背景:用于盆腔前哨淋巴结(SLN)标测的吲哚菁绿(ICG)在子宫内膜癌中已得到很好的建立(Persson等人。,2019年7月)。然而,主动脉旁SLN的应用报道较少;主动脉旁SLN的检出率,主要是在宫颈注射ICG后,在14%和71%之间变化(Rossi等人。,2013年11月;Kim等人。,2020年3月;Gallotta等人。,2019年3月)。最近的一份报告区分了子宫内膜癌中主动脉下段和上段SLN(Kim等人。,2020年3月)。在这里,我们描述了一种使用ICG识别骨盆SLN的技术,宫颈癌的下和上主动脉旁SLN。
UNASSIGNED:一名46岁女性在宫颈涂片上表现为高度宫颈异型增生/原位癌。宫颈锥形活检显示二级鳞状细胞癌(浸润深度6.8mm,宽度20.8mm)。在临床上,她被上演为早期FIGO期IB2宫颈癌。核磁共振显示双侧髂淋巴结肿大。额外的PET-CT显示盆腔淋巴结肿大的FDG摄取。鉴于影像学发现,计划进行分期机器人骨盆和主动脉旁SLN手术,在选择主要治疗(根治性子宫切除术或化疗放疗)之前。ICG被注射到宫颈基质中,和机器人骨盆和主动脉旁SLN夹层(使用FireflySystem®,直观外科公司)启动15分钟和35分钟,分别,宫颈注射后。
结果:本视频演示了ICG在绘制双侧原发性骨盆SLN中的应用,二级和三级主动脉旁SLN分别位于下主动脉旁区域和上主动脉旁区域,在宫颈癌中。病理显示左侧有一个转移性骨盆SLN,其他4个盆腔SLN均为阴性;二级/下(n=3)和三级/上(n=5)主动脉旁SLN均为阴性,以及非SLN(n=8)。
结论:ICG在主动脉旁SLN标测中的应用应进一步研究和验证,以对局部晚期宫颈癌和影像学可疑淋巴结进行手术分期。
BACKGROUND: Indocyanine green (ICG) for pelvic sentinel lymph node (SLN) mapping is well established in endometrial cancer (Persson et al., 2019 Jul). However, the application for para-aortic SLNs is less reported; and the detection rate of para-aortic SLNs, mainly after cervical injection of ICG, varies between 14% and 71% (Rossi et al., 2013 Nov; Kim et al., 2020 Mar; Gallotta et al., 2019 Mar). One recent report differentiates between lower and upper para-aortic SLNs in endometrial cancer (Kim et al., 2020 Mar). Here we describe a technique using ICG for identifying pelvic SLNs, lower and upper para-aortic SLNs in cervical cancer.
UNASSIGNED: A 46-year old female presented with high grade cervical dysplasia/carcinoma in situ on cervical smear. Cervical cone biopsy revealed a grade two squamous cell carcinoma (depth of invasion 6.8mm, width 20.8mm). Clinically she was staged as an early FIGO-stage IB2 cervical cancer. NMR revealed bilaterally enlarged iliac lymph nodes. Additional PET-CT revealed FDG-uptake in the enlarged pelvic lymph nodes. In view of the imaging findings a staging Robotic pelvic and para-aortic SLN procedure was planned, prior to select the primary treatment (radical hysterectomy or chemo-radiation). ICG was injected into the cervical stroma, and a robotic pelvic and para-aortic SLN dissection (using Firefly System ®, Intuitive Surgical Inc.) was initiated 15 minutes and 35 minutes, respectively, after cervical injection.
RESULTS: This video demonstrates the application of ICG for mapping bilateral primary pelvic SLNs, secondary and tertiary para-aortic SLNs in the lower and upper para-aortic region respectively, in cervical cancer. Pathology revealed one metastatic pelvic SLN on the left side, other four pelvic SLNs were negative; both the secondary/lower (n = 3) and tertiary/upper (n = 5) para-aortic SLNs were negative, as well as the non-SLNs (n = 8).
CONCLUSIONS: The application of ICG for para-aortic SLN mapping should further be investigated and validated in staging surgically locally advanced cervical cancer and those with suspicious lymph nodes on imaging.