MÃtodo de anÃlise anatomopatolÃgica de linfonodo sentinela aplicado ao cÃncer de colo de Ãtero: impacto sobre a determinaÃÃo do status linfonodal

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

The status of regional lymph nodes is an important factor for prognosis and indication of adjuvant treatment in uterine cervical cancer. The success of methodology employed in the detailed histopathologic examination of sentinel lymph nodes, particularly in breast cancer and melanomas, has led to the proposal for its use in the evaluation of conventional lymphadenectomy specimens, in which tipically only a single lymph node section is examined. For the present study, the authors utilized the method proposed by the College of American Pathologists for the evaluation of sentinel lymph nodes in breast cancer (submitting all sections obtained from longitudinal cuts at 2 or 3 mm intervals, along the long axis), for the analysis of lymph nodes derived from bilateral pelvic lymphadenectomies. A prospective study was carried out including 34 patients with stage I and II uterine cervical cancer. The study evaluated the impact of this method in the detection of metastases compared to the conventional examination of a single section per lymph node. The control group (conventional examination) had a single (the largest) histopathological section per lymph node evaluated, and the case group had all obtained sections evaluated, including the largest one examined in the control group (CAP method). This process was repeated for each of the lymph nodes from 34 patients. Four hundred and seventy four lymph node and 953 histological sections were examined. Six patients (17,6%) had metastases, five (14,7%) detected by both metodologies. In five cases (14,7%) metastases were of subcapsular location and measured an average 17mm in greatest dimension. For the case free of metastases (28 cases; 82,3%) and for the ones with metastases ( 6 cases; 7,6%) the number and average size of lymph nodes evaluated were 13 and 12 mm and 16 and 19mm, respectively. In only one patient (2,9%) metastases measuring 5 mm were detected, which were not found by the conventional method in the analysis of 17 lymph nodes. Double the amount of time (405,3 x 223,6 seconds) and materials (958 x 474 paraffin blocks and slides) were spent on the histopathological analysis of the CAP method in comparison with the conventional evaluation of a single section

ASSUNTO(S)

metastasis linfonodos cÃncer uterino cervix anatomia patologica e patologia clinica cancer metÃstases lymph nodes colo de Ãtero

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