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1.
Int J Gynecol Cancer ; 32(1): 15-20, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-32546643

RESUMO

OBJECTIVE: Sentinel lymph node (SLN) biopsy aims to assess lymph node status with reduced surgical morbidity. The aim of the study was to determine the accuracy and safety of SLN biopsy in the management of early cervical carcinoma using a double technique (technetium-99m (Tc-99m) nanocolloid and methylene blue dye injection). METHODS: This was a 10-year study from January 2009 to January 2019 that recruited 103 consecutive women undergoing surgery for early cervical carcinoma, FIGO 2009 stage IA1 (grade 3, and grade 2 with lymphovascular space invasion) to IB1 (<2 cm), at the West Kent Gynaecological Oncology Centre, Maidstone, UK. All patients were given the choice of pelvic node dissection and SLN mapping or SLN only. All patients elected to undergo SLN only. In total 97 patients had SLN mapping performed laparoscopically. We used the combined method (Tc-99m nanocolloid and/or methylene blue dye). All SLN routinely underwent ultrastaging. RESULTS: At least one SLN was detected in all 103 patients, using at least one of the combined methods (Tc-99m nanocolloid or blue dye). Bilaterally SLN were removed in 85/103 women with an 83% bilateral detection rate. The median SLN count was 2.3 (range 1-6) nodes. Of 103 patients, 7 (6.7%) patients had lymph node involvement. There were no pelvic or para-aortic lymph node recurrences with a median follow-up of 53 (range 8-120) months. The specificity and negative predictive value of a negative SLN was 100%. None of our 103 patients reported lower extremity lymphedema. CONCLUSION: In carefully selected patients with early cervical carcinoma, SLN biopsy alone appears to be a safe method for lymph node assessment of women undergoing surgical staging. Ultrastaging is an essential part of histologic examination of SLN.


Assuntos
Carcinoma/patologia , Linfonodos/patologia , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Carcinoma/cirurgia , Feminino , Humanos , Linfonodos/cirurgia , Metástase Linfática , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/cirurgia
2.
Int J Gynecol Cancer ; 25(9): 1663-8, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26270124

RESUMO

OBJECTIVE: The aims of this study were to assess locality of the sentinel lymph node (SLN) in cervical carcinoma and examine factors affecting bilateral SLN detection. METHODS: This was a retrospective review of SLN data (anatomical location, count and laterality) in patients with early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA1 with lymphovascular space invasion to stage IIA) using intraoperative gamma probe and blue dye. The preoperative single-photon emission computed tomography with computed tomography was used to detect laterality, number of the SLNs, and rare locations. Patients were treated between January 2005 to January 2015 at the West Kent Gynaecological Oncology Centre, Maidstone Hospital, Maidstone, United Kingdom. RESULTS: A total of 132 women were investigated. The most common SLN location was the external iliac (38.6%) followed by obturator (25.3%) and internal iliac (23.6%) regions. A small percentage was identified in presacral (1.4%) and para-aortic regions (0.7%). Older age (P = 0.01) and an elevated body mass index (P = 0.03) were associated with decreased SLN count by preoperative single-photon emission computed tomography with computed tomography, and only age affected SLN count by gamma probe (P = 0.01). Initial surgery, large loop excision of the transformation zone, or cone biopsy of the cervix had no effect on SLN count. There was no difference observed in bilateral detection with respect to surgical approach (open: n = 48/laparoscopic: n = 84). However, older age was independently associated with a decrease in bilateral SLN detection (P = 0.003). In these patients who underwent unilateral full pelvic lymphadenectomy, all the nonsentinel nodes were negative. CONCLUSIONS: The majority of SLNs were located in the external iliac, obturator, and internal iliac regions. Both older age and an elevated body mass index were associated with a reduced SLN count. Unilateral detection of SLN was independently associated with older age, which may be due to sclerosis in the lymphatic vessels or reduced perfusion in the pelvis in these women. If no SLN is detected on one side, the consensus is to perform a full pelvic lymphadenectomy on that side of the pelvis.


Assuntos
Carcinoma/secundário , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Biópsia de Linfonodo Sentinela , Neoplasias do Colo do Útero/patologia , Adulto , Fatores Etários , Idoso , Aorta , Índice de Massa Corporal , Carcinoma/cirurgia , Corantes , Feminino , Humanos , Veia Ilíaca , Região Lombossacral , Metástase Linfática , Azul de Metileno , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nervo Obturador , Cuidados Pré-Operatórios , Estudos Retrospectivos , Agregado de Albumina Marcado com Tecnécio Tc 99m , Tomografia Computadorizada de Emissão de Fóton Único , Neoplasias do Colo do Útero/cirurgia , Adulto Jovem
3.
Int J Gynecol Cancer ; 22(6): 1044-9, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22622952

