자궁경부암에서 Sentinel lymph node의 동정과발견률에 영향을 미치는 요소에 대한 연구
Study of Factors that Influence Sentinel Lymph Node Identification and Detection Rate in Cervical Cancer of Uterus
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목적: 자궁경부암 수술 시 sentinel lymph node (SN)의 유용성과 이의 발견률에 영향을 미치는 인자들을 전향적 연구를 통하여 알아보았다. 연구 방법: 2003년 1월부터 7월 사이에 자궁경부암 환자 43명의 자궁경부에 수술직전 염색약 (1% isosulfan blue dye)을 주입하고 근치적 자궁절제술과 림프절 절제술을 시행하였다. 우선 후복막강의 염색된 림프절만을 절제하였으며 그 후에 골반 및 대동맥주위 림프절을 모두 제거하였다. 제거된 림프절이 동결절편 검사에서 음성이면 근치적 자궁절제술을 시행하였다. 이전 원추절제술의 여부, 이전 항암화학치료의 여부, SN의 발견 유무 및 위치, 동결절편 검사 결과와 수술소견 및 최종 조직검사 결과 등을 기록하여 비교, 분석하였다. 결과: 환자의 평균 연령은 49.3세 (30-78) 였고, SN는 43명 중 23명 (53%)에서 구분되었다. SN의 위치는 바깥엉덩 (external iliac, 48.7%), 폐쇄 (obturator, 31.7%), 속엉덩 (internal iliac, 17.0%), 온엉덩 (common iliac, 2.4%) 림프절 순이었다. 조직학적으로 양성인 림프절은 26% (11/43)에서 발견되었다. SN가 발견된 23명 중 5명의 림프절이 양성이었고 SN가 발견되지 않은 20명 중 8명의 림프절이 양성이었다. SN 중 위음성인 경우는 없었다. 수술 전 원추절제술을 받은 경우에 더 높은 SN 발견률을 보였으며 (P=0.0156), 환자의 나이 및 병기, 조직학적 종류, 수술 방법, 항암화학치료 여부 등은 유의한 영향을 끼치지 않았다. 결론: 자궁경부암 수술 시 염색약 (1% isosulfan blue dye)을 사용하여 SN를 구분하는 것은 유용한 방법이며 수술 전 원추절제술을 받은 환자에서 높은 발견률을 보였다. 발견률을 더욱 높이기 위한 연구가 필요하다.
Abstract
Objective: The purpose of this prospective study was to determine the feasibility of sentinel lymph node (SN) identification and to evaluate the factors that influence the sentinel node detection rate in patients with cervical cancer of the uterus. Methods: Forty three patients underwent intracervical injection of 1% isosulfan blue dye at the time of planned radical hysterectomy and lymphadenectomy between January 2003 and July 2003. With visual detection of blue nodes, SNs were identified and separately removed. And then all patients underwent complete pelvic lymph nodes dissection and/or para-aortic lymph nodes dissection. If frozen sections of the lymph nodes were negative, radical hysterectomy was performed. Tumor characteristics, surgical findings, specific locations of SN and final pathologic results were recorded and correlated with final pathologic results. Results: The mean age of patients was 49.3 years (30-78). SNs were identified in 23 of 43 (53%) patients. About 48.7% of SNs were found in the external iliac region, 31.7% in the obturator region, 17.0% in the internal iliac region and 2.4% in the common iliac region. Metastatic nodes were detected in 11 of 43 (26%) patients. Among 23 patients whose SNs were detected, 5 patients had metastatic nodes while among 20 patients whose SNs were not detected, 8 patients had metastatic nodes. No false negative SN results were obtained. Successful SN detection was more likely performed in patients with preoperative conization (P=0.0156). However, age, stage, histologic type, operation type, and neoadjuvant chemotherapy did not show any significant differences in SN detection rate. Conclusion: The identification of the SN with isosulfan blue dye is feasible and safe. SN detection rate was high in patients with preoperative conization. But low detection rate should be further investigated.
참고문헌 (22)
- "한국중앙암등록사업 연례 보고서" (2003), 한국중앙암등록본부
- 대한산부인과학회 부인종양위원회, "한국 부인암 등록사업 조사보고서", 46(2), pp.221~58 (2003)
- Takeda N, "Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with stages IB and IIB cervical carcinoma treated with radical hysterectomy", 85, pp.1547~54 (1999)
- Benedetti-Panici P, "Early cervical carcinoma:the natural history of lymph node involvement redefined on the basis of thorough parametrectomy and giant section study", 88, pp.2267~74 (2000)
- 박종택, "209예의 임상병리학적 양상 및 5년 생존률", 46, pp.1404~10 (2003)
- Beyersdorff D, "Nodal involvement in cancer of the uterine cervix:value of lymphography and MRI", 16, pp.274~7 (1995)
- Morton DL, "Technical details of intraoperative lymphatic mapping for early stage melanoma", 127, pp.392~9 (1992)
- Statius Muller MG, "The sentinel node procedure in cutaneous melanoma An overviex of 6 years experience", 26, pp.20~5 (1999)
- Cabanas RM, "An approach for the treatment of penile carcinoma", 39, pp.456~66 (1977)
- Krag D, "The sentinel node in breast cancer", 339, pp.941~6 (1998)
- Finan MA, "Detection of sentinel lymph nodes with Lymphazurin in cervical", 92, pp.204~8 (1999)
- Malur S, "Sentinel lymph node detection in patients with cervical cancer", 80, pp.254~7 (2001)
- Dargent D, "Laparoscopic assessment of the sentinel lymph node in early stage cervical cancer", 79, pp.411~5 (2000)
- Levenback C, "Lymphatic mapping and sentinel node identification in patient with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy", 20, pp.688~93 (2002)
- O'Boyle JD, "Intraoperative lymphatic mapping in cervix cancer patients undergoing radical hysterectomy:A pilot study", 79, pp.238~43 (2000)
- Rhim CC, "Sentinel node biopsy as an indicator for pelvic nodes dissection in early cervical cancer", 17, pp.507~11 (2002)
- Verheijen RHM, "Sentinel node detection in cervical cancer", 96, pp.135~8 (2000)
- Leong SP, "Adverse reactions to isosulfan blue during selective sentinel lymph node dissections in melanoma", 7(5), pp.361~6 (2000)
- Montgomery LL, "Isosulfan blue dye reactions during sentinel lymph node mapping for breast cancer", 95(2), pp.385~8 (2002)
- 임채춘, "자궁경부암 환자에서 sentinel lymph node 탐색을 위해 isosulfan blue dye 사용시 발생한 급성 과민반응 1예", 46(2), pp.484~7 (2003)
- Buist MR, "Laparoscopic detection of sentinel lymph nodes followed by lymph node dissection in patients with early stage cervical cancer", 90, pp.290~6 (2003)
- Barranger E, "Sentinel lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma", 101(8), pp.1919~1920 (2004)