Značaj sentinel limfnog čvora u hirurškom lečenju karcinoma endometrijuma
The significance of sentinel lymph node (SLN) in surgical treatment of endometrial cancer
Author
Nejković, Lazar V.Mentor
Pažin, VladimirCommittee members
Dikić, SrđanRakić, Snežana
Kisić-Tepavčević, Darija

Oprić, Dejan
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Uvod: Trend porasta ucestalosti obolevanja i umiranja od karcinoma endometrijuma, koji se
poslednjih godina registruje širom sveta, uslovio je da ovo oboljenje postane jedan od vodecih
javno-zdravstvenih problema u populaciji žena širom sveta. Preživljavanje obolelih od
endometrijalnog karcinoma je skoro 90% , dok se taj procenat drasticno smanjuje ukoliko su
limfni cvorovi male karlice pozitivni na metastatsku bolest i iznosi oko 50% . Istraživanja su
pokazala da ucestalost metastaza u limfaticima iznosi oko 10% i uveliko zavisi od klinickih,
patoanatomskih i morfoloških karakteristika samog oboljenja. Meutim, limfadenektomija u
tretmanu pacijentkinja obolelih od karcinoma tela materice je predmet mnogih debata na
nacionalnim i meunarodnim skupovima što jasno ukazuje na cinjenicu da ne postoji
konzistentan stav o znacaju njene uloge u terapijskom pristupu ovog oboljenja. Naime,
mnogobrojna istraživanja su pokazala su da je ucestalost ozbiljnih komplikacija kod
pacijentkinja kod kojih ...je raena sistematska limfadenektomija, znacajno viša u odnosu na
grupe pacijentkinja koje nisu bile podvrgnute ovoj opsežnijoj hirurškoj proceduri. Iz tog
razloga, veliki broj studija je sproveden u cilju identifikacije najoptimalnijeg nacina selekcije
pacijentkinja kod kojih je zaista neophodno da se uradi sistematska limfadenektomija. U tom
smislu, u cilju smanjenja postoperativnog morbiditeta, poslednjih godina, sve više se ispituje
uloga biopsije limfnog cvora stražara - SLN (engl. Sentinel node lymphadenectomy) u proceni
statusa limfnog sisitema male karlice u grupi žena obolelih od karcinoma endometrijuma.
Ciljevi: (I) Odreivanje stope detekcije SLN (engl. Sentinel node lymphadenectomy) u uzorku
žena sa ranim stadijumom karcinoma endometrijuma; (II) Ispitivanje vrednosti stope lažno
negativnih nalaza, senzitivnosti, specificnosti, pozitivne i negativne prediktivne vrednosti SLN
(engl. Sentinel node lymphadenectomy) u proceni statusa limfnih cvorova male karlice; (III)
Uporeivanje histološkog nalaza limfnih cvorova dobijenog H&E (hematoxylin and eosin)
tehnikom i ostalim limfnim cvorovima dopunskom tehnikom ultrastadiranja - IHH (engl.
immunohistochemistry), kada je tehnikom H&E (hematoxylin and eosin) potvreno odsustvo
metastaza; (IV) Ispitivanje korelacije izmeu prisusutva metastaza u SLN (engl. Sentinel node
lymphadenectomy) sa postoperativnim histološkim nalazom i stepenom zrelosti
endometrijalnog karcinoma.
Materijal i metode: Studija preseka je izvedena na Klinici za Ginekologiju i akušerstvo
"Narodni front" u Beogradu u periodu od februara 2015. do juna 2016 godine...
Introduction: The growing trend of incidence of suffering and dying from endometrial
carcinoma, which has been registered across the world in recent years, is the reason why this
disease has become one of the major public health problems in the female population all over
the globe. The survival rate of those suffering from endometrial carcinoma is almost 90%,
while that percentage is drastically reduced if pelvic lymph nodes are positive to a metastatic
disease and amounts to around 50%. The studies have demonstrated that the incidence of
metastases in adenoids amounts to around 10% and highly depends on clinical,
pathoanatomical, and morphological characteristics of the actual disease. However,
lymphadenectomy in the treatment of patients suffering from the uterine cancer is the subject
matter of numerous debates at national and international conferences, which clearly points to
the fact that there is no consistent position concerning the importance of its role in the
therapeutic appr...oach to this disease. Namely, numerous studies have indicated that the
incidence of serious complications in patients, who had been subjected to systematic
lymphadenectomy, is significantly higher compared to the groups of patients who had not been
subjected to this extensive surgical procedure. For this reason, a great number of studies have
been conducted for the purpose of identification of the most optimal method of selection of
patients who really need to be subjected to the systematic lymphadenectomy. In recent years, in
these terms, for the purpose of reduction of the postoperative morbidity, the role of the Sentinel
node lymphadenectomy - SLN in the assessment of the status of the pelvic lymphatic system in
the group of women suffering from endometrial carcinoma has been increasingly investigated.
Objectives: (I) Determining of SLN (Sentinel node lymphadenectomy) detection rate on the
sample of women in early stage of endometrial carcinoma; (II) Investigation of the value of the
rate of false negative findings, sensitivity, specifics, positive and negative predictive SLN
(Sentinel node lymphadenectomy) value in the assessment of the status of the pelvic lymph
nodes; (III) Comparison of histological findings of lymph nodes obtained using H&E
(hematoxylin and eosin) technique and other lymph nodes using supplementary ultra staging
technique - IHH (immunohistochemistry), when the H&E (hematoxylin and eosin) technique
has confirmed the absence of metastases; (IV) Investigation of the correlation between the
presence of metastases in SLN (Sentinel node lymphadenectomy) with the postoperative
histological finding and the degree of advancement of endometrial carcinoma...