RESUMO

OBJECTIVE: To establish the accuracy of sentinel lymph node (SLN) detection in early cervical cancer. MATERIALS AND METHODS: Sentinel lymph node detection was performed prospectively over a 6-year period in 86 women undergoing surgery for cervical carcinoma by the combined method (Tc-99m and methylene blue dye). Further ultrastaging was performed on a subgroup of 26 patients who had benign SLNs on initial routine histological examination. RESULTS: The SLN was detected in 84 (97.7%) of 86 women by the combined method. Blue dye uptake was not seen in 8 women (90.7%). Sentinel lymph nodes were detected bilaterally in 63 women (73.3%), and the external iliac region was the most common anatomic location (48.8%). The median SLN count was 3 nodes (range, 1-7). Of the 84 women with sentinel node detection, 65 also underwent bilateral pelvic lymph node dissection, and in none of these cases was a benign SLN associated with a malignant non-SLN (100% negative predictive value). The median non-SLN count for all patients was 19 nodes (range, 8-35). Eighteen patients underwent removal of the SLN without bilateral pelvic lymph node dissection. Nine women (10.5%) had positive lymph nodes on final histology. One patient had bulky pelvic nodes on preoperative imaging and underwent removal of the negative bulky malignant lymph nodes and a benign SLN on the contralateral side. This latter case confirms the unreliability of the SLN method with bulky nodes. The remaining 8 patients had positive SLNs with negative nonsentinel lymph nodes. Fifty-nine SLNs from 26 patients, which were benign on initial routine histology, underwent ultrastaging, but no further disease was identified. Four patients (5%) relapsed after a median follow-up of 28 months (range, 8-80 months). CONCLUSION: Sentinel lymph node detection is an accurate and safe method in the assessment of nodal status in early cervical carcinoma.


Assuntos
Carcinoma/patologia , Linfonodos/patologia , Biópsia de Linfonodo Sentinela , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Adulto Jovem
4.
Int J Gynecol Cancer ; 22(2): 311-7, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22237381

RESUMO

OBJECTIVE: To evaluate whether certain patients with early-stage cervical cancer are candidates for less radical surgery when considering fertility-sparing surgery. DESIGN: Prospective cohort study. SETTING: Two gynecologic cancer centers (St Thomas' Hospital, London; and West Kent Gynaecological Cancer Centre, Maidstone). POPULATION: Women with early-stage cervical cancer (n = 66) undergoing fertility-sparing surgery, either simple (SVT) or radical vaginal trachelectomy (RVT). METHODS: Prospective clinical data collection and review of patient notes, pathology and radiology data, and pregnancy outcomes. MAIN OUTCOME MEASURES: Postoperative complications, surgical specimen histologic analysis, follow-up data, and obstetric outcome. RESULTS: A total of 66 women underwent either SVT (n = 15) or RVT (n = 51), with pelvic lymphadenectomy, for stage IA2 or IB1 cervical cancer. There was no residual disease in the SVT specimen in 53% versus 29% after RVT. Clear surgical margins in 100% of SVT specimens with residual disease versus 94% after RVT. Two patients had positive lymph nodes after RVT; one of these declined adjuvant treatment until after egg harvesting and subsequently died of disease (1.5%). Median follow-up was 96 months (range, 12-120 months). One patient had a mid vaginal recurrence (1.5%). Twenty-four women have tried to conceive to date, with 14 women having 17 live births. Live birth pregnancy rate was 70.8%. CONCLUSIONS: It is possible to select patients for a less radical fertility-sparing procedure through identification of measurable low-risk factors and thus reduce the morbidity caused by conventional RVT. The selection criteria should be stringent and applied within the setting of a cancer center.


Assuntos
Fertilidade , Histerectomia/métodos , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Carcinoma Adenoescamoso/patologia , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Estudos de Coortes , Inglaterra , Feminino , Humanos , Estadiamento de Neoplasias , Gravidez , Taxa de Gravidez , Estudos Prospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia , Adulto Jovem
5.
Int J Gynecol Cancer ; 21(3): 559-64, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21430459

RESUMO

OBJECTIVES: To determine the accuracy of sentinel lymph node (SLN) detection in vulval carcinoma and to report the reliability and safety of this procedure. METHODS/MATERIALS: For a period of 6 years, we recruited women undergoing surgery for vulval carcinoma. All women had a preoperative biopsy confirming the depth of invasion greater than 1 mm. Sentinel lymph node detection was performed using the combined method (Tc-99m and methylene-blue dye). The standard management included complete inguinofemoral lymphadenectomy. When inguinofemoral lymph nodes were found grossly to be enlarged, these nodes were debulked, and the women subsequently treated with radiotherapy with or without chemotherapy. During the last 2 years of the study, a selected group of women had an SLN dissection alone. The SLNs were ultrastaged when they were negative on routine hematoxylin and eosin examination. RESULTS: Among 60 women undergoing SLN detection, SLN was detected in 59 women (98.3%) with combined method. Blue dye did not detect an SLN in 3 women resulting in a 93.3% detection rate. The median SLN count was 2 nodes (range, 1-9). Of the 60 women, 41 had inguinofemoral lymphadenectomy, 4 had only enlarged inguinofemoral nodes debulked, and 15 had the SLN only removed. The non-SLN count was 9 nodes (range, 3-17). There were no false-negative SLNs. Twenty-one women (35%) had positive nodes on final histology. Ultrastaging increased detection of metastases in 6.9% of nodes relative to routine hematoxylin and eosin examination and upstaged 12% of women. The median follow-up was 24 months (range, 2-66 months). CONCLUSIONS: Sentinel lymph node detection is safe and accurate in assessing lymph node status in women with vulval cancer undergoing staging. The combined method using Tc-99m and methylene blue dye injection for SLN detection has the best detection rate. Routine ultrastaging of negative SLN improves the detection of nodal metastases.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Azul de Metileno , Padrões de Prática Médica , Compostos Radiofarmacêuticos , Coloide de Enxofre Marcado com Tecnécio Tc 99m , Neoplasias Vulvares/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Biópsia de Linfonodo Sentinela , Taxa de Sobrevida , Resultado do Tratamento , Neoplasias Vulvares/cirurgia
6.
Int J Gynecol Cancer ; 20(4): 570-5, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20686375

