Značaj sentinel limfnog čvora u hirurškom lečenju karcinoma endometrijuma

Abstract

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 approach 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...