Ist die Sentinel-Lymphknotenmarkierung bei Patientinnen mit tief infiltrierender rektovaginaler Endometriose sinnvoll?

Subscribe to RSS DOI: 10.1055/s-0030-1249879 © Georg Thieme Verlag KG Stuttgart · New York Ist die Sentinel-Lymphknotenmarkierung bei Patientinnen mit tief infiltrierender rektovaginaler Endometriose sinnvoll? Is Sentinel Lymph Node Examination in Patients with Deep Infiltrating Rectovaginal Endometriosis Beneficial?Publication History eingereicht 12.8.2009 revidiert 2.9.2009 akzeptiert 1.3.2010 Publication Date: 21 May 2010 (online) Zusammenfassung Fragestellung: Die tief infiltrierende Endometriose ist eine chronische Erkrankung, deren Pathogenese weitgehend ungeklärt ist. Eine lymphogene Dissemination von Endometriosezellen in zufällig entnommenen mesorektalen Lymphknoten und in pelvinen Sentinel-Lymphknoten (SLK) konnte bei Patientinnen mit rektovaginaler Endometriose gezeigt werden. Die Bedeutung dieser Beobachtung ist derzeitig jedoch unklar und bedarf weitergehender klinischer Untersuchungen. Um zu evaluieren, welche Lymphknoten für weiterführende Studien geeigneter sind, wurden das Vorkommen und die Morphologie von Endometrioseläsionen (EM-Läsionen) in pelvinen SLK mit solchen in zufällig entnommenen regionalen LK (zufällige LK) verglichen. Material und Methode: Bei 18 Patientinnen wurden 58 pelvine SLK und bei 23 weiteren Patientinnen 105 zufällige sich im Resektionsgewebe befindliche LK auf das Vorkommen von EM-Läsionen hin untersucht. Zur Identifikation von EM-Läsionen wurde immunhistochemisch die Expression von Östrogen- und Progesteronrezeptoren sowie CD10 und Zytokeratin untersucht. Anschließend wurde die Größe der EM-Läsionen 2-dimensional (Längsdurchmesser: Größe A; Querdurchmesser: Größe B) ermittelt. Ergebnisse: Bei insgesamt 14 Patientinnen konnten EM-Läsionen gefunden werden: bei 6 Patientinnen aus der SLK-Gruppe (33 %) und bei 8 Patientinnen aus der Gruppe der zufällig entnommenen LK (28 %). Die EM-Läsionen der SLK waren signifikant größer als die Läsionen in den zufällig entnommenen regionalen LK (Größe A: p = 0,014; Größe B: p = 0,006). Schlussfolgerung: Das Vorkommen von EM-Läsionen in SLK sowie in regionalen LK demonstriert eine lymphogene Ausbreitung der Endometriose. Das Sentinel-Konzept ist im Vergleich zu zufällig resezierten LK bei Patientinnen mit rektovaginaler Endometriose besser geeignet, die relevanten Lymphknoten zu identifizieren. Damit sollte bei zukünftigen Studien zur Evaluierung der klinischen Bedeutung der lymphogenen Endometrioseausbreitung das SLK-Konzept Anwendung finden. Abstract Purpose: Deep infiltrating endometriosis (DIE) is a chronic disease with an unknown pathogenesis. The occurrence of endometriosis in mesorectal and pelvic lymph nodes suggests a lymphatic spread of endometriotic cells. However, the biological potential of such nodal endometriotic lesions and the subsequent therapeutic consequences are currently unknown. The aim of this study was to compare the occurrence and morphology of endometriotic lesions in pelvic sentinel lymph nodes (SLN) and in incidentally removed lymph nodes (LN) of patients with deep infiltrating endometriosis. Material and Methods: In 18 patients with DIE, 58 pelvic SLNs were examined for the occurrence of endometriotic lesions as were 105 incidentally removed LNs from 23 patients. In order to identify endometriotic lesions, immunohistochemical analysis of estrogen and progesterone receptors, CD10 and cytokeratin was performed. Furthermore, the size of the endometriotic lesions including their cytogenic stroma was measured twodimensionally (size A and B). Results: Endometriotic lesions were detected in LNs in a total of 14 patients: in 6 patients from the SLN group (33 %) and in 8 patients in the incidental lymph node group (28 %). The size of endometriotic lesions found in sentinel lymph nodes was significantly (size A: p = 0.014; size B: p = 0.006) larger compared to incidental lymph nodes. Conclusion: The occurrence of endometriotic lesions in lymph nodes demonstrates lymphatic spread of the disease. The SLN concept is more capable of identifying relevant nodal endometriotic lesions than the investigation of incidentally removed LNs. SLNs seem more feasible to evaluate the clinical relevance of nodal endometriotic lesions in patients with deep infiltrating endometriosis. Schlüsselwörter tief infiltrierende Endometriose - Sentinel‐Lymphknoten - rektovaginale Endometriose - lymphogene Ausbreitung - kombinierte vaginal‐laparoskopisch assistierte Resektion Key words deep infiltrating endometriosis - sentinel lymph node - lymphatic spread - rectovaginal endometriosis - combined vaginal laparoscopic‐assisted resection Literatur - 1 Giudice L C, Kao L C. Endometriosis. Lancet. 2004; 364 1789-1799 - 2 Bulun S E. 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