背景:宫颈癌是发展中国家女性恶性肿瘤相关死亡的第四大常见原因。据估计,宫颈癌每年导致全球527.600例新病例和265.700例死亡。
目的:本研究旨在通过对所有淋巴结(LN)进行超标记来评估宫颈癌患者,哨兵LN(SLN)和非SLN,以提高LN转移检测的敏感性和诊断在宫颈癌的准确性与五年随访。
方法:这是一项2017年至2019年在蒂米什瓦拉市急诊临床医院进行的14例宫颈癌病例的回顾性研究,罗马尼亚。这些病例是根据其LN受累的高风险选择的,但术中病理LN阴性。在重新评估29例石蜡块活检样本后,14例纳入研究,符合手术活检样本超稳定的所有标准。
结果:纳入研究的患者年龄为43至70岁(中位数:57.14岁)。根据国际妇产科联合会(FIGO)分期,大多数患者处于IB期:7例(50%).研究显示,患者年龄与FIGO分期呈正相关,Pearson的相关系数为0.707,p值小于0.05,表明老年患者更有可能被诊断为更高的FIGO分期。平均随访34.5个月,中位随访时间为36个月(6~60个月)。我们获得了167个节点,平均为11.92个节点/案例。用超稳定方法发现21个LN为阳性。我们检测到11例LN伴巨大转移(MAC)(52.38%),7例微转移(MIC)(33.3%),和三个肿瘤细胞胰岛(14.4%)。这将是新诊断的超稳定病例的13%为阳性淋巴结。这种超分类方法在14例患者中检测到8例(57.1%)的淋巴结MIC,最初使用常规苏木精和伊红(HE)方法检测LN受累呈阴性。这些患者微转移的检测强调了超稳定的高敏感性,这8例患者中4例(28.57%)随后复发,进一步凸显了这一点.该研究还发现FIGO标准化与这些患者中发现的MIC数量之间没有相关性。
结论:预测宫颈LN转移(LNM)对于提高生存率和减少复发至关重要。很少有小型队列研究使用超稳定方法来评估非SLN;他们中的大多数只评估SLN。我们在研究中表明,超稳定方法,在SLN和非SLN的情况下,与H&E分析相比,新结节诊断阳性率为13%。根据超分类方法,在所有病例中超过50%(8/14)发现了非SLN的转移受累。此外,我们的研究证实,对于SLN骨盆LN中MIC和MAC的存在,SLN超稳定的敏感性很高。因此,我们认为超突变是对早期宫颈癌患者进行SLN分析的最有效方法,双边检测更可取,显著减少假阴性结果。SLN的常规使用以及超稳定将导致更准确的手术分期和更好的肿瘤随访。
BACKGROUND: Cervical cancer is the fourth most common cause of malignant tumor-related deaths among women in developing nations. Cervical cancer has been estimated to cause 527.600 new cases and 265.700 deaths globally per year.
OBJECTIVE: This study aimed to evaluate patients with cervical cancer by ultrastaging all the lymph nodes (LN), sentinel LN (SLN) and non-SLN, to increase the sensitivity of the detection of LN metastases and the diagnostic accuracy in cervical cancer with a five-year follow-up.
METHODS: This is a retrospective study of 14 cervical cancer cases from 2017 to 2019 at the Municipal Emergency Clinical Hospital of Timisoara, Romania. The cases were selected based on their high risk of LN involvement but negative intraoperative pathologic LN. After re-evaluating all paraffin block biopsy samples from 29 cases, 14 cases were included in the study, which met all criteria for ultrastaging on surgical biopsy samples.
RESULTS: Patients\' ages included in the study ranged from 43 to 70 years (median: 57.14 years). According to the International Federation of Gynecology and Obstetrics (FIGO) staging, the majority of the patients were in stage IB: seven cases (50%). The study revealed a positive correlation between patient age and FIGO staging, with Pearson\'s correlation coefficient of 0.707 and a p-value of less than 0.05, indicating that older patients were more likely to be diagnosed with a higher FIGO stage. The mean follow-up was 34.5 months, and the median follow-up was 36 months (range: 6-60 months). We obtained 167 nodes, with a mean of 11.92 nodes/case. Twenty-one LN were found to be positive with the ultrastaging method. We detected 11 LN with macrometastases (MAC) (52.38%), seven with micrometastasis (MIC) (33.3%), and three with tumor cell islets (14.4%). That would be 13% of newly diagnosed ultrastaging cases as positive nodes. This ultrastaging method detected nodal MIC in eight (57.1%) out of the 14 patients, who initially tested negative for LN involvement using the routine Hematoxylin and Eosin (HE) method. The detection of micrometastases in these patients underscored the superior sensitivity of ultrastaging, which was further highlighted by the subsequent relapse of four (28.57%) out of these eight patients. The study also found no correlation between the FIGO standardization and the number of MIC found in these patients.
CONCLUSIONS: Predicting cervical LN metastasis (LNM) is crucial for improving survival rates and reducing recurrence. Very few small cohort studies used an ultrastaging method to assess non-SLNs; most of them only assessed SLNs. We showed in our study that the ultrastaging method, both in the case of SLN and non-SLN, is superior compared with H&E analysis, with a 13% rate of new positive nodule diagnosis. Metastatic involvement of non-SLN was found in over 50% of all cases (8/14) according to the ultrastaging method. Additionally, our study confirms that the sensitivity of SLN ultrastaging is high for the presence of both MIC and MAC in SLN pelvic LN. As a result, we feel that ultrastaging is the most effective method for SLN analysis in patients with early-stage cervical cancer, and bilateral detection is preferable, significantly reducing false-negative results. The routine use of SLN along with ultrastaging would lead to more accurate surgical staging and better oncological follow-up of cases.