| Objective SLNB(Sentinel lymph node biopsy)in the operation of early cervical cancer is considered to be superior to traditional pelvic lymphadenectomy,However,the use of intraoperative cases and the choice of tracer is still controversial.In this study,SLNB,was performed in patients with early cervical cancer to explore whether CNP(carbon nanoparticles)can be used as a tracer for SLN(sentinel lymph node),and the factors that may affect the detection rate of SLNs were discussed.Methods A total of 158 patients with early cervical cancer(including transabdominal or laparoscopic surgery)in Dalian Obstetrics and Gynecology Hospital from November2017 to June 2019 were selected.The tumor tissue was avoided during the operation.0.3 ml of CNP was injected into the mucous layer of the cervix at 3,6 and 9 points,and0.1 ml was injected at 12 points of the cervix.The depth of injection was about 2mm.After laparoscopic or intraperitoneal lymphatic drainage,all patients with black-stained SLNs,in 20 min underwent modified radical hysterectomy / radical hysterectomy +pelvic lymphadenectomy with or without aortic lymphadenectomy after SLNB.The SLNs resected during the operation was sent to the pathology room for examination together with other lymph nodes and uterus samples after the operation,and the location,number,development time,operator,mode of operation and other basic conditions of the SLNs were recorded.The characteristics of the cases were summarized by postoperative pathological results.Using IBM SPSS 25.0 software,? 2 test and Fisher's exact text were used to compare between groups.Binary Logistic regression analysis was used to analyze the influencing factors(age,BMI,conization,neoadjuvant chemotherapy,and LVSI).If P <0.1,multivariate analysis was included.And the Kappa test of SLNs and PLN(Pelvic lymph node)was performed.The sensitivity,specificity,accuracy and negative predictive value of SLNs were calculated.Results1.In the study,the total detection rate of SLNs was 86.1%(136 cases / 158 cases),andthe bilateral detection rate was 60.8%(96 cases / 158 cases).The total detection rate of tumor size 2-4cm was 91.5%,and the bilateral detection rate was 69.0%.There was no significant difference in the detection rate between groups with different lesion sizes.The sensitivity of SLNs was 86.7%,the specificity was 99.1%,the accuracy was 98.5%,and the negative predictive value was 98.3%.There were two false negative cases.2.A total of SLNs 536 were detected in this study,with an average of 3.9 per patient.SLNs was mainly distributed in external iliac lymph nodes(42.7%),internal iliac lymph nodes(21.8%),obturator lymph nodes(27.4%),and a few common iliac lymph nodes and para-uterine lymph nodes.3.In the univariate analysis of the effects of age,BMI,conization,neoadjuvant chemotherapy and LVSI on the total detection rate of SLNs,there was no statistical significance.In the univariate analysis of the influence of bilateral detection rate of SLNs,there was statistical significance in age,BMI and conization.Further multivariate analysis was performed,Age(OR=0.925;95%CI=0.885-0.967;P=0.001),BMI(OR=0.878;95%CI=0.781-0.981;P=0.021)and conization(OR=2.916;95%CI=1.295-6.564;P=0.010)were significantly different(p < 0.05).4.In this study,the consistency of cancer metastasis between SLNs and PLNs was tested by Kappa test,and the Kappa value was 0.93 and p < 0.01,which showed a high degree of consistency between the two groups.Conclusion1.CNP can be used in SLNB technology of early cervical cancer.2.SLNB technique can also be used in patients after conization,but the detection rate of bilateral SLNs is lower.If there is no SLN detected on one side,all PLNs on that side still need to be removed.3.It is safe to use SLNB in patients with early cervical cancer whose tumor size is less than 4cm and whose age and BMI are lower.4.Patients with tumor size > 2cm and LVSI+ should be combined with pathological ultrastaging or other techniques to detect micrometastasis of lymph nodes. |
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