Background: Accurate intraoperative assessment of sentinel lymph node (SLN) status is critical for staging and guiding surgical management in gynaecological malignancies. Frozen-section histopathology remains the gold standard, but it is time-consuming and resource-intensive. Shear-wave elastography (SWE) quantifies tissue stiffness in real time and may offer a rapid alternative. Methods: In this prospective single-centre study, 63 women (median age 62 years) undergoing primary surgery with sentinel lymph node biopsy (SLNB) for endometrial, cervical, vulvar, or early ovarian carcinoma were enrolled. A total of 172 SLNs were excised, submerged in coupling gel, and scanned ex vivo using a 9 MHz linear probe. Results: A total of 172 SLNs underwent SWE (mean 2.7 nodes/patient). Endometrial primaries accounted for 58% of nodes, mostly retrieved by robotic-assisted surgery (71.8%). Node dimensions were significantly larger in malignant lesions for sonographic (long-axis: 13.02 ± 3.31 mm vs. 10.80 ± 3.28 mm;p= 0.002) and pathological long-axis measurements (11.45 ± 2.83 mm vs. 9.75 ± 2.61 mm;p= 0.004). Mean SWE velocities were similar between groups (1.381 ± 0.307 vs. 1.343 ± 0.236 m/s;p= 0.541). Histopathology identified metastases in 18% of SLNs, comprising macrometastases (7%), micrometastases (5%), and isolated tumour cells (6%). Conclusions: Although ex vivo SWE is rapid, reproducible, and integrates seamlessly into the sterile field, stiffness measurements alone lack sufficient discriminatory power for SLN staging in gynaecological cancers. Future research should focus on three-dimensional SWE, advanced radiomic analyses, and machine-learning algorithms to improve the detection of low-volume metastatic disease.
背景：术中准确评估前哨淋巴结（SLN）状态对于妇科恶性肿瘤的分期和手术决策至关重要。冰冻切片组织病理学仍是金标准，但其耗时且资源密集。剪切波弹性成像（SWE）可实时量化组织硬度，或能提供一种快速替代方案。方法：在这项前瞻性单中心研究中，纳入了63名因子宫内膜癌、宫颈癌、外阴癌或早期卵巢癌接受原发手术及前哨淋巴结活检（SLNB）的女性患者（中位年龄62岁）。共切除172枚SLN，将其浸入耦合剂中，并使用9 MHz线阵探头进行离体扫描。结果：共172枚SLN接受了SWE检查（平均每例患者2.7枚）。子宫内膜原发癌占淋巴结来源的58%，其中71.8%通过机器人辅助手术获取。恶性病灶的淋巴结尺寸在超声测量（长轴：13.02 ± 3.31 mm vs. 10.80 ± 3.28 mm；p=0.002）和病理长轴测量（11.45 ± 2.83 mm vs. 9.75 ± 2.61 mm；p=0.004）中均显著更大。两组间的平均SWE速度相似（1.381 ± 0.307 vs. 1.343 ± 0.236 m/s；p=0.541）。组织病理学发现18%的SLN存在转移，包括大体转移（7%）、微转移（5%）和孤立肿瘤细胞（6%）。结论：尽管离体SWE快速、可重复且能无缝整合入无菌手术区域，但仅凭硬度测量缺乏足够的鉴别力用于妇科癌症的SLN分期。未来研究应聚焦于三维SWE、先进的影像组学分析和机器学习算法，以提高低负荷转移性疾病的检测能力。
肿瘤(癌症)患者之家