Blumenthal R, Banic A, Brand C U, Ris H B, Lardinois D
Division of Thoracic Surgery, University Hospital, Inselspital, Bern.
Swiss Surg. 2002;8(5):209-14. doi: 10.1024/1023-9332.8.5.209.
Prospective analysis of the morbidity and outcome of the sentinel lymph node (SLN) technique in a consecutive series of patients with early-stage melanoma.
Between 1997 and 1998, 60 patients with stage IB-II malignant melanoma underwent SLN dissection. Preoperative dynamic lymphoscintigraphy with mapping of the lymph vessels and lymph nodes and location of the sentinel node was performed the day before SLN dissection. SLN was identified by use of the blue dye technique. SLN was assessed for histopathological and immunohistochemical examination. Postoperative morbidity and mortality were recorded. Follow-up consisted of repetitive clinical examination with lymph nodes status, laboratory and radiologic findings.
Tumor-positive SLN was observed in 18% of the patients and stage II disease was found in 91% of the patients with positive SLN. Breslow thickness was the only significant factor predicting involvement of a SLN (p = 0.02). In 36% of the positive SLN, metastases could be assessed only by immunohistochemical examination. Postoperative complications after SLN dissection were observed in 5% in comparison with 36% after elective lymph node dissection. After a mean follow-up of 32 months, recurrence was observed in 3% with a mean disease-free survival of 8 months. Overall survival was 82% and 90% in patients with positive and negative SLN, respectively. Overall mortality was 15%, due to distant metastases in 78% of the cases.
Staging of early-stage melanoma with the SLN dissection by use of the blue dye technique combined to lymphoscintigraphy and immunohistochemistry is reliable and safe, with less morbidity than elective lymphadenectomy. Long-term follow-up is mandatory to establish the exact reliability of SLN dissection.
对一系列连续的早期黑色素瘤患者进行前哨淋巴结（SLN）技术的发病率及转归的前瞻性分析。
1997年至1998年间，60例IB-II期恶性黑色素瘤患者接受了SLN清扫术。在SLN清扫术前一天，进行术前动态淋巴闪烁显像，以绘制淋巴管和淋巴结图并确定前哨淋巴结的位置。通过使用蓝色染料技术识别SLN。对SLN进行组织病理学和免疫组织化学检查。记录术后发病率和死亡率。随访包括对淋巴结状态进行重复临床检查、实验室检查和影像学检查结果。
18%的患者观察到肿瘤阳性的SLN，91%的SLN阳性患者发现处于II期疾病。Breslow厚度是预测SLN受累的唯一重要因素（p = 0.02）。在36%的阳性SLN中，仅通过免疫组织化学检查才能评估转移情况。SLN清扫术后的术后并发症发生率为5%，而选择性淋巴结清扫术后为36%。平均随访32个月后，3%的患者出现复发，平均无病生存期为8个月。SLN阳性和阴性患者的总生存率分别为82%和90%。总死亡率为15%，78%的病例死于远处转移。
通过使用蓝色染料技术结合淋巴闪烁显像和免疫组织化学进行SLN清扫术对早期黑色素瘤进行分期是可靠且安全的，发病率低于选择性淋巴结切除术。必须进行长期随访以确定SLN清扫术的确切可靠性。
