Pu L L, Cruse C W, Wells K E, Cantor A, Glass L F, Messina J L, Reintgen D S
Division of Plastic Surgery, University of South Florida College of Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa 33606, USA.
Plast Reconstr Surg. 1999 Sep;104(4):964-9. doi: 10.1097/00006534-199909040-00010.
Lymphatic mapping and sentinel lymph node biopsy is a new technique used in the surgical treatment of patients with malignant melanoma. The purpose of this study was to evaluate the results of this approach for patients with melanoma of the lower extremity. Between May of 1994 and June of 1997 at the H. Lee Moffitt Cancer Center and Research Institute, 85 consecutive patients with clinical stage I and II melanoma of the lower extremity underwent lymphatic mapping and sentinel lymph node biopsy. These nodes were identified in all 85 patients by intraoperative lymphatic mapping with both radiolymphoscintigraphy and a vital blue dye injection. Eleven patients (12.9 percent) had histologically positive sentinel lymph nodes, and 10 patients underwent inguinal complete lymph node dissections. All 10 patients had no further histologically positive lymph nodes confirmed by subsequent complete dissection. Among 74 patients with histologically negative sentinel lymph nodes, only 2 patients (2.7 percent) developed inguinal nodal metastases during a mean follow-up period of 21.8 months (range, 13.5 to 58.3 months). The sensitivity of lymphatic mapping and sentinel lymph node biopsy in this series was 100 percent and the specificity was 97.3 percent. Therefore, we conclude that the use of lymphatic mapping and sentinel lymph node biopsy can accurately stage patients with melanoma of the lower extremity and provide a rational surgical approach for these patients.
淋巴绘图和前哨淋巴结活检是用于恶性黑色素瘤患者外科治疗的一项新技术。本研究的目的是评估这种方法对下肢黑色素瘤患者的治疗效果。1994年5月至1997年6月期间，在H. Lee Moffitt癌症中心和研究所，85例连续的临床I期和II期下肢黑色素瘤患者接受了淋巴绘图和前哨淋巴结活检。通过术中淋巴绘图，使用放射性淋巴闪烁造影术和注射活性蓝色染料，在所有85例患者中均识别出了这些淋巴结。11例患者（12.9%）的前哨淋巴结组织学检查呈阳性，10例患者接受了腹股沟区完全淋巴结清扫术。所有10例患者后续的完全清扫术中均未发现组织学检查呈阳性的其他淋巴结。在74例前哨淋巴结组织学检查呈阴性的患者中，在平均21.8个月（范围为13.5至58.3个月）的随访期内，只有2例患者（2.7%）出现了腹股沟淋巴结转移。本系列研究中淋巴绘图和前哨淋巴结活检的敏感性为100%，特异性为97.3%。因此，我们得出结论，使用淋巴绘图和前哨淋巴结活检能够准确地对下肢黑色素瘤患者进行分期，并为这些患者提供合理的手术方法。
