RESUMEN
OBJECTIVE: Sentinel node mapping (SLN) has replaced lymphadenectomy for staging surgery in apparent early-stage low and intermediate risk endometrial cancer (EC). Only limited data about the adoption of SNM in high risk EC is still available. Here, we evaluate the outcomes of high-risk EC undergoing SNM (with or without back-up lymphadenectomy). METHODS: This is a multi-institutional international retrospective study, evaluating data of high-risk (FIGO grade 3 endometrioid EC with myometrial invasion >50% and non-endometrioid histology) EC patients undergoing SNM followed by back-up lymphadenectomy and SNM alone. RESULTS: Chart of consecutive 196 patients were evaluated. The study population included 83 and 113 patients with endometrioid and non-endometrioid EC, respectively. SNM alone and SNM followed by back-up lymphadenectomy were performed in 50 and 146 patients, respectively. Among patients having SNM alone, 14 (28%) were diagnosed with nodal disease. In the group of patients undergoing SNM plus back-up lymphadenectomy 34 (23.2%) were diagnosed with nodal disease via SNM. Back-up lymphadenectomy identified 2 (1%) additional patients with nodal disease (in the para-aortic area). Back-up lymphadenectomy allowed to remove adjunctive positive nodes in 16 (11%) patients. After the adoption of propensity-matched algorithm, we observed that patients undergoing SNM plus back-up lymphadenectomy experienced similar disease-free survival (p = 0.416, log-rank test) and overall survival (p = 0.940, log-rank test) than patients undergoing SLN alone. CONCLUSIONS: Although the small sample size, and the retrospective study design this study highlighted that type of nodal assessment did not impact survival outcomes in high-risk EC. Theoretically, back-up lymphadenectomy would be useful in improving the removal of positive nodes, but its therapeutic value remains controversial. Further prospective evidence is needed.
Asunto(s)
Neoplasias Endometriales/patología , Neoplasias Endometriales/cirugía , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Biopsia del Ganglio Linfático Centinela/métodos , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Humanos , Escisión del Ganglio Linfático , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Factores de Riesgo , Ganglio Linfático Centinela/patología , Ganglio Linfático Centinela/cirugía , Tasa de SupervivenciaRESUMEN
The present study is focused on the implementation of a novel, low cost, urban grid of nanostructured chemresistor gas sensors for ammonia concentration ([NH(3)]) monitoring, with NH(3) being one of the main precursors of secondary fine particulate. Low-cost chemresistor gas sensors based on carbon nanotubes have been developed, their response to [NH(3)] in the 0.17-5.0 ppm range has been tested, and the devices have been properly calibrated under different relative humidity conditions in the 33-63% range. In order to improve the chemresistor selectivity towards [NH(3)], an Expert System, based on fuzzy logic and genetic algorithms, has been developed to extract the atmospheric [NH(3)] (with a sensitivity of a few ppb) from the output signal of a model chemresistor gas sensor exposed to an NO(2), NO(X) and O(3) gas mixture. The concentration of these pollutants that are known to be the most significant interfering compounds during ammonia detection with carbon nanotube gas sensors has been tracked by the ARPA monitoring network in the city of Milan and the historical dataset collected over one year has been used to train the Expert System.