子宫癌诊断A-微创路线

在妇女以高品位的研究子宫癌，研188bet体育网址究人员在MD安德森癌症中心发现了前哨淋巴结（SLN）映射准确地确定淋巴结阳性的，高风险的子宫癌的妇女，当前瞻性比较完整的盆腔及腹主动脉旁淋巴结清扫（LAD），现行标准关心。

该研究提供了保证，该微创方法可能有一天作为最常见的妇科恶性肿瘤的分期工具 - 象现在这样对其他癌症 - 用更少的相关风险和并发症给患者。

帕梅拉·索利曼，医学博士，副教授Gynecologic Oncology and Reproductive Medicine，提出的调查结果，在对妇女癌症在芝加哥妇科肿瘤年会的会的全体会议。

According to the American Cancer Society, 54,870 women will be diagnosed with uterine cancer in 2015, and 10,170 will die from the disease. It’s the most common gynecological cancer, says Soliman, and with its strong association with obesity, there’s been an increase both in overall incidence as well as the number of younger women diagnosed with disease.

For women with uterine cancer, the current standard of care for initial evaluation usually involves a hysterectomy and complete LAD. However, in addition to obesity, other risk factors associated with the disease include diabetes and hypertension. These comorbidities inherently can make surgery more difficult and put women at higher risk for complications such as lymphedema and swelling, explains Soliman.

SLN mapping涉及使用染料和/或放射性物质的确定在哪些癌症是最有可能扩散的第一淋巴结。索利曼说，可以想像，癌症应该出现在身体的其他节点和地方之前前哨淋巴结。

As the technique has been proven and accepted for the staging of diseases such as breast and vulva cancers and melanoma, other institutions have looked at the technique in uterine cancer. Yet the MD Anderson research is the first validation study in which patients received both the mapping and the complete LAD.

“It was important for us to understand that if we performed only the sentinel lymph node mapping, there would be patients who wouldn’t be identified with appropriate disease, as well as to understand the false negatives rate of the technique,” she explains. “If we could still identify patients with positive nodes yet not have to do a full lymphadenectomy, we could potentially decrease the morbidity of the procedure and still appropriately determine post-operative therapy.”

对于单机构前瞻性研究，MD安德森目前正在招收100例高风险，三级子宫癌。会上，索利曼报道了73例入组患者，60人是可评估的。妇女的平均年龄和身体质量指数为61.1岁及30.1，分别。患者被认为如果评估前哨尝试并进行充分的小伙子。所有参与者的手术获得了PET / CT之前。

To date, when comparing the mapping results to final surgical pathology, the researchers found that each patient with positive lymph nodes was also found to have a positive SLN — meaning no false negatives were found. In the evaluable women, the researchers were able to identify at least one positive SLN and bilateral SLN in 92.3% (56) and 60.7% (37) of the patients, respectively. These findings are consistent with other research to date, showing the feasibility of the procedure.

For each patient with a node positive for metastatic disease, at least one SLN was also positive for metastatic disease, for a rate of both specificity and sensitivity of 100%.

With further study, the findings could impact standard of care for women with both high- and low-risk disease, says Soliman.

“This study serves as a proof of principal and based on our early results, finds an acceptable false negative rate,” she explains. “Potentially, if we continue to see such promising results, and can identify patients with positive nodes by sentinel lymph node mapping only, it could change practice for the overall management of the endometrial cancer’s general population, much like we have for others diseases.”

Soliman and her colleagues will continue to enroll patients with high-risk endometrial cancer, and the study of SLN in women with early-stage, low-risk disease is ongoing.