Neville H L, Andrassy R J, Lally K P, Corpron C, Ross M I
Department of Surgery, University of Texas-Houston Medical School, the Memorial Hermann Children's Hospital, and the University of Texas MD Anderson Cancer Center, USA.
J Pediatr Surg. 2000 Jun;35(6):961-4. doi: 10.1053/jpsu.2000.6936.
BACKGROUND/PURPOSE: Lymphatic mapping with sentinel node biopsy is used widely in adult melanoma and breast cancer to determine nodal status without the morbidity associated with elective lymph node dissection. This technique can be used in children to determine lymph node status with limited dissection and accurate interpretation. The authors report their initial experience.
The charts of patients who underwent lymphatic mapping with sentinel node biopsy were reviewed retrospectively. Lymphoscintigraphy was performed in patients with truncal lesions 24 hours before surgery to determine the draining nodal basin (for surgical mapping). The tumors were injected 1 hour preoperatively with technetium sulfur colloid and in the operating room with Lymphazurin blue. The draining basin was examined using a radioisotope detector. The blue nodes with high counts were localized and removed. If nodal metastases were identified, lymph node dissection was recommended. Four patients were injected only with Lymphazurin blue.
Thirteen children (7 girls, 6 boys; mean age, 7 years) underwent lymphatic mapping with sentinel node biopsy. The tumor types were as follows: 8 malignant melanoma (6 extremity, 2 truncal), 1 malignant peripheral nerve sheath tumor, 1 alveolar soft part sarcoma, and 3 rhabdomyosarcoma. A mean of 2.4 nodes (range, 1 to 6) were removed from each patient. Six patients had a positive sentinel node. Formal lymph node dissection was performed on 4 of the 6 patients, 1 of whom had further nodal disease with 2 of 13 nodes containing micrometastases. One of the 6 patients refused lymph node dissection and adjuvant therapy; the final patient had rhabdomyosarcoma, a malignancy for which lymph node dissection is not indicated. Pulmonary metastasis developed 26 months after diagnoses in the patient with alveolar soft part sarcoma and a negative sentinel node. This patient was injected only with Lymphazurin blue at the time of sentinel node biopsy and refused adjuvant therapy. There have been no other recurrences. There were no complications related to lymphatic mapping or sentinel node biopsy.
Lymphatic mapping with sentinel node biopsy, using both technetium-labeled sulfur colloid and Lymphazurin blue, can be performed safely in pediatric skin and soft tissue malignancies. Further study with long-term follow-up will determine the utility and accuracy of this technique in pediatric malignancies.
背景/目的：前哨淋巴结活检的淋巴绘图技术在成人黑色素瘤和乳腺癌中被广泛应用，以确定淋巴结状态，同时避免了选择性淋巴结清扫术带来的并发症。该技术可用于儿童，通过有限的清扫和准确的解读来确定淋巴结状态。作者报告了他们的初步经验。
回顾性分析接受前哨淋巴结活检淋巴绘图的患者病历。对于躯干病变患者，在手术前24小时进行淋巴闪烁显像，以确定引流淋巴结区域（用于手术定位）。术前1小时给肿瘤注射硫化锝胶体，在手术室注射亚甲蓝。使用放射性同位素探测器检查引流区域。定位并切除计数高的蓝色淋巴结。如果发现淋巴结转移，则建议进行淋巴结清扫。4例患者仅注射了亚甲蓝。
13名儿童（7名女孩，6名男孩；平均年龄7岁）接受了前哨淋巴结活检的淋巴绘图。肿瘤类型如下：8例恶性黑色素瘤（6例位于四肢，2例位于躯干），1例恶性外周神经鞘瘤，1例肺泡软组织肉瘤，3例横纹肌肉瘤。每名患者平均切除2.4个淋巴结（范围1至6个）。6例患者前哨淋巴结阳性。6例患者中的4例进行了正式的淋巴结清扫，其中1例有进一步的淋巴结疾病，13个淋巴结中有2个含有微转移。6例患者中的1例拒绝淋巴结清扫和辅助治疗；最后1例患者患有横纹肌肉瘤，该恶性肿瘤不建议进行淋巴结清扫。肺泡软组织肉瘤且前哨淋巴结阴性的患者在诊断后26个月发生了肺转移。该患者在前哨淋巴结活检时仅注射了亚甲蓝，并拒绝辅助治疗。没有其他复发情况。没有与淋巴绘图或前哨淋巴结活检相关的并发症。
使用锝标记的硫化锝胶体和亚甲蓝进行前哨淋巴结活检的淋巴绘图，可安全地应用于儿童皮肤和软组织恶性肿瘤。长期随访的进一步研究将确定该技术在儿童恶性肿瘤中的实用性和准确性。
