Evaluación del estado ganglionar mediante biopsia selectiva de ganglio centinela en carcinoma de endometrio

• Autores: Carmen Céspedes Casas, Carlos López de la Manzanara Cano, Mariano Amo Salas , Cator Martín-Francisco, L. Sánchez Hipólito, Celia Pérez Parra
• Localización: Ginecología y Obstetricia de México, ISSN 0300-9041, ISSN-e 2594-2034, Vol. 87, Nº. 10, 2019, págs. 637-646
• Idioma: español
• DOI: 10.24245/gom.v87i10.3297
• Títulos paralelos:
  • Evaluation of lymph node status by the selective sentinel lymph node biopsy technique in endometrial cancer
• Enlaces
  • Texto completo
• Resumen
  • español

    Resumen : OBJETIVO: Evaluar la utilidad de la biopsia selectiva de ganglio centinela en pacientes con carcinoma de endometrio en estadio inicial, mediante la inyección de tecnecio 99-azul de metileno en el cuello uterino, el valor predictivo negativo de la técnica y conocer la distribución y su tasa de bilateralidad. MATERIALES Y MÉTODOS: Estudio observacional, prospectivo, de cohortes, efectuado en el Hospital General Universitario de Ciudad Real (2011-2016). Criterios de inclusión: pacientes con diagnóstico de carcinoma de endometrio estadio I-II, aptas para intervención quirúrgica con cuello uterino accesible para la inyección del marcador. Criterios de exclusión: pacientes con afectación de órganos adyacentes o a distancia. Se estudiaron 34 variables, para el análisis estadístico se utilizó el programa informático SPSS. RESULTADOS: Se estudiaron 65 pacientes y de éstas 59 tenían carcinoma de endometrio tipo 1 y 6 tipo 2. La tasa de identificación de ganglio centinela en el SPECT TAC fue de 84% y con tinción dual (radiocoloide y azul de metileno) de 100%. El ganglio centinela se localizó en la región pélvica en 60 de 65 y en la región paraaórtica en 5 de 65 casos; el territorio ganglionar más frecuente fueron los ganglios adyacentes a los vasos iliacos externos. No se identificó ningún caso de metástasis en ganglios no centinela. La tasa de bilateralidad fue de 9.2% y la de recidiva tumoral de 3%, con supervivencia a 5 años de 96.9%. CONCLUSIONES: El valor predictivo negativo de la técnica fue de 100%, lo que la convierte en una buena alternativa a la linfadenectomía. Se recomienda la tinción dual inyectada en el cuello uterino para conseguir mayor localización de ganglio centinela.

  • English

    Abstract OBJECTIVE: To analyze the Negative Predictive Value of the Sentinel Lymph Node Selective Biopsy Technique in Endometrial Carcinoma. MATERIALS AND METHODS: Prospective cohort observational study. Carried out in the General University Hospital of Ciudad Real between 2011 and 2016. Patients diagnosed with endometrial carcinoma with stage I-II, suitable for surgical intervention with uterine cervix accessible for marker injection, were included. Patients with involvement of adjacent or distant organs were excluded. 34 variables were studied, for the statistical analysis the SPSS computer program was used. RESULTS: 65 patients were included in the study. 59 of the tumors were endometrial carcinoma type 1 and 6 type 2. The rate of identification of sentinel lymph node in the SPECT TAC was 84% and with dual staining (radiocolloid and methylene blue) of 100%. The sentinel lymph node was located in the pelvic region in 60/65 and in the para-aortic region in 5/65 of the cases, whose most frequent lymph node territory was the lymph nodes adjacent to the external iliac vessels. No cases of metastasis in non-sentinel lymph nodes were detected. The bilaterality rate was 9.2%. The tumor recurrence rate was 3%, with a 5-year survival of 96.9%. CONCLUSIONS: The Negative Predictive Value of the technique was 100%, it is a good alternative to lymphadenectomy. We recommend dual staining injected into the cervix to achieve greater localization of sentinel lymph node.

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