Background: SLN mapping has emerged as a standard of care in endometrial cancer due to its high sensitivity and significant reduction in morbidity. Although lymphovascular space invasion (LVSI) is a known risk factor for lymph node metastasis and recurrence, evidence on the reliability of SLN mapping in LVSI-positive patients is scarce. The aim of this study was to determine the impact of LVSI on the diagnostic performance of SLN mapping. Methods: This retrospective cohort study included patients with endometrial cancer who underwent primary surgical treatment at the Bern University Hospital, Switzerland, between 2012 and 2022. Results: LVSI was present in 22% of patients and was significantly associated with lymph node metastasis (p< 0.001) and recurrence (p< 0.001). In node-negative patients with only SLN mapping performed, LVSI was an independent predictor of recurrence during multivariable Cox regression analysis (p= 0.036). The negative predictive value of SLN mapping was 91.5% and was significantly lower in tumors with LVSI (75.0%) compared to LVSI-negative tumors (95.6%,p= 0.004). Conclusion: The presence of LVSI was significantly associated with worse oncological outcomes. LVSI was an independent predictor of recurrence in node-negative patients with only SLN mapping performed. Furthermore, the negative predictive value of SLN mapping was significantly lower in LVSI-positive tumors.
背景：前哨淋巴结（SLN）定位因其高敏感性和显著降低并发症发生率，已成为子宫内膜癌的标准诊疗手段。尽管淋巴血管间隙浸润（LVSI）是淋巴结转移和复发的已知危险因素，但关于SLN定位在LVSI阳性患者中可靠性的证据尚不充分。本研究旨在确定LVSI对SLN定位诊断效能的影响。 方法：这项回顾性队列研究纳入了2012年至2022年间在瑞士伯尔尼大学医院接受初次手术治疗的子宫内膜癌患者。 结果：22%的患者存在LVSI，其与淋巴结转移（p<0.001）和复发（p<0.001）显著相关。在仅接受SLN定位的淋巴结阴性患者中，多变量Cox回归分析显示LVSI是复发的独立预测因子（p=0.036）。SLN定位的阴性预测值为91.5%，且在LVSI阳性肿瘤中（75.0%）显著低于LVSI阴性肿瘤（95.6%，p=0.004）。 结论：LVSI的存在与较差的肿瘤学结局显著相关。在仅接受SLN定位的淋巴结阴性患者中，LVSI是复发的独立预测因子。此外，SLN定位在LVSI阳性肿瘤中的阴性预测值显著降低。
肿瘤(癌症)患者之家