| Background: Cervical cancer is still one of the main problems of gynecological tumors now.In recent years,the age of diagnosis of cervical cancer has gradually become more and more young and cervical cancer stays at an early stage when it is clearly diagnosed.With the opening of the national second-child policy and the popularization of late marriage and late childbirth ideas,the need for cervical cancer patients to retain reproductive functions has gradually increased.In order to analyze the indications of fertility-sparing surgery,how to standardize the surgery to minimize complications and improve the quality of patient s' life.The fertility-sparing cervical cancer patients information were collected and analyzed,hoping to provide clinical guidance for fertility-preserving treatment of cervical cancer.Sentinel lymph nodes were first proposed by Kabanas,and were defined as the first node to receive primary tumor metastasis,which can reflect the status of lymph nodes in the pelvic cavity.Sentinel lymph node metastasis status can indicate the presence or absence of pelvic lymph node metastasis,which can guide the safety and feasibility of fertility-sparing surgery in patients with cervical cancer.Sentinel lymph node biopsy is designed as a possible alternative to pelvic lymph node dissection to avoid overtreatment,reduce postoperative complications,and improve patient quality of life after surgery.The use of sentinel lymph node localization biopsy technology can accurately determine whether lymph node metastasis has occurred,which can reduce complications and improve the quality of patients' life.Therefore,it is necessary to detect little metastases in the lymph nodes.In order to improve the detection rate of lymph node metastasis and provide clinical guidance for the treatment of cervical cancer.We studied pathologic ultrastaging detection of the sentinel lymph node and analyzed all patients who underwent primary surgery for cervical cancer and received a cervical injection of methylene blue with successful mapping of at least one SLN at the Department of Obstetrics and Gynecology of the Anhui Provincial Hospital Affiliated to Anhui Medical University.All patients whose SLNs and non-SLNs were all negative in routine hematoxylin and eosin(HE)diagnoses were reviewed.All negative SLNs were examined by ultrastaging protocol.This article is composed by two parts,study on fertility-sparing surgery in young patients with cervical cancer and study on pathologic ultrastaging detection of sentinel lymph nodes in cervical cancer.Part One: Study on fertility-sparing surgery in young patients with cervical cancer Objective: To describe the fertility-sparing surgery in young patients with cervical cancer,and analysis fertility-preserving surgery indications,how to reduce complications,improve quality of patients' life,increase the survival rate,the pregnancy rate,and provide clinical guidance for cervical fertility-sparing treatment.Methods: Patients with cervical cancer collected from 2010.11 to 2019.9 in the Department of Obstetrics and Gynecology of the Anhui Provincial Hospital Affiliated to Anhui Medical University.The clinical data of the patients were collected and reviewed,and the follow-up information was collected by effective methods such as outpatient service and telephone inquiries.Results:(1)46 cervical cancer patients were collected in the study,according to the 2018 FIGO stage,there were 13 patients in stage IA1,17 patients in stage IA2-IB1,6 patients in stage IB2,10 patients in stage IB3-IIA2.15 patients of them received NACT.As for the pathologic types,41 patients were squamous cell carcinoma,4 patients were adenocarcinoma,and the other one was treated with endometrial cancer for additional surgery due to the pathologic report changes.(2)23 patients received the fertility-sparing surgery successfully,according to the 2018 FIGO stage,there were 8 patients in stage IA1,2 patients in stage IA2,10 patients in stage IB1,1 patient in stage IB2,2 patients in stage IB3;2 patients eceived the fertility-sparing surgery after NACT;9 patients underwent cervical conization,14 patients underwent radical trachelectomy and pelvic lymphadenectomy.3 patients of them got pregnancy successfully.(3)4 patients had tumor recurrence after laparoscopic hysterectomy after NACT,1 of them in stage IIA1,and 3 in stage IIA2.Conclusions:(1)The key to preserving fertility in early cervical cancer is to ensure the effect of tumor treatment and obtain better pregnancy outcomes.For patients with cervical cancer FIGO stage IA1-IB2 and stage IB3 patients who have strong fertility requirements with NACT sensitive,fertility-sparing surgery can be used as alternative treatment options.(2)NACT can reduce the difficulty of surgery and decrease the FIGO staging.It is an effective choice for patients with large tumor tissues who still want to preserve fertility.(3)Gynecologic oncologists should grasp the indications for fertility-sparing surgery strictly and standardize operations to reduce complications.Follow-up information is important to guide pregnancy and improve the quality of patients' life.Part Two: Study on pathologic ultrastaging detection of sentinel lymph nodes in cervical cancerObjective: To investigate the application of sentinel lymph nodes biopsy and pathologic ultrastaging in detecting micrometastasis in cervical cancer.Methods: We analyzed all patients who underwent primary surgery for cervical cancer between October 2016 and September 2018 and received a cervical injection of methylene blue with successful mapping of at least one SLN at the Department of Obstetrics and Gynecology of the Anhui Provincial Hospital Affiliated to Anhui Medical University.51 patients whose SLNs and non-SLNs were all negative in HE diagnoses were reviewed.All negative SLNs were examined by ultrastaging protocol.The clinical data of the patients were collected and reviewed,and the follow-up information was collected by effective methods such as outpatient service and telephone inquiries.Results:(1)51 cervical cancer patients admitted from October 2016 to September 2018 in the Provincial Hospital Affiliated to Anhui Medical University were collected.Among the 51 patients with at least one detected SLN,the median age at the time of surgery was 46 years(range: 28–72).Final tumor histology included 31(60.8%)squamous cell,8 adenocarcinoma,1 small cell carcinoma,2 adenosquamous carcinoma,and 9 poorly differentiated carcinoma.Final International Federation of Gynecology and Obstetrics(FIGO)stage?and?tumors were found in 49 and 2patients.As for myometrial invasion,32 patients had <50% myoinvasion,and 19 had ?50% myoinvasion.A total of 227 SLNs and 1151 non-SLNs were detected from the 51 patients.(2)Of 51 patients with SLNs and pelvic non-SLNs negative in primary diagnoses,ultrastaging detected an additional 5 patients who would have otherwise been missed.MMs and ITCs were detected by SLN ultrastaging in 3.9%(2/51)and 5.8%(3/51)patients,respectively.Among the 5 patients,final tumor histology included 2(40%)adenocarcinoma,1(20%)small-cell carcinoma,and 2(40%)poorly differentiated carcinoma.Final FIGO stage?tumors were found in all patients.As for myometrial invasion,4 patients(80%)had <50% myoinvasion,and 1(20%)had ?50% myoinvasion.These 5 patients had received chemotherapy or radiotherapy as adjuvant treatment,and there was no evidence of tumor recurrence on follow-up laboratory and image examinations.Conclusions:(1)Pathologic ultrastaging detection can detect micrometastasis of tumors that may be missed by HE staining.(2)Sentinel lymph node pathologic ultrastaging technology can improve the detection rate of tumor metastases,which further suggests the safety and feasibility of fertility-sparing surgery in patients with cervical cancer.(3)The SLN mapping and biopsy aims to treat cervical cancer individually and can be considered an appropriate alternative to pelvic lymph node dissection to improve the diagnosis rates of metastasis to lymph nodes and avoid overtreatment and lymphadenectomy side effects such as nerve injury,lymphatic edema,and cyst,which can seriously decrease the quality of the cervical cancer patient's life. |
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