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Sentinellymphadenektomie bei Patientinnen mit Zervixkarzinom

Sentinel lymph node biopsy in women with cervical cancer

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Der Gynäkologe Aims and scope

Zusammenfassung

Die Anwendung des Sentinelkonzepts bei der operativen Therapie des Zervixkarzinoms ist Gegenstand intensiver wissenschaftlicher Untersuchungen. Gegenwärtig werden Farbstoffe, radioaktiv markierte Eiweiße und deren Kombination zur Markierung verwendet. Die vorliegenden Untersuchungen weisen darauf hin, dass sich mit der kombinierten Markierung die besten Ergebnisse erzielen lassen. Neben der Detektionsrate ist der negative Vorhersagewert der wichtigste Bewertungsfaktor dieser Untersuchungsmethodik. Eine ausbleibende Detektion kann durch fehlerhafte Applikation bedingt sein. Falsch negative Detektionen kommen bei metastatisch durchsetzten Lymphknoten vor. In den unmittelbar an die Zervix grenzenden Anteilen der Parametrien sind Sentinellymphknoten nur schwer zu detektieren, da diese Bereiche intensiv gefärbt oder überstrahlt sind. Die Sentinellymphknoten werden arbeits- und kostenintensiven Untersuchungen unterzogen, die zum Ziel haben, neue Prognosefaktoren zu etablieren. Weitere Studien müssen herausarbeiten, für welche Patientinnen mit Zervixkarzinom das Sentinelkonzept besonders geeignet ist.

Abstract

Sentinel lymph node biopsy in women with cervical cancer is an object of current clinical research. Blue dye, technetium-labeled colloids, or their combination are used to detect sentinel lymph nodes. Several studies showed that the best results were achieved through the combination of these agents. Beside the rate of detection the negative predictive value is the most important factor to assess the impact of the sentinel lymph node concept. Incorrect application of the agents used to detect sentinel lymph nodes is one reason for failure of detecting sentinel lymph nodes. False negative detections are seen in patients with grossly metastatic lymph nodes. The detection of sentinel lymph nodes in the parametrial tissue close to the cervix is hampered, as the tissue is either intensively colored or the activity of technetium within the cervix does not allow a detection of smaller deposits of activity within the sentinel lymph nodes. Isolated sentinel lymph nodes can be used for special investigations establishing new prognostic markers. Future studies should clarify which group of patients with cervical cancer will benefit most.

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  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland

    C. Altgassen, M. Löning & K. Diedrich

  2. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsfrauenklinik Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    C. Altgassen

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Altgassen, C., Löning, M. & Diedrich, K. Sentinellymphadenektomie bei Patientinnen mit Zervixkarzinom. Gynäkologe 38, 904–913 (2005). https://doi.org/10.1007/s00129-005-1749-2

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