Gallegos-Hernández J Francisco, Nieweg Omgo E, Tanis Pieter J, Valdés-Olmos Renato A, Kroon Bin B
División de Cirugía Hospital de Oncología CMN SXXI, IMSS, Av. Cuauhtémoc 330 Col. Doctores, CP 06725, México, D.F.
Gac Med Mex. 2003 Sep-Oct;139(5):449-52.
The trend to implement sentinel node biopsy as standard of care in patients with clinically localized melanoma is encouraged by the following three factors: the technique of lymphatic mapping has matured to the point that consensus was reached on how the procedure should be carried out, surgeons showed that they can find the node in nearly 100% of patients, and tumor-status was shown to be the most powerful prognostic factor. However, recent studies revealed unfavorable new information that questions the wisdom of this trend. Three studies published in 2001 with a combined total of 1,851 patients show false-negative rates of 16-25%. Another unnerving finding is the 13-19% incidence of in-transit metastases in patients with a tumor-positive sentinel node, reported by three groups. The ultimate purpose of lymphatic mapping is to provide sentinel node positive patients with early therapeutic measures, such as regional node dissection and adjuvant systemic treatment. However, there is currently no evidence that this approach results in improved regional control and survival. Sentinel node biopsy can only become part of routine patient management if the tumor-status of the sentinel node carries clear implications of proven benefit for the manner in wich patients are managed and if regional control is not jeopardