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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Study of the sentinel node in endometrial cancer at early stages: Preliminary re...
Journal Information
Vol. 31. Issue 5.
Pages 243-248 (September - October 2012)
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Vol. 31. Issue 5.
Pages 243-248 (September - October 2012)
Original article
DOI: 10.1016/j.remnie.2012.06.010
Study of the sentinel node in endometrial cancer at early stages: Preliminary results
Estudio del ganglio centinela en el cáncer de endometrio en estadios iniciales: resultados preliminares
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J.M. Cordero Garcíaa,
Corresponding author
jmcorderogarcia@gmail.com

Corresponding author.
, C.A. López de la Manzanara Canob, A.M. García Vicentea, R.A. Garrido Estebanb, A. Palomar Muñoza, M.P. Talavera Rubioa, J.P. Pilkington Wolla, B. González Garcíaa, A. Soriano Castrejóna
a Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Cuidad Real, Spain
b Servicio de Ginecología y Obstetricia, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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Figures (2)
Tables (3)
Table 1. Staging of endometrial carcinoma (FIGO, 2009) (adapted from Mariani A, Dowdy SC, Podratz KC. New surgical staging of endometrial cancer: 20 years later. Int J Gynaecol Obstet. 2009;105:110–1).
Table 2. Characteristics of the sample studied.
Table 3. Number and anatomical localization of the sentinel lymph nodes (SLNs) detected in the scintigraphic studies and during intraoperative localization.
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Abstract
Aim

To investigate the applicability of the sentinel lymph node biopsy technique in early stages of endometrial cancer.

Material and methods

A prospective study that included consecutive patients with a histological diagnosis of clinical state I endometrial carcinoma was performed. Two doses of 2mCi (74MBq) of 99mTc-albumin nanocolloid were injected in the uterine cervix, and planar and SPECT-CT images were obtained at 1h, and at 24h if no migration of the tracer was observed.

Methylene blue dye was also injected into the cervix immediately prior to the surgery.

A gamma probe was used during the surgical procedure for sentinel lymph node identification.

In all cases, a hysterectomy, double adnexectomy and pelvic lymphadenectomy were performed, carrying out a histological analysis (hematoxylin–eosin) of the sentinel lymph nodes and the lymphadenectomy specimen.

Results

We included 19 patients, with a final diagnoses of endometrioid carcinoma (18 cases) and endometrial stromal sarcoma (1 case). At least one sentinel lymph node was identified in 17 of them (89.5% detection rate).

Twenty-nine sentinel lymph nodes were identified during surgery, all of them negative for neoplastic infiltration. No metastatic invasion was found in the pelvic lymphadenectomy specimens as well.

Conclusions

The sentinel lymph node biopsy technique seems to be a reliable tool in nodal staging of endometrial cancer at early stages, with an acceptable detection rate and high histological correlation.

The low prevalence of lymphatic spread in this group of patients and the encouraging results obtained could make the sentinel lymph node an alternative to routine complete lymphadenectomy.

Keywords:
Sentinel lymph node
Lymphoscintigraphy
Endometrial cancer
Resumen
Objetivo

Estudiar la aplicabilidad de la técnica del ganglio centinela en los estadios iniciales del carcinoma endometrial.

Material y métodos

Estudio prospectivo que incluyó pacientes consecutivas con diagnóstico histológico de carcinoma de endometrio, en estadio clínicamente I. Se inyectaron dos dosis de 2mCi (74MBq) de 99mTc-nanocoloide de albúmina en el cérvix uterino, obteniendo imágenes planares y SPECT-TC de la región pelviana una hora después, y a las 24 cuando no se observó migración del trazador.

Inmediatamente antes de la intervención, se inyectó azul de metileno vía cervical.

Los ganglios centinela se identificaron durante la intervención mediante sonda quirúrgica.

En todas se realizó histerectomía, doble anexectomía y linfadenectomía pélvica bilateral, con estudio histológico (hematoxilina–eosina) de los ganglios centinela y las piezas de linfadenectomía.

Resultados

Incluimos 19 pacientes, con diagnóstico final de carcinoma endometrioide (18 casos), tumor del estroma endometrial (1 caso). Se identificó al menos un ganglio centinela en 17 (tasa de detección del 89,5%).

Se identificaron 29 ganglios centinela en el acto quirúrgico, todos negativos para infiltración neoplásica. Tampoco se observó afectación metastásica ganglionar en las piezas de linfadenectomía.

Conclusiones

La técnica del ganglio centinela puede ser fiable en la estadificación ganglionar del carcinoma endometrial en estadios iniciales, con una aceptable tasa de detección y correlación histológica.

La escasa prevalencia de diseminación linfática en este grupo de pacientes y los alentadores resultados obtenidos podrían hacer de la técnica del ganglio centinela una alternativa a la realización linfadenectomía pélvica completa sistemática.

Palabras clave:
Ganglio centinela
Linfogammagrafía
Cáncer de endometrio

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