Haigh P I, Lucci A, Turner R R, Bostick P J, Krasne D L, Stern S L, Morton D L
Roy E. Coats Research Laboratories, Division of Surgical Oncology, John Wayne Cancer Institute at Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA 90404, USA.
Cancer. 2001 Aug 1;92(3):535-41. doi: 10.1002/1097-0142(20010801)92:3<535::aid-cncr1352>3.0.co;2-3.
False-negative results from lymphatic mapping and sentinel lymphadenectomy (LM/SL) are associated with technical failures in nuclear medicine and surgery or with erroneous histologic evaluation. Any method that can confirm sentinel lymph node (SN) identity might decrease the false-negative rate. Carbon dye has been used as an adjunct to assist lymphadenectomy for some tumors, and the authors hypothesized that it could be used for the histologic verification of SNs removed during LM/SL. The current study assessed the clinical utility of carbon dye as a histopathologic adjunct for the identification of SNs in patients with melanoma and correlated the presence of carbon particles with the histopathologic status of the SNs.
LM/SL was performed using carbon dye (India ink) combined with isosulfan blue dye and sulfur colloid. Blue-stained and/or radioactive lymph nodes (two times background) were defined as SNs. Lymph nodes were evaluated for the presence of carbon particles and melanoma cells. If an SN lacked carbon dye in the initial histologic sections, four additional levels were obtained with S-100 protein and HMB-45 immunohistochemistry. Completion lymph node dissection (CLND) was performed if any SN contained melanoma cells.
One hundred patients underwent successful LM/SL in 120 lymph node regions. Carbon particles were identified in 199 SNs from 111 lymph node regions of 96 patients. Sixteen patients had tumor-positive SNs, all of which contained carbon particles. The anatomic location of the carbon particles within these tumor-positive SNs was found to be correlated with the location of tumor cells in the SNs. The presence of carbon particles appeared to be correlated with blue-black staining (P = 0.0001) and with tumor foci (P = 0.028). All 35 non-SNs that were removed during LM/SL were tumor-negative, and only 2 contained carbon particles. Of the 272 non-SNs removed during CLND, 5 contained metastases; 3 of these 5 were the only non-SNs that had carbon particles. The use of carbon particles during LM/SL was found to be safe and nontoxic.
Carbon dye used in LM/SL for melanoma permits the histologic confirmation of SNs. Carbon particles facilitate histologic evaluation by directing the pathologist to the SNs most likely to contain tumor. The location of carbon particles within SNs may assist the pathologist in the detection of metastases, thereby decreasing the histopathologic false-negative rate of LM/SL and subsequently reducing the same-basin recurrence rate.
前哨淋巴结活检（LM/SL）的假阴性结果与核医学和手术中的技术失误或错误的组织学评估有关。任何能够确认前哨淋巴结（SN）身份的方法都可能降低假阴性率。碳染料已被用作辅助手段，帮助某些肿瘤的淋巴结切除术，作者推测它可用于组织学验证LM/SL过程中切除的SN。本研究评估了碳染料作为组织病理学辅助手段在黑色素瘤患者SN识别中的临床效用，并将碳颗粒的存在与SN的组织病理学状态相关联。
使用碳染料（印度墨水）联合异硫蓝染料和硫胶体进行LM/SL。蓝色染色和/或放射性淋巴结（背景值的两倍）被定义为SN。评估淋巴结中碳颗粒和黑色素瘤细胞的存在情况。如果初始组织学切片中的SN缺乏碳染料，则用S-100蛋白和HMB-45免疫组织化学再获取四个层面的切片。如果任何SN含有黑色素瘤细胞，则进行根治性淋巴结清扫术（CLND）。
100例患者在120个淋巴结区域成功进行了LM/SL。在96例患者的111个淋巴结区域的199个SN中发现了碳颗粒。16例患者的SN有肿瘤转移，所有这些SN都含有碳颗粒。发现这些肿瘤阳性SN内碳颗粒的解剖位置与SN内肿瘤细胞的位置相关。碳颗粒的存在似乎与蓝黑色染色（P = 0.0001）和肿瘤灶（P = 0.028）相关。在LM/SL过程中切除的所有35个非SN均为肿瘤阴性，只有2个含有碳颗粒。在CLND过程中切除的272个非SN中，5个有转移；这5个中的3个是唯一含有碳颗粒的非SN。发现在LM/SL过程中使用碳颗粒是安全无毒的。
在黑色素瘤的LM/SL中使用碳染料可对SN进行组织学确认。碳颗粒通过引导病理学家找到最可能含有肿瘤的SN来促进组织学评估。SN内碳颗粒的位置可能有助于病理学家检测转移灶，从而降低LM/SL的组织病理学假阴性率，并随后降低同侧复发率。
