show any evidence of metastatic disease. The patient underwent laparoscopic radical hysterectomy with sentinel lymph node mapping. On laparoscopic exposure of the pelvic spaces, a cervical injection of ICG (1?mL superficial and deep) was administered using a spinal needle at the 3 o'clock and 9 o'clock positions. Sentinel lymph node mapping was then performed using the ICG (Pulsion Medical Systems, Feldkirchen, Germany) and an iSpies near-infrared camera (Karl Storz Endoskope, Tuttlingen, Germany). Bilateral sentinel lymph nodes were detected on the left external iliac artery and in the right obturator space. Both were confirmed ex vivo. The total operative time was 170 minutes. No intraoperative or postoperative complications were reported, and the patient was discharged at 48 hours after surgery. Estimated blood loss was minimal. Sentinel lymph node mapping alone is not the standard of care in our institution, and thus bilateral lymphadenectomy was performed. Ultrastaging is routinely performed when a sentinel lymph node is evaluated. Final pathology revealed a tumor confined to the cervix, with tumor-free margins, and a total of 10 lymph nodes that were negative for any evidence of disease. Disadvantages of this technology compared with the Pinpoint ICG system (Novadaq Technologies; Bonita Springs, FL) is the lack of simultaneous white vision and fluorescence ICG detection, and the to manually change normal vision to infrared vision. An advantage of the Storz iSpies system is its availability in our country, considering that the technology developed by Novadaq is not yet approved in Argentina.Conclusion
Although ICG sentinel lymph node mapping is becoming a standard of care 1, 2, a lack of ICG dye or laparoscopic near-infrared technologies could be a deterrent to its use in developing countries. A focus on expanding this technology in countries with limited resources would allow patients the opportunity to avoid the morbidity associated with full lymphadenectomy. 相似文献15.
马小静 《国际妇产科学杂志》2012,39(5):510-513
妇科恶性肿瘤转移的途径主要有淋巴结转移和直接蔓延。前哨淋巴结是最先接受肿瘤部位的淋巴引流并最早发生肿瘤转移的淋巴结,前哨淋巴结检测不仅对妇科恶性肿瘤的分期和手术方案的制定具有重要的指导意义,还与患者的预后密切相关,现将前哨淋巴结检测在妇科恶性肿瘤中应用的最新进展进行简要综述。 相似文献
16.
《Journal of minimally invasive gynecology》2021,28(8):1531-1535
Study ObjectiveTo determine whether the concomitant use of indocyanine green (ICG) with technetium-99m–filtered sulfur colloid (Tc99m-FSC) improves bilateral sentinel lymph node (SLN) detection rate in endometrial cancer and whether anatomic concordance of pelvic lymph nodes exists and can be used to predict SLN location in cases of unilateral mapping failure.DesignRetrospective cohort study.SettingTertiary academic medical center in Holon, Israel.PatientsPatients diagnosed with endometrial cancer, who underwent SLN mapping with Tc99m-FSC, ICG, or both, at our center between 2014 and 2019.InterventionsA total of 111 patients were included in the study. SLN mapping using Tc99m-FSC was performed in 101 (91.9%) patients, and ICG injection was given to 64 (57.6%) patients of whom 55 (49.5%) received both. We compared SLN detection rates (unilateral and bilateral) and anatomic symmetry for each method alone and for a combination of the 2.Measurements and Main ResultsThe overall detection rate for unilateral SLNs was 96.4%; 96.9% with ICG, 93.1% with gamma-probe, and 98.2% by combining both methods. The total bilateral detection rate was 72.1%, with ICG performing better as a single tracer than Tc99m-FSC (75% vs 63.4%, respectively). In 55 women in whom both tracers were used, the bilateral detection rate was significantly higher compared with Tc99m-FSC alone. Symmetric pelvic anatomic concordance of SLN was found in only 35 of 80 patients with bilateral SLN detection (43.8%).ConclusionThe combination of preoperative radioisotope injection and intraoperative ICG administration may yield the best bilateral SLN detection rate. In cases of unilateral mapping failure, one cannot rely on the anatomic location of the ipsilateral SLN detected to harvest the complementary node because the symmetric concordance is poor. 相似文献
17.
Wen-Fang Cheng MD Chi-An Chen MD Chien-Nan Lee MD Tzer-Ming Chen MD PhD Kuang-Ta Huang MD Chang-Yao Hsieh MD MSPH Fon-Jou Hsieh MD 《Gynecologic oncology》1998,71(3):424-427
Objective.The objective of this study was to evaluate the efficacy of preoperative ultrasound (US) findings such as tumor size, status of myometrial invasion, and intratumoral “resistance index” (RI) in predicting lymph node metastasis in endometrial carcinoma patients.Methods.Forty-two patients with endometrial cancer were enrolled. All patients underwent total abdominal hysterectomy, pelvic lymph node dissection or sampling, and para-aortic lymph node sampling. Two-dimensional and color Doppler US were performed before surgery to measure tumor size, depth of myometrial invasion, and intratumoral arterial RI. Formalin-fixed, paraffin-embedded pathologic slides from surgical specimens were reviewed by a senior pathologist to evaluate histologic type and grade, depth of myometrial invasion, cervical involvement, lymph-vascular emboli, and status of lymph node metastasis.Results.There were 12 patients with pelvic and/or para-aortic lymph node metastases and 30 patients without nodal metastases. Patients with tumors larger than 2.5 cm by US (11/12 vs 14/30,P= 0.008), more than half myometrial invasion by US (9/12 vs 5/30,P< 0.001), and intratumoral RI values less than 0.4 by US (12/12 vs 4/30,P< 0.001) had a significantly higher incidence of nodal metastases as compared with patients with tumors smaller than 2.5 cm, no or superficial myometrial invasion, and RI values higher than 0.4, respectively. Multiple regression analysis showed that only intratumoral RI values less than 0.4 were significantly correlated with nodal metastasis (P< 0.001,r2= 0.650). We used the intratumoral RI value as the parameter to evaluate nodal metastasis in endometrial cancer patients. Twelve of sixteen patients with intratumoral RI values <0.4 had a high incidence of nodal metastases. None of the 26 patients with intratumoral RI values >0.4 had nodal metastases.Conclusions.Preoperative ultrasound features can offer important information for predicting lymph node metastasis in endometrial cancer patients. Patients with tumors with intratumoral RI values less than 0.4 should be highly suspected of having lymph node metastases and further management such as pelvic lymph node dissection or postoperative pelvic radiotherapy would be needed for these patients. 相似文献
18.
子宫内膜癌是妇科常见恶性肿瘤之一,发病率逐年上升。淋巴结转移为子宫内膜癌患者的主要转移途径,其中盆腔淋巴结转移较为常见,腹主动脉旁淋巴结转移较为少见。但存在腹主动脉旁淋巴结转移的患者预后相对较差。腹主动脉旁淋巴结转移情况可以通过术前、术中相关方法进行预测。预测子宫内膜癌患者是否存在腹主动脉旁淋巴结转移方法的研究近年来发展迅速,但目前尚无预测方法的统一标准。综合分析患者的病理、血清学和影像学检查方法对腹主动脉旁淋巴结转移的预测价值,对指导临床决策,避免不必要的腹主动脉旁淋巴结切除术,减少不良反应,降低手术费用以及选择合适的术后辅助治疗显得尤为重要。 相似文献
19.
Stefano Uccella Alessandro Buda Chiara Morosi Giampaolo Di Martino Martina Delle Marchette Claudio Reato Jvan Casarin Fabio Ghezzi 《Journal of minimally invasive gynecology》2018,25(3):461-466.e1