Vidal-Sicart Sergi, Pons Francesca, Puig Susana, Ortega Marisa, Vilalta Antonio, Martín Francisco, Rull Ramón, Palou Josep Ma, Castel Teresa
Department of Nuclear Medicine, Hospital Clínic, University of Barcelona, Spain.
Eur J Nucl Med Mol Imaging. 2003 Mar;30(3):362-6. doi: 10.1007/s00259-002-1051-7. Epub 2002 Dec 18.
Scintigraphic identification of the sentinel lymph node is achievable in nearly all patients with malignant melanoma. However, in a very small number of cases the sentinel node fails to be detected, and sometimes recurrence appears during follow-up in patients who had previously tested negative for metastatic disease. The purpose of this study was to review our experience in order to isolate the reasons for erroneous sentinel lymph node identification. The evaluation involved 435 consecutive malignant melanoma patients with AJCC stages I and II (clinically negative nodes) and Breslow thickness >0.76 mm. Lymphoscintigraphy was performed the day before surgery by intradermal administration of technetium-99m labelled nanocolloid. Dynamic and static images were obtained. The sentinel node was intraoperatively identified with the aid of patent blue dye and a hand-held gamma probe. After removal, routine histopathological examination with haematoxylin-eosin (H-E) and immunohistochemistry with S 100 and HMB45 (IHC) were performed. In those patients who developed regional recurrences during follow-up, sentinel nodes were further evaluated by reverse transcriptase-polymerase chain reaction (RT-PCR). Lymphoscintigraphy visualised at least one sentinel node in 434 out of 435 patients (99.8%). Uptake in in-transit sentinel lymph nodes was observed in 32 patients (7.4%). During surgery, localisation and removal of sentinel nodes was successful in 430/435 patients (98.8%). A total of 790 sentinel lymph nodes were harvested, with a mean of 1.8 per patient. Routine histopathological examination with H-E or IHC revealed metastatic disease in 72 patients (16.8%). During a mean follow-up of 26 months, seven of those patients with a negative sentinel node developed regional lymph node metastases. In five of them RT-PCR was positive for micrometastases within the sentinel node. In conclusion, erroneous sentinel lymph node identification can be due to changes in the surgical team, difficult lymph node location or absence of a thorough histological study. Nevertheless, it is not possible to explain completely why, in a very small percentage of cases, the sentinel node is erroneously identified.
几乎所有恶性黑色素瘤患者都能通过闪烁扫描法识别前哨淋巴结。然而，在极少数情况下，前哨淋巴结无法被检测到，而且在先前转移性疾病检测呈阴性的患者随访期间，有时会出现复发情况。本研究的目的是回顾我们的经验，以找出前哨淋巴结识别错误的原因。该评估纳入了435例连续的AJCC I期和II期（临床淋巴结阴性）且Breslow厚度>0.76 mm的恶性黑色素瘤患者。术前一天通过皮内注射99m锝标记的纳米胶体进行淋巴闪烁扫描。获取动态和静态图像。术中借助专利蓝染料和手持式γ探测器识别前哨淋巴结。切除后，进行苏木精-伊红（H-E）常规组织病理学检查以及S 100和HMB45免疫组织化学（IHC）检查。在随访期间出现区域复发的患者中，通过逆转录聚合酶链反应（RT-PCR）对前哨淋巴结进行进一步评估。淋巴闪烁扫描在435例患者中的434例（99.8%）中显示至少一个前哨淋巴结。在32例患者（7.4%）中观察到途中前哨淋巴结有摄取。手术期间，435例患者中的430例（98.8%）成功定位并切除前哨淋巴结。共采集了790个前哨淋巴结，平均每位患者1.8个。H-E或IHC常规组织病理学检查在72例患者（16.8%）中发现转移性疾病。在平均26个月的随访期间，7例前哨淋巴结阴性的患者出现区域淋巴结转移。其中5例RT-PCR显示前哨淋巴结内存在微转移。总之，前哨淋巴结识别错误可能是由于手术团队的变动、淋巴结位置困难或缺乏全面的组织学研究。然而，在极少数情况下前哨淋巴结被错误识别的原因仍无法完全解释清楚。
