| ObjectiveThis study was designed to map sentinel lymph nodes(SLN)by using indocyanine green as a tracer in laparoscopic surgery for endometrial carcinoma(EC)with high-risk factors.To explore the method and feasibility of using SLN biopsy in retroperitoneal lymph node in EC with high-risk factors.to evaluate the forecasts of the SLN for retroperitoneal lymph node status for high risks EC.Methods46 cases of high-risk EC were selected from August 2016 to March 2018.At the beginning of the operation,a cervical injection with indocyanine green was injected at 3 and 9 o’clock.The earliest high-level fluorescent signal lymph nodes as SLN.The red and blue patterns can be seen in the green nodules and the red core group can be seen to confirm SLN again.under the direct vision of laparoscope and removed,to send frozen and routine pathological examination.Continue to laparoscopic hysterecto-my+bilateral salpingo+ retroperitoneal lymphadenectomy ± omentumectomy.The location,time,number,frozen and conventional pathological results of SLN and retroperitoneal lymph nodeswere recorded in all patients.Results1.In the 46 patients with EC in high-risk factors,140 SLNs were excised,1058 pelvic lymph nodes were removed,and abdominal aortic lymph node 581.At least one of SLN was detected successfully in 45 patients,82 sides of 46 patients,Overall detection rates was 89.1%(82/92),the negative predictive value((NPV)was 97.3%(36/37),the sensitivity and the false negative rate(FNR)were 85.7%(6/7)and 14.3%(1/7),respectively,When the SLN algorithm was applied retrospectively the FNR was 10.0%(1/10)and the sensitivity up to 90.0%(9/10).2.At first 19 patients,The total detection rate 86.8%(33/38),NPV was 93.8%(15/16),the FNR was 25.0%(1/4),After 19 cases of experience,the total detection rate of SLN was 91.0%(49/54),negative predictive value 100%(21/21),and the false negative rate was reduced to 0(0/6).3.Of the 45 patients who successfully detected SLNs,140 SLNs were detected,The median number was 2(range0–6)per patient.and the mapping time of SLN was 0-19 minutes,with an average of 7 minutes.In EC,SLN was found in external iliac lymph nodes of 49,accounting for 35%(49/140).The obturator lymph nodes were 48,accounting for 34.3%,and the total iliac lymph nodes were 16,accounting for 11.4%.There were 23 internal iliac lymph nodes,16.4%,and 4 para-aortic lymph nodes,accounting for 2.9%.4.140 pieces of SLNs were detected intraoperative frozen pathological examination,with 13 pieces of SLNs positive,10 patients with EC have metastatic lymph nodes,1 case of SLN negative,detected by the abdominal aorta positive lymph nodes,1 case of pelvic negative SLNs and abdominal aorta positive lymph nodes,detected by the left common iliac positive SLN.2 case of SLNs was not detected in one side,pelvic lymph node positive,3 cases of SLNs positive,detected NSLN positive,3 cases of SLNs positive,detected NSLN negative.5.The single factor analysis of risk factors the SLN Mapping is no relation to high risks in EC and the lymph node metastasis of EC is associated with muscular infiltration depth(P = 0.047)and Lymphovascular space invasion(P=0.012),Analysis of SLNs and the consistency of pelvic lymph node metastasis status,detected by Kappa coefficient was 0.934,P<0.001,suggesting highly consistency.Conclusions1.With the high risk factors of EC after cervical injection of indocyanine green laparoscopic,SLN mapping following SLNs algorithm has high detection rate and accuracy,And the SLN detection is a relatively safe and feasible method.2.The SLNs of EC most commonly occurs in the external iliac and obturator lymph nodes,There is a high consistency with the standardization of the SLN drainage pathway,and SLN has a higher value in the evaluation of lymph node metastasis.3.In this study,single factor analysis showed that lymph node metastasis were related to some high-risk factors,The analysis of SLNs and the consistency of pelvic lymph node metastasis status,detected by Kappa coefficient,suggest that SLN detection is highly consistent with pelvic lymph node metastasis,and SLN biopsy is suitable for EC with high risk factors.4.Lymph node metastasis is easily(P=0.001)in high-risk groups which should be focused on follow-up treatment.Lymphatic vascular invasion and deep muscle infiltration may increase the rate of false negatives,we should continue to monitor the index after enlarging the sample size. |
