Background: Since October 2018, lymph node status has become part of the FIGO staging, given that it is one of the most important prognostic factors among women with CC. The aim was to determine the rate of atypical lymphatic drainage in patients with clinical early-stage cervical cancer using a hybrid tracer (ICG-99mTc nanocolloid). Methodology: A prospective, observational, single-centre study conducted at Son Espases University Hospital between January 2019 and October 2023. Patients with clinical early-stage CC who underwent SLN mapping were included. External iliac and obturator nodes were defined as common locations. Para-aortic, common iliac, presacral, internal iliac, and parametrial nodes were defined as atypical locations. Results: Thirty-nine cases of CC were included. The overall SLN detection rate was 97.4%, with 89.5% bilaterally. Positive nodes were found in 21.1% of patients. Atypical lymphatic drainage was present in 8 out of 38 (21.1%) patients. Of all the SLNs biopsied (146), 10.3% corresponded to an atypical zone. SLN in the atypical area had a higher proportion of metastasis than the usual area (37.5% vs. 16.7%;p= 0.327). Conclusions: SLN biopsy can detect unusual drainage in a significant proportion of patients. Atypical lymph nodes have a higher percentage of metastasis, which consequently improves staging and tailoring therapy. SLN mapping performed via a standardized surgical technique using a hybrid tracer (ICG-99mTc) could help in the identification of the “true SLN”.
背景：自2018年10月起，鉴于淋巴结状态是宫颈癌患者最重要的预后因素之一，其已被纳入国际妇产科联盟（FIGO）分期系统。本研究旨在通过使用混合示踪剂（吲哚菁绿-99m锝标记纳米胶体）确定临床早期宫颈癌患者非典型淋巴引流的比例。方法：本研究为2019年1月至2023年10月在松塞斯佩大学医院开展的前瞻性、观察性、单中心研究。纳入接受前哨淋巴结定位的临床早期宫颈癌患者。将髂外及闭孔淋巴结定义为常规引流区域，腹主动脉旁、髂总、骶前、髂内及宫旁淋巴结定义为非典型引流区域。结果：共纳入39例宫颈癌病例。前哨淋巴结总体检出率为97.4%，其中双侧检出率为89.5%。21.1%的患者发现阳性淋巴结。38例患者中有8例（21.1%）存在非典型淋巴引流。在所有活检的前哨淋巴结（146枚）中，10.3%位于非典型区域。非典型区域前哨淋巴结的转移比例高于常规区域（37.5% vs. 16.7%；p=0.327）。结论：前哨淋巴结活检可在相当比例患者中检测到非常规引流路径。非典型淋巴结具有更高的转移比例，这有助于改善分期并实现个体化治疗。通过标准化手术技术使用混合示踪剂（吲哚菁绿-99m锝）进行前哨淋巴结定位，有助于识别“真实前哨淋巴结”。
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