子宫内膜癌前哨淋巴结假阴性患者的临床病理特征分析

摘要/Abstract

摘要：

目的对比子宫内膜癌前哨淋巴结活检病理假阴性与真阴性患者的临床病理特征，探讨前哨淋巴结漏诊的相关因素。方法回顾性分析2020年1月至2022年1月在betway必威登陆网址第一附属医院做前哨淋巴结活检随后行系统性淋巴结切除的患者31例，其中2例假阴性，29例真阴性。检索PubMed从建库至2022年12月关于子宫内膜癌前哨淋巴结假阴性的文献，检索词为“Sentinel lymph node”“Endometrial neoplasms”和“False negative”。提取15例与本院研究方法相似的假阴性患者的临床资料。假阴性组为前哨淋巴结阴性但非前哨淋巴结阳性的假阴性患者共17例，包括本院2例和文献中的15例。真阴性组为前哨淋巴结和非前哨淋巴结均为阴性的真阴性患者29例，均来自本院。对比两组患者的临床病理特征。结果两组患者在肿瘤分级（χ²=6.09，P=0.014）、淋巴脉管间隙浸润（P=0.012）、肌层浸润深度（χ²=9.66，P=0.002）方面的差异均有统计学意义。但是，两组患者组织类型差异无统计学意义（χ²=0.19，P=0.661）。结论肿瘤分级为高级别、肌层浸润深度≥1/2、有淋巴脉管间隙浸润的子宫内膜癌患者行前哨淋巴结活检术有发生假阴性的风险。

关键词:子宫内膜肿瘤,前哨淋巴结,前哨淋巴结活组织检查,假阴性反应

Abstract:

ObjectiveTo compare the clinicopathological features of patients with false negative and true negative pathological biopsy of sentinel lymph nodes in endometrial cancer， and to explore the related factors of missed diagnosis of sentinel lymph nodes.MethodsFrom January 2020 to January 2022， 31 patients underwent sentinel lymph node biopsy combined with systematic lymph node resection in the First Affiliated Hospital of Shandong First Medical University were retrospectively analyzed， of which 2 were false negative and 29 were true negative. PubMed literature on sentinel lymph node false negative of endometrial cancer was searched from the establishment of the database to December 2022， with the search terms “Sentinel lymph node” “Endometrial neoplasms” and “False negative”. A total of 15 cases of false negative patients with similar methods to this study were extracted. In the false negative group， there were 17 false negative patients with sentinel lymph node negative but systemically excised lymph node positive， including 2 cases in our hospital and 15 cases in the literature. The true negative group included 29 true negative patients with negative sentinel and systemic lymph nodes， all from our hospital. The clinicopathologic features of the two groups were compared.ResultsThere were statistically significant differences in tumor grade （χ²=6.09，P=0.014）， lymph vascular space invasion （P=0.012） and myometrial invasion （χ²=9.66，P=0.002） between the two groups. However， there was no significant difference in histological type between the two groups （χ²=0.19，P=0.661）.ConclusionThere is a risk of false negative for sentinel lymph node biopsy in patients with endometrial carcinoma with high-grade tumor， myometrial invasion ≥1/2 and lymph vascular space invasion.

Key words:Endometrial neoplasms,Sentinel lymph node,Sentinel lymph node biopsy,False negative reaction

凡梦思, 陆雅萍, 闫莉. 子宫内膜癌前哨淋巴结假阴性患者的临床病理特征分析[J]. 国际肿瘤学杂志, 2023, 50(5): 274-279.

Fan Mengsi, Lu Yaping, Yan Li. Analysis of clinicopathologic features of false negative sentinel lymph nodes in patients with endometrial cancer[J]. Journal of International Oncology, 2023, 50(5): 274-279.

