Sentinel lymfeknuter kartlegging og biopsi for endometrial kreft på tidlig stadium med Laparoscopy
Summary
Denne protokollen beskriver identifisering og reseksjon av sentinel lymfeknuter for å gjøre operasjonen så enkel og minimalt invasiv som mulig.
Abstract
Sentinel lymfeknute (SLN) kartlegging og biopsi er en lovende teknikk for å visualisere og evaluere lymfeknutestatus hos kreft. Denne tilnærmingen har blitt anbefalt for lavrisiko endometriekreft (EC) pasienter ved autoritative internasjonale retningslinjer, men det har ikke blitt utført bredt i Kina og over hele verden. Dette arbeidet tar sikte på å beskrive detaljerte SLN-kartleggings- og biopsiprosedyrer for å fremme den kliniske anvendelsen. SLN-kartlegging og postoperativ patologisk ultrastaging ble utført hos en pasient med lavrisiko-EC ved hjelp av indocyaningrønn (ICG) fargestoff for å spore SLN-ene under laparoskopi og resecting dem helt for ultrastaging. Til slutt beskriver denne protokollen detaljer om ICG-injeksjon, og SLN-kartlegging og biopsi hos EC-pasienter basert på erfaringene fra klinisk praksis.
Introduction
Endometrial kreft (EC) er en av de vanligste sykdommene i gynekologisk onkologi, og forekomsten stiger1,2. Kirurgi er førstelinjebehandling for tidlig stadium EC3,4. Evalueringen av lymfeknutemetastase er en viktig del av kirurgisk iscenesettelse i EC. Gynecologic Oncology Group (GOG) studie 33 viste at lymfeknutemetastaser er forbundet med dårlig prognose5.
Som en ny og essensiell teknikk for evaluering av lymfeknutemetastase har sentinel lymfeknute (SLN) kartlegging og biopsi dukket opp de siste årene og har blitt anbefalt å bli ansatt for pasienter med tilsynelatende livmor-begrenset EC i henhold til National Comprehensive Cancer Network (NCCN) retningslinjer for livmorkreft6,7,8,9,10. SLN-kartlegging har også blitt mye brukt i svulster som brystkreft11, lungekreft12, skjoldbruskkreft13og melanom14. Patologisk ultrastaging har oppnådd god ytelse i kolorektal og gynekologisk kreft15,16,17 og anbefales av de autoritative europeiske retningslinjene18. Selv om prinsipper for SLN-kartlegging for EC-iscenesettelse er gitt i internasjonale retningslinjer10,19, er det ingen detaljerte manipulasjoner av kirurgi i andre nåværende verk.
Dette arbeidet presenterer protokollen for detaljert SLN-kartlegging og biopsi med ICG hos en 28 år gammel kvinne som hadde blitt klinisk diagnostisert med tidlig eus, og dermed forbedret og fremmet diagnosen pasienter.
Protocol
Representative Results
Discussion
SLN-kartlegging og biopsi er en mer selektiv og skreddersydd lymfeknute disseksjonstilnærming som har blitt brukt i klinikken i nesten 20 år. Innen EF har SLN-kartlegging og biopsi i økende grad blitt anbefalt av flere retningslinjer på grunn av deres høye diagnostiske effektivitet i tidlig fase EC, og oppnår generelle og bilaterale deteksjonsrater på henholdsvis 89% -95% og 52% -82%, med en følsomhet på 84% -100% og negativ prediktiv verdi på henholdsvis 97%-100%22. Den nåværende stud…
Divulgations
The authors have nothing to disclose.
Acknowledgements
Dette arbeidet ble delvis støttet av tilskudd fra National Natural Science Foundation of China (81772777), Shanghai Science and Technology Commission Medical Guidance Project (18411963700), Clinical Research Plan of SHDC (No. SHDC2020CR4079); Shanghai Pujiang Talents Prosjekt (17PJ14014000). Vi takker rettidig hjelp gitt av Fenghua Ma fra radiologi avdeling for MR bilder og Chao Wang fra patologi avdeling for patologiske bilder fra Obstetrikk og Gynecology Hospital of Fudan University.
Materials
| 2-mL syringe | Becton, Dickinson and Company, USA | 301940 | |
| Coagulation forceps | Shanghai Medical Instrument (Group) Co., Ltd. Surgical Instrument Factory | D0A010 | |
| Fluorescence microscope | Olympus | IX73 | |
| Harmonic scalpel | Soering GmbH | SONOCA190 | |
| Hematoxylin-eosin staining | Beyotime Biotechnologies Corporation,CN | C0107 | |
| Immunohistochemical cytokeratin staining | MXB Biotechnologies Corporation, CN | Kit-0020 | |
| Indocyanine green (ICG) | Dandong Medical Innovation Pharmaceutical Corporation. | 3599-32-4 | |
| Pararaffin | Sangon biotech Co., Ltd. | A601889 | |
| Pinpoint Endoscopic Fluorescence Imaging system | Novadaq Technoloies Bonita, Springs, FL | NA | |
| Propofol Injection | Fresenius Kabi Deutschland GmbH D-61346 Bad Homburg v.d.H., Germany | H20030124 | |
| Silk Braided non-absorbable suture | Shanghai Ethicon | SA854G | |
| Silk thread | Beijing AKIN AIEN International Medical Technology Co.,Ltd. | VCPP71D | |
| Suction-Irrigation Tube | Shanghai SMAF | YX980D | |
| Toothless forceps | Shanghai Medical Instrument (Group) Co., Ltd. Surgical Instrument Factory | J41010 | |
| Trocar | ETHICON Co,. Ltd, USA | B10LT, B5LT |
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