| Objective The purpose of this study was to research treatment significance of SLN in early-stage endometrial cancer, radiologic safety of SLNB marked with 99mTC and feasibility of SLNB as an alternative to systematic lymphadenectomy. simultineously, the value of preoperative lymphoscintigraphy in SLNB and intraoperative diagnosis of SLN in endometrial cancer. To set up proper pathological detection methods of micrometastasis in SLN. Methods 59 patients from September 2007, who underwent comprehensive staging surgery, were treated with SLNB followed by systematic lymphadenectomy using 99mTc. TLD was used to detect radiation dose received by patients and medical stuff in 57 patients. Analyzed the results of SLNs in preoperative lymphoscintigraphy and intraoperative detection of gamma detector. Pathological diagnosis was used for the intraoperative diagnosis of SLNs. SS pathological analysis combined with IHC,111 SLNs of 45 patients were identified negative by HE using SS at 100μm intervals, H-E and IHC staining were performed for each slice. Compare the effect on metastasis detection rate between different methods and intervals.Results SLNs were successfully identified in 57 of 59 (96.6%) patients, the accuracy rate was 96.1%, with 8.3% false negative rate.97.7% of SLNs were located at pelvic. No relationships were found of the success rate and false negative rate with Clinicopathological factors. The radiation dose received at the uterine cavity was significantly higher than that at the thoracic gland and cavitas pelvis gonad of the patients. The radiation dose is safe to patients and medical stuff, and annually surgeons perform 1000 SLNBs safely also.SLNs from 52 patients were determined successfully by lymphoscintigraphy, success rate was 88.1%. The failure rate of SLN in lymphoscintigraphy was not associated with histopathologic type, tumor location and myometrial invasion, and time interval from injection of radiocolliod to surgery. There was a significant difference between the success rate of SLN in operation and the successful and failure group of pre-operation lymphoscintigraphy. Whether lymphoscintigraphy image succeeds or not identified, that there was no significant difference in the false negative rate.The diagnoses of TIC of 128 SLNs were as follows:sensitivity 52.9%, specificity 86.5%, false negative rate 47.1%, false positive rate 13.5%, and accuracy 82.0%, respectively. The intraoperative pathological diagnoses with frozen section,EPOS and combined diagnoses of intraoperative frozen and TIC were as fellows:sensitivity 88.2%.100%,94.1%, specificity 100%,100%,100%, false negative rate 11.8%,0%,5.9%, false positive rate 0,0,0, and accuracy 98.4%,100%,99.2%, respectively. In 45 SLN negative cases, using SS and combined with IHC, positive detection rate increased 11.1% and 15.6%, respectively. Combined with IHC,8 cases of positive SLN were added. For the detection of MMs, 3 cases by H-E staining,4 cases by IHC and 4 cases by SS combined with IHC. There was a great difference between the method of H-E staining and SS combined with IHC. For ITCs,1 case by H-E staining,1 case by IHC and 2 cases by SS combined with IHC. There was a great difference between the method of H-E staining and SS combined with IHC. In all 1175 slides,35 slides were added by SS combined with IHC than that of SS pathology. Significance could be drawn between the method of H-E stain and SS combined with IHC for the detection of positive slides. Rate of detection of MMs in 300μm had a significant advantage. Conclusion①SLN could accurately predict retroperitoneal lymph node status in early-stage endometrial cancer.②Most of SLNs were located at pelvic, espescially internal iliac and obturator node.③No relations were found between the success rate, false negative rate and age, tumor size, tumor location, histopathological type, myometrial invasion, level of CA125.④The accuracy rate was high enough for SLNB as an alternative to systematic retroperitoneal lymphadenectomy in endometrial cancer.⑤The SLNB in endometrial cancer was radiologically safe both for patients and medical stuff, It was safe for surgeons to perform 1000 SLNBs annually.⑥Preoperative lymphoscintigraphy was unnecessary for operation.⑦The combined intraoprative diagnosis of SLNs with frozen section and EPOS immunohistochemistry or TIC had very high accuracy and very low false negative rate.⑧SS H-E combined with IHC could further significantly improve the detection of SLN MMs compared to SS H-E alone.300-μm might be the optimal interval for SS.
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