Lean Cynthia L, Bourne Roger, Thompson John F, Scolyer Richard A, Stretch Jonathan, Li Ling-Xi Lawrence, Russell Peter, Mountford Carolyn
Institute for Magnetic Resonance Research, University of Sydney, PO Box 148, St Leonards, NSW 1590, Australia.
Melanoma Res. 2003 Jun;13(3):259-61. doi: 10.1097/00008390-200306000-00006.
Accurate staging of patients with primary cutaneous melanoma includes assessment of regional lymph nodes for the presence of micrometastatic disease. Sentinel lymph node biopsy is highly accurate but is an invasive surgical procedure with a 5-10% complication rate, and requires labour-intensive and expensive histological examination to identify disease. A rapid, accurate and cost-effective non-surgical technique able to detect micrometastatic deposits of melanoma in regional lymph nodes would be of great benefit. Fine needle aspiration biopsies and tissue specimens were obtained from lymph nodes from 18 patients undergoing node resection for metastatic melanoma and five patients undergoing radical retropubic prostatectomy. One-dimensional proton magnetic resonance spectroscopy was undertaken at 360 MHz (8.5 T). Lymph nodes were cut into 3 mm thick slices and embedded. Four sequential 5 microm tissue sections were cut from each block and stained, with haematoxylin and eosin, for S100 protein, for HMB45, and again with haematoxylin and eosin, respectively. Proton magnetic resonance spectroscopy distinguished between benign and malignant lymph node tissue (P < 0.001, separate t-test) and benign and malignant lymph node fine needle aspiration biopsy (P < 0.012) based on the ratio of the integrals of resonances from lipid/other metabolites (1.8-2.5 p.p.m. region) and 'choline' (3.1-3.3 p.p.m. region). In conclusion, one-dimensional proton magnetic resonance spectroscopy on a simple fine needle aspiration biopsy can distinguish lymph nodes containing metastatic melanoma from uninvolved nodes, providing a rapid, accurate and cost-effective non-surgical technique to assess regional lymph nodes in patients with melanoma.
原发性皮肤黑色素瘤患者的准确分期包括评估区域淋巴结是否存在微转移疾病。前哨淋巴结活检高度准确，但它是一种侵入性手术，并发症发生率为5%-10%，并且需要耗费人力和昂贵的组织学检查来识别疾病。一种能够检测区域淋巴结中黑色素瘤微转移沉积物的快速、准确且具有成本效益的非手术技术将大有裨益。从18例因转移性黑色素瘤接受淋巴结切除的患者以及5例接受耻骨后前列腺根治术的患者的淋巴结中获取细针穿刺活检样本和组织标本。在360 MHz（8.5 T）下进行一维质子磁共振波谱分析。将淋巴结切成3毫米厚的切片并包埋。从每个组织块上切取四个连续的5微米厚的组织切片，分别用苏木精和伊红染色、检测S100蛋白、检测HMB45，然后再分别用苏木精和伊红染色。基于脂质/其他代谢物（1.8 - 2.5 ppm区域）和“胆碱”（3.1 - 3.3 ppm区域）共振积分的比率，质子磁共振波谱能够区分良性和恶性淋巴结组织（独立t检验，P < 0.001）以及良性和恶性淋巴结细针穿刺活检（P < 0.012）。总之，对简单的细针穿刺活检样本进行一维质子磁共振波谱分析可以区分含有转移性黑色素瘤的淋巴结和未受累的淋巴结，从而提供一种快速、准确且具有成本效益的非手术技术来评估黑色素瘤患者的区域淋巴结。