图/表4

表1

31例子宫内膜癌患者临床资料"

临床资料	M（范围）/例（%）
年龄（岁）	55（29~73）
病理类型
子宫内膜样癌	27（87.1）
浆液性癌	2（6.5）
黏液性癌	1（3.2）
透明细胞癌	1（3.2）
手术病理分期
ⅠA	22（71.0）
ⅠB	2（6.5）
Ⅱ	5（16.1）
ⅢC1	2（6.5）
分级
低级别	23（74.2）
高级别	8（25.8）
肌层浸润深度
<1/2	28（90.3）
≥1/2	3（9.7）
淋巴脉管间隙浸润
否	27（87.1）
是	4（12.9）

表1

表2

关于子宫内膜癌前哨淋巴结假阴性的文献基本信息"

作者	发表年份	样本量	年龄[ $\bar{x}±s$ /M（范围），岁]	体重指数（M（范围）/ $\bar{x}±s$ ，kg/m²）	假阴性数
Altgassen等^{[ 6 ]}	2007	25	64.7±8.5	27.5（19~42）	1
Ballester等^{[ 7 ]}	2011	125	63（38~100）	27（18~54）	3
Favero等^{[ 8 ]}	2015	42	62（44~74）	37（27~48）	3
Ye等^{[ 9 ]}	2019	131	55.8（35~76）	24.8（18.5~37.8）	4
Renz等^{[ 10 ]}	2020	90	61±10	31±8	1
Ruiz等^{[ 11 ]}	2021	278	63.2±10.5	28.4±5.8	1
Xue等^{[ 12 ]}	2022	269	52（29~89）	24.5（15.8~37.4）	2

表2

表3

本院和文献检索共计17例子宫内膜癌前哨淋巴结假阴性患者信息"

示踪剂	注射部位	淋巴脉管间隙浸润	病理类型	浸润范围	分级	级别	前哨淋巴结部位
吲哚菁绿	宫颈	无	子宫内膜样腺癌	<1/2肌层	2	低危	右侧髂外静脉
吲哚菁绿	宫颈	无	子宫内膜样腺癌	<1/2肌层	2	低危	右侧髂外动静脉
蓝色染料	浆膜	NA	子宫内膜样癌	<1/2肌层	2~3	高危	盆腔
吲哚菁绿	宫颈	NA	子宫内膜样癌	<1/2肌层	1	低危	右侧髂外及腹主动脉旁
吲哚菁绿	宫颈和宫底	有	子宫内膜样腺癌	<1/2肌层	3	高危	双侧盆腔和腹主动脉旁
⁹⁹Tc^m	肿瘤下方	有	子宫内膜样腺癌	≥1/2肌层	2	低危	腹主动脉旁
⁹⁹Tc^m	肿瘤下方	有	子宫内膜样腺癌	≥1/2肌层	2	低危	腹主动脉旁
⁹⁹Tc^m	肿瘤下方	无	子宫内膜样腺癌	≥1/2肌层	1	低危	盆腔
吲哚菁绿	宫颈	有	子宫内膜样癌	≥1/2肌层	2~3	高危	盆腔
吲哚菁绿	宫颈	有	子宫内膜样癌	≥1/2肌层	2~3	高危	盆腔
⁹⁹Tc^m和蓝色染料	宫颈	NA	子宫内膜样癌	≥1/2肌层	3	高危	盆腔
⁹⁹Tc^m和蓝色染料	宫颈	NA	子宫内膜样癌	≥1/2肌层	3	高危	盆腔
⁹⁹Tc^m和蓝色染料	宫颈	NA	子宫内膜样癌	≥1/2肌层	3	高危	腹主动脉旁
吲哚菁绿	宫颈	NA	浆液性癌	NA	3	高危	右闭孔1/左髂外2
吲哚菁绿	宫颈	NA	透明细胞癌	NA	3	高危	右髂外2/左髂内3
吲哚菁绿	宫颈	NA	浆液性癌	NA	3	高危	右髂外1/左髂外1
吲哚菁绿	宫颈	NA	浆液性癌	NA	3	高危	右髂外1/左闭孔1

表3

病理特征	假阴性组（n=17）	真阴性组（n=29）	χ²值	P值
组织类型
子宫内膜样癌	13	25	0.19	0.661
其他	4	4
肿瘤分级
低级别	6	21	6.09	0.014
高级别	11	8
淋巴脉管间隙浸润^a
无	3	25	-	0.012
有	5	4
肌层浸润深度^a
<1/2肌层	5	26	9.66	0.002
≥1/2肌层	8	3

表4

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