Kliničko značenje određivanja limfnoga čvora čuvara u ranim stadijima raka vrata maternice FIGO stadija IA2–IIA1

Planinić, Pavao (2019) Kliničko značenje određivanja limfnoga čvora čuvara u ranim stadijima raka vrata maternice FIGO stadija IA2–IIA1. PhD thesis, Sveučilište u Zagrebu.

PDF Download (1MB)

Abstract

Research goals: Determine the success of sentinel lymph node detection in the early stages of cervical cancer by applying dilute methylene blue to 8 places in the uterine cervix. Determine the diagnostic value of the sentinel lymph node biopsy in assessing the status of pelvic lymph nodes. Determine the location of the sentinel lymph nodes in the early stages of cervical cancer. ----- Examinees and methods: This study included 49 patients who were treated for cervical cancer. We did not have complete data in 3 patients. The statistical analysis included 46 patients. Diluted methylene blue is injected intracervicaly prior to surgery at 4 quadrants and intracervicaly at 4 quadrants on the level of transition of the cervix to vaginal vaults. After detecting and removing the sentinel lymph nodes, complete pelvic lymphadenectomy and radical hysterectomy is performed in all patients. ----- Results: A total of 1338 lymph nodes (29 per patient) were removed, 254 were sentinel lymph nodes (5.5 per patient). Sentinel lymph node detection rate was 100%, and in all patients sentinel lymph nodes were detected bilaterally. There was no difference in sentinel lymph node detection rates depending on the age of the patient, stage of the disease and the size of the tumor. Lymph node metastases were found in 8 patients (17.4%). By patient-specific analysis, the sensitivity of lymph node biopsy was 87.5% and negative predictive value was 97.44%. By side-specific analysis, the sensitivity of lymph node biopsy was 88.89%, and negative predictive value was 98.81%. The lymph nodes were detected: 43.21% obturator region, 41.15% interiliac region, 14.4% external iliac region, 0.8% common iliac region and 0.4% parametrial. ----- Conclusion: Sentinel lymph node mapping by applying diluted methylene blue intracervicaly to 8 places is a quick, simple and easily applicable method. The results of this study show a high bilateral sentinel lymph node detection rate by using our labeling method. We recommend using our labeling method in further investigation of sentinel lymph node biopsy in cervical cancer. Bilateral negative sentinel lymph nodes accurately predict regional lymph node status.

Abstract in Croatian

Ciljevi istraživanja: Odrediti uspješnost otkrivanja limfnih čvorova čuvara kod ranih stadija raka vrata maternice aplikacijom razrijeđenog metilenskog modrila na 8 mjesta u vrat maternice. Odrediti dijagnostičku vrijednost biopsije limfnih čvorova čuvara u procjeni statusa zdjeličnih limfnih čvorova. Odrediti smještaj limfnih čvorova čuvara kod ranih stadija raka vrata maternice. ----- Ispitanice i metode: U naše istraživanje je uključeno 49 pacijentica operiranih zbog raka vrata maternice. Kod 3 bolesnice nismo imali potpune podatke te smo u statističku obradu uključili 46 bolesnica. Prije operacije aplicirali smo 8 ml razrijeđenog metilenskog modrila u vrat maternice u 4 kvadranta u te dodatno u 4 kvadranta na spoju vrata maternice i svodova rodnice. Nakon otkrivanja i odstranjivanja limfnih čvorova čuvara kod svih pacijentica je učinjena kompletna zdjelična limfadenektomija i radikalna histerektomija. ----- Rezultati: Ukupno je odstranjeno 1338 limfnih čvorova (29 po bolesnici), 254 su bili limfni čvorovi čuvari (5.5 po bolesnici). Stopa otkrivanja limfnih čvorova čuvara je bila 100%. Kod svih bolesnica smo otkrili limfne čvorove čuvare obostrano. Nije bilo razlike u stopama otkrivanja limfnih čvorova čuvara ovisno o dobi bolesnica, stadiju bolesti i veličini tumora. Metastaze u limfne čvorove smo našli u 8 bolesnica (17.4%). Analizom podataka po broju bolesnica osjetljivost biopsije limfnih čvorova čuvara je bila 87.5%, a negativna prediktivna vrijednost 97.44%. Analizom podatak po stranama zdjelice osjetljivost biopsije limfnih čvorova čuvara je bila 88.89%, a negativna prediktivna vrijednost 98.81%. Limfni čvorovi čuvari su otkriveni: 43.21% obturatorno, 41.15% interilijakalno, 14.4% uz vanjsku ilijačnu arteriju, 0.8% uz zajedničku ilijačnu arteriju i u 0.4% u parametrijima. ----- Zaključak: Označavanje limfnih čvorova čuvara aplikacijom razrijeđenog metilenskog modrila na 8 mjesta u vrat maternice je brza, jednostavna i lako primjenjiva metoda. Rezultati ovog istraživanja pokazuju visoku stopu obostranog označavanja i otkrivanja limfnih čvorova čuvara primjenom naše metode označavanja. Preporučamo korištenje naše metode označavanja u daljnjim istraživanjima biopsije limfnih čvorova čuvara kod raka vrata maternice. Obostrano metastatski negativni limfni čvorovi čuvari dobro predviđaju status regionalnih limfnih čvorova.

Actions (login required)

View Item

Downloads