Kliničko značenje određivanja limfnog čvora čuvara u početnom stadiju raka stidnice [Clinical significance of sentinel lymph node detection in early vulvar cancer]

Stepanić, Vesna (2011) Kliničko značenje određivanja limfnog čvora čuvara u početnom stadiju raka stidnice [Clinical significance of sentinel lymph node detection in early vulvar cancer]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

OBJECTIVES. To investigate the real sentinel lymph node (SLN) in vulvar cancer, the best method of detection, and the significance of the absence of metastases in SLN for spread of disease. ----- MATERIALS AND METHODS. Twenty-eight patients with early vulvar cancer (FIGO I and II) were treated in the Department of Gynecologic Oncology, University Clinic Zagreb, from January, 1st, 2004 to December, 31st, 2010. Detection of SLN was done by using technetium-99m radioisotope, standard sectioning with haematoxylin and eosin staining (H&E) and immunostaining by cytokeratin cocktail, AE1/AE3. All patients underwent “triple separate incision” surgical procedure. Data were statistically analyzed. ----- RESULTS. In all 28 patients, the detection of SLNs was performed. A total of 346 were removed, and 57 of those were SLNs. All positive SLNs were detected (kappa coefficient 1.000, P<0.001). When the primary lesion was situated laterally, the SLN was detected among the ipsilateral inguinofemoral lymph nodes. When the primary lesion was situated in the midline and bilaterally, the SLNs were detected among bilateral inguinofemoral lymph nodes. Chi-square-test with Yates-correction and, alternatively Fisher’s test proved that the reoccurrence of disease is more often when the SLNs are positive (P=0.001; P=0.002). Patients with negative SLNs had a median time interval to reoccurrence of disease of 12 months (5.0-12.0 months) in contrast with patients with positive SLNs who had a median time interval to reoccurrence of disease of 1 month (1.0-1.0 months) (Mann-Whitney U-test, P=0.001). With Cox regression analysis, at least one positive SLN was marked as a very important factor for reoccurrence of disease with odds chance of 4.11 (P=0049, 95% CI 1.21 – 13.89). ----- CONCLUSION. By using technetium-99m radioisotope, H&E staining, and immunostaining with AE1/AE3, recognition accuracy of positive SLN is 100%. Analyzing parameters all together, the status of SLNs is the most important prognostic factor.

Abstract in Croatian

UVOD. Cilj istraživanja bio je ustanoviti limfni čvor čuvar kod raka stidnice, najpogodniji način njegove detekcije, te koliko odsustvo metastaza u sentinel limfnom čvoru korelira s proširenošću bolesti. ----- ISPITANICE I METODE. Na uzorku od 28 bolesnica s početnim stadijem raka stidnice, liječenih u Zavodu za ginekološku onkologiju Klinike za ženske bolesti i porode KBC-a Zagreb i MF-a Sveučilišta u Zagrebu, od 01. siječnja 2004. do 31. prosinca 2010, određivali smo sentinel limfni čvor kombinirajući limfoscintigrafsko obilježavanje radioaktivnim tehnecijem, patohistološku te imunohistokemijsku analizu preparata. Sve su bolesnice operirane kirurškom metodom „3 u 1”. Podaci su statistički obrađeni. ----- REZULTATI. U 28 ispitanica određivan je sentinel limfni čvor. Ukupno je odstranjeno 346 limfnih čvorova, od toga je 57 bio SLN. Točno su prepoznati svi pozitivni limfni čvorovi (kappa koeficijent podudarnosti od 1,000 i razina značajnosti P<0,001). Kod lateralnog sijela primarnog tumora SLN je dokazan ipsilateralno, kod centralnih i multifokalnih bilateralno. χ2-testom uz Yatesovu korekciju i, alternativno Fisherovim egzaktnim testom dokazali smo kako je recidiv češći u bolesnica s pozitivnim SLN (P=0,001; P=0,002). Ispitanice koje su imale negativne sentinel limfne čvorove imale su medijan vremena do pojave recidiva od 12 (5,0 – 12,0) mjeseci naprama ispitanicama koje su imale pozitivan sentinel limfni čvor u kojih je medijan vremena bio 1 mjesec (1,0 – 1,0) (Mann-Whitneyjev U-test, P=0,001). Regresijskim modelom je kao značajan prediktor rizika za nastanak recidiva bolesti izdvojeno prisustvo barem jednog pozitivnog limfnog čvora čuvara s omjerom šansi od 4,11 (P=0,049, 95% CI 1,21-13,89). ----- ZAKLJUČAK. Kombinirajući limfoscintigrafsko obilježavanje sentinel limfnog čvora radioaktivnim tehnecijem, Tc-99m, patohistološku analizu preparata na standardni način (H&E) i imunohistokemijsku analizu (AE1/AE3), točnost prepoznavanja pozitivnog sentinel limfnog čvora je 100%. Analizirajući sve parametre ukupno utvrdili smo kako je nalaz limfnog čvora značajan prediktor pojave recidiva bolesti, odnosno najvažniji nezavisni prognostički čimbenik.

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