Doting M H E, Hoekstra H J, Plukker J Th, Piers D A, Jager P L, Tiebosch A T M G, Vermey A, Schraffordt Koops H
Department of Surgical Oncology, University Hospital Groningen, The Netherlands.
Eur J Surg Oncol. 2002 Sep;28(6):673-8. doi: 10.1053/ejso.2002.1297.
The aim of this study was to evaluate the reliability and clinical impact of sentinel node biopsy, including preoperative lymphoscintigraphy and intraoperative lymphatic mapping in patients with cutaneous melanoma of the head, neck, trunk or extremities.
Two hundred patients (103 women, 97 men), median age 57 (range 21-86) years with cutaneous melanoma > or =1.0mm Breslow thickness and clinically negative lymph nodes participated in a single institutional prospective study from May 1995 to January 2000. Primary melanoma sites included: 22 head and neck (11%), 67 trunk (34%), 29 upper extremity (14%) and 82 lower extremity (41%). The median Breslow thickness was 2.5 (range 1.0-20.0)mm. Preoperative dynamic and static lymphoscintigraphy, intraoperative blue dye and a gamma detection probe were used. If histological examination with HE or IHC showed metastases, therapeutic lymph node dissection (TLND) was performed.
Sentinel node(s) could be identified in 197 patients (99%); 393 sentinel nodes (mean: 2.0 per patient, range 1-7) were removed from 241 basins. Three procedures failed in the head and neck region. In 167 patients, the sentinel nodes were both blue and radioactive (85%); in 26 patients, they were only radioactive (13%) and in four patients only blue (2%). In total, 150 patients had tumour-negative sentinel nodes (76%). During a median follow-up of 47 (range 24-79) months, nodal recurrence in a negative mapped basin was documented in six patients of which isolated recurrence was in two patients and recurrence together with locoregional recurrence in four patients (false negative rate 6/54=11%). Estimated three-year recurrence-free survival in the node-negative patients and node-positive patients was 83 and 66% respectively (P<0.05). The overall survival at three years was 92 and 73% respectively (P<0.05).
Sentinel node biopsy provides accurate staging and important prognostic information. The final place of sentinel node biopsy is still undefined, and therefore sentinel node biopsy is still considered as an experimental surgical staging procedure.
本研究旨在评估前哨淋巴结活检的可靠性及临床影响，包括对头、颈、躯干或四肢皮肤黑色素瘤患者进行术前淋巴闪烁显像和术中淋巴管造影。
1995年5月至2000年1月，200例患者（103例女性，97例男性）参与了一项单机构前瞻性研究，这些患者患有Breslow厚度≥1.0mm的皮肤黑色素瘤且临床淋巴结阴性。原发性黑色素瘤部位包括：22例头颈部（11%）、67例躯干（34%）、29例上肢（14%）和82例下肢（41%）。Breslow厚度中位数为2.5（范围1.0 - 20.0）mm。采用术前动态和静态淋巴闪烁显像、术中蓝色染料及γ探测仪。若HE或IHC组织学检查显示有转移，则进行治疗性淋巴结清扫（TLND）。
197例患者（99%）可识别出前哨淋巴结；从241个区域切除了393个前哨淋巴结（平均每位患者2.0个，范围1 - 7个）。头颈部区域有3例手术失败。167例患者的前哨淋巴结呈蓝色且有放射性（85%）；26例患者的前哨淋巴结仅呈放射性（13%），4例患者的前哨淋巴结仅呈蓝色（2%）。总共150例患者的前哨淋巴结无肿瘤（76%）。在中位随访47（范围24 - 79）个月期间，6例患者在已绘制的阴性区域出现淋巴结复发，其中2例为孤立复发，4例为与局部区域复发同时出现（假阴性率6/54 = 11%）。淋巴结阴性患者和淋巴结阳性患者的估计三年无复发生存率分别为83%和66%（P<0.05）。三年总生存率分别为92%和73%（P<0.05）。
前哨淋巴结活检可提供准确的分期及重要的预后信息。前哨淋巴结活检的最终地位仍未明确，因此前哨淋巴结活检仍被视为一种实验性手术分期方法。
