南方医科大学学报

南方医科大学学报 ›› 2022, Vol. 42 ›› Issue (12): 1896-1901.doi: 10.12122/j.issn.1673-4254.2022.12.20

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纳米炭示踪前哨淋巴结在宫颈癌诊治中的应用价值

林小丽，何金梅，卢佳蕴，黄承颖，刘 楠   

  1. 南方医科大学南方医院妇产科，广东 广州 510515；湛江中心人民医院妇产科，广东 湛江 524000
  • 出版日期:2022-12-20 发布日期:2023-01-12

Carbon nanoparticle tracing of sentinel lymph nodes in diagnosis and treatment of cervical cancer and clinical value of lymph node ultrastaging detection

LIN Xiaoli, HE Jinmei, LU Jiayun, HUANG Chengying, LIU Nan   

  1. Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; Department of Gynecology and Obstetrics, Zhanjiang Central People's Hospital, Zhanjiang 524000, China
  • Online:2022-12-20 Published:2023-01-12

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摘要： 目的 探讨纳米炭示踪前哨淋巴结（SLN）检测在宫颈癌诊治中的应用价值及淋巴结超分期检测的临床价值。方法 选取2018年6月~2021年1月在南方医科大学南方医院妇产科收治IA2期、IB1期、IB2期、IIA1期、IIICp1期的宫颈癌患者79例，术前于宫颈3点、9点注射纳米炭示踪剂，术中将最先黑染的淋巴结作为SLN并切除，然后均行盆腔淋巴结清扫术+广泛性子宫切除术±腹主动脉旁淋巴切除术。SLN单独送病理检查，并随机抽取其中30例阴性的SLN进行病理超分期检测。结果 79例患者中共67例至少成功检出1枚SLN，检出率为84.8%，共检出SLN 417枚，平均每例检出5.28枚。术后5例SLN阳性，1例SLN阴性而非SLN阳性，SLN检测的灵敏度为83.3%，特异度为100%，假阴性率为16.7%，准确率为98.5%，阴性预测值为98.4%。SLN主要分布于髂外、闭孔、髂内、髂总区。在单因素分析、多因素分析中，术前宫颈锥切（P=0.045、P=0.009）、肿瘤大小（P=0.033、P=0.008）对SLN总体检出率的影响均有统计学意义。对SLN与盆腔淋巴结转移状态的一致性进行Kappa检验，Kappa值为0.901，P<0.001，SLN和盆腔淋巴结转移状态高度一致。对30例阴性的SLN进行病理超分期检测后，未检出微转移或孤立肿瘤细胞，其检出率为0%。结论 纳米炭示踪SLN在宫颈癌的诊治中具有较好的安全性及可行性；肿瘤原发病灶<2 cm或术前未行宫颈锥切的宫颈癌患者应用SLN检测技术较安全；SLN联合病理超分期检测，并不能提高孤立肿瘤细胞和微转移的检出率。

关键词: 宫颈癌；前哨淋巴结；纳米炭；超分期

Abstract: Objective To evaluate the clinical value of sentinel lymph node (SLN) detection using carbon nanoparticles in the diagnosis and treatment of cervical cancer and the value of lymph node pathological ultrastaging detection. Methods A total of 79 patients with cervical cancer in IA2, IB1, IB2, IIA1 and IIICp1 stages admitted to the Department of Gynecology and Obstetrics, Nanfang Hospital between June, 2018 and January, 2021 were included in this study. During the operation, the patients were injected with a total of 0.25 mL carbon nanoparticles at 3 and 9 o'clock of the normal cervix after general anesthesia. The first black-dyed lymph nodes were identified as SLNs and removed one by one. All the patients underwent pelvic lymph node dissection and radical hysterectomy with or without para-aortic lymphadenectomy. The black-dyed SLNs were removed for routine pathological examination. Thirty patients with negative SLNs were randomly selected for pathological ultrastaging. Results In 67 of the 79 patients, a total of 417 SLNs were detected with a detection rate of 84.8%; in each patient, at least 1 SLN was detected with a mean SLN number of 5.28. After the operation, 5 patients were found to have positive SLNs; 1 patient was negative for SLN but positive for non- SLN. The sensitivity of SLN biopsy was 83.3% with a specificity of 100% , false negative rate of 16.7% , an accuracy of 98.5% and a negative predictive value of 98.4% . SLN was distributed mainly in the obturator region, the external iliac region, the internal iliac region and the total iliac region (15.11%). Univariate and multivariate analyses suggested that preoperative cervical coning (P=0.045 and 0.009) and tumor size (P=0.033 and 0.008) significantly affected the overall detection rate of SLN. Kappa test showed a high consistency between SLN and pelvic lymph node metastasis status (Kappa value=0.901, P<0.001). In 30 patients with negative pathological results of SLN, pathological ultrastaging detection identified no micrometastases or isolated tumor cells. Conclusion Carbon nanoparticle tracing of the SLNs is safe and feasible in the diagnosis and treatment of cervical cancer, and SLN detection is safe in patients with primary lesion size below 2 cm or without cervical conization. SLN combined with pathological ultrastaging detection does not improve the detection rate of isolated tumor cells or micrometastases.

Key words: cervical cancer; sentinel lymph node; carbon nanoparticles; ultrastaging