Endometrial cancer intraoperative sentinel lymph node identification can effectively guide treatment.

Am J Transl Res 2023;15(10):6115-6121 www.ajtr.org /ISSN:1943-8141/AJTR0151239 Original Article Endometrial cancer intraoperative sentinel lymph node identification can effectively guide treatment Fanchen Zhou1, Bangruo Qi2 Department of Gynecology, Dalian Central Hospital, Dalian, Liaoning, China; 2Department of Obstetrics and Gynecology, Sanya Women and Children’s Hospital, Sanya, Hainan, China 1 Received May 16, 2023; Accepted September 15, 2023; Epub October 15, 2023; Published October 30, 2023 Abstract: Objective: To explore the significance of intraoperative sentinel lymph node (SLN) identification in endometrial cancer. Methods: We retrospectively analyzed the clinical data of 56 patients with intraoperative SLN recognition (group A) and 50 patients without intraoperative SLN recognition (group B). SLN and pelvic abdominal lymph node distribution, SLN recognition rate, SLN recognition effect, mortality, the incidence of adverse events, and cumulative survival rate were statistically analyzed. Results: SLN were identified and removed in 41 of the 56 patients, with a recognition rate of 82.14% (46/56). The sensitivity of SLN was 83.72%, the specificity was 84.62%, and the negative predictive value was 61.11%. There were 15 patients with no SLN metastasis found in the pathological examination during the operation, among which two patients with poorly differentiated adenocarcinoma and clinical stage II patients underwent immunohistochemical staining, and three patients showed SLN micro-metastasis but no cancer tissue metastasis in the lymph node dissection. There was no significant difference in the incidence of total adverse events between group A and group B (P>0.05). The cumulative survival rate of group A was higher than that of group B (P=0.018). Conclusion: Intraoperative SLE identification can avoid false negative results, is safe and feasible, and can prolong the survival time of patients with endometrial cancer. Keywords: Endometrial cancer, sentinel lymph node, identification, pathological examination, accumulate survival rate Introduction Endometrial cancer (EC) is a malignant tumor type of the female reproductive system, and its incidence is second only to cervical cancer, with an increasing trend of occurrence [1]. At present, the primary treatment for EC is a surgery, which mainly includes hysterectomy and pelvic and abdominal lymph node dissection [2]. Study [3] has pointed out that lymph node metastasis of endometrial cancer is random, and the possibility of lymph node metastasis is only 10% in patients with clinical stage I to stage II. Another study [4] showed that 80% of endometrial cancers were diagnosed at the early stage, and there was only less than 4% developed lymphatic metastasis in early endometrial cancers without high-risk factors. Some clinical studies have shown that systematic lymph node dissection for patients with earlystage endometrial cancer cannot improve survival [5]. In addition, extensive blind lymph node dissection is prone to complications (such as postoperative lymphocytes and lower limb lymphedema) and does not improve the prognosis of patients. Therefore, how to evaluate the status of lymph node metastasis individually is a priority in the treatment of endometrial cancer. The sentinel lymph nodes (SLN) are the first lymph nodes through which tumor metastasis occurs, and it can reflect lymph nodes involved in all subsequent areas [6]. Intraoperative SLN identification and pathological examination can help determine whether to perform lymph node dissection and the scope of dissection, which has been successfully applied in cervical cancer, breast cancer, vulvar cancer and other cancers, providing guidance for lymph node dissection scope for malignant tumors [7-9]. After reviewing the literature, we found a few reports on the application of intraoperative SLN recognition in endometrial cancer, and whether SLN recognition is necessary for endometrial cancer treatment is still in Sentinel lymph node identification for endometrial cancer examination results were missing. Patients with intraoperative SLN recognition were included in group A, and patients without intraoperative SLN recognition were included in group B. One percent methylene blue was the tracer used in patients undergoing intraoperative SLN identification, and these patients also underwent pathological examination. Figure 1 is the flow chart of this study. Clinical data collection Figure 1. The technical steps of this study. To explore the significance of intraoperative sentinel lymph node (SLN) identification in endometrial cancer, clinical baseline data, SLN test data, and pathological examination results of 106 patients with endometrial carcinoma were analyzed retrospectively. SLN, sentinel lymph node. debate. Therefore, this study analyzed the application value of intraoperative SLN identification and pathological examination in endometrial carcinoma. Material and methods Data source The Medical Ethics Committee of Dalian Central Hospital approved the study. We performed a retrospective analysis of data from 106 patients with endometrial cancer who underwent surgery in our hospital from July 2020 to June 2021. Inclusion criteria: (1) Patients who met the clinical diagnostic criteria for endometrial cancer [10]; (2) Patients who were diagnosed and treated for the first time; (3) Patients who received surgical treatment under general intravenous anesthesia. Exclusion criteria: (1) Patients complicated with malignant tumors other than endometrial cancer; (2) Patients with incomplete data regarding clinical baseline data, SLN test data, and pathological 6116 (1) Clinical baseline data were collected, including age, disease course, body mass index, clinical stage, histological type, degree of differentiation, muscular invasion, cervical interstitial, adnexal metastasis, vascular cancer thrombus, menopause, comorbidities, and tumor size. (2) SLN and pelvic abdominal lymph node distribution of the patients was collected. (3) Incidence of adverse events (including death, upper limb lymphedema, distant metastasis, and regional lymph node recurrence) and cumulative survival rate were also collected. The end time of follow-up was December 2022. Overall survival time was defined as the time from the discovery of EC to death or the end of follow-up. Judging criteria During the operation, doctors injected 1% methylene blue into the uterus and identified the first blue-stained lymph node. The SLN was removed and sent for frozen pathological examination. The positive expression of cytokeratin (CK) in SLN was observed by immunohistochemistry. CK positive expression is defined as cells with brown-yellow granules visible in the cytoplasm of lymph nodes. The patients with lymph node metastasis were performed with lymph node dissection. SLN identification and inspection methods (1) All patients underwent general intravenous anesthesia; (2) After laparotomy, doctors reta (...truncated)