RESUMO

OBJECTIVE: To determine the feasibility and safety of laparoscopically assisted vaginal hysterectomy in the treatment of presumed stage I endometrial cancer. STUDY DESIGN: This was a prospective cohort study without randomization of 182 consecutive patients who underwent surgery for early endometrial cancer or atypical hyperplasia at the West Kent Gynaecological Oncology Centre, UK. Seventy-four had laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (BSO), and 108 had a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Lymphadenectomy was performed in 153 patients, and lymph node sampling was performed in 2 patients. Twenty-seven patients with serous papillary endometrial cancer in addition had an omentectomy. The groups were compared for epidemiological and clinical characteristics, surgical outcomes, hospital stay, lymph node harvest, and intraoperative and postoperative complications. RESULTS: The patients in the laparoscopy group had less blood loss, similar number of lymph nodes removed, less need for analgesia, and shorter hospital stay but longer operative time than those treated by laparotomy. In our study, we had 4 conversions (5.4%) from laparoscopy to laparotomy. Twenty-eight (41%) patients who had laparoscopic surgery were obese (body mass index [BMI] >30 kg/m2). Postoperative complications were more common in the laparotomy group (34%) than in the laparoscopy group (6%). No major complications occurred in the laparoscopy group. Wound infection was the most common complication in laparotomy patients, and this invariably happened to obese patients (BMI >30 kg/m2). There were 6 readmissions, all from the laparotomy group. CONCLUSIONS: Laparoscopic surgery is a safe and reliable alternative to open surgery in the management of early endometrial cancer patients, with significantly reduced hospital stay and complications, especially in those patients with an elevated BMI.


Assuntos
Abdome/cirurgia , Carcinoma Papilar/cirurgia , Cistadenocarcinoma Seroso/cirurgia , Neoplasias do Endométrio/cirurgia , Histerectomia , Laparoscopia , Abdome/patologia , Idoso , Carcinoma Papilar/patologia , Estudos de Coortes , Cistadenocarcinoma Seroso/patologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Laparotomia , Excisão de Linfonodo , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Taxa de Sobrevida , Resultado do Tratamento
7.
Eur J Surg Oncol ; 46(10 Pt A): 1795-1806, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32788096

RESUMO

BACKGROUND: The intra-operative application of collagen-fibrin sealants (CFS) has emerged as a promising intervention to reduce post-operative morbidity associated with inguino-femoral lymph node dissection (IFLND). AIM: The purpose of this systematic review was to ascertain the efficacy and safety of CFS to reduce lymphatic morbidity after IFLND. DESIGN: We systematically searched MEDLINE, SCOPUS, ClinicalTrials.gov, and Cochrane Database to identify all registered articles pertaining to the use of CFS during IFLND spanning the period Jan 1975 to April 2020. A direct-comparison meta-analysis was performed. Odds ratios (OR), standartised mean difference (SMD) and 95%| confidence intervals were calculated using the random-effect model. RESULTS: A total of six randomised control trials (RCTs) and four observational studies were included in this study. The studies were characterised by significant clinical heterogeneity. The meta-analysis of RCTs showed that the application of CFS did neither decrease the length of drainage [SDM -0.55 (95% CI -1.34 to 0.23), p = 0.17] nor the amount of drained output [SMD 0.46 (95% CI -0.29 to 1.20), p = 0.23]. No significant different was found concerning the incidence of lymphocele(s) formation [OR 0.96 (95% CI 0.56-1.65), p = 0.88] or other wound complications. The safety profile of CFS was favourable. CONCLUSIONS: Our findings suggest that the use of CFS was not associated with difference in the incidence of lymphatic morbidity related to IFLND. In light of the limited data available and the high inter-study heterogeneity, this evidence should be interpreted with caution. More high quality RCTs are warranted to draw firmer conclusions.


Assuntos
Adesivo Tecidual de Fibrina/uso terapêutico , Excisão de Linfonodo/métodos , Linfedema/epidemiologia , Linfocele/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Seroma/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adesivos Teciduais/uso terapêutico , Virilha , Humanos , Complicações Pós-Operatórias/epidemiologia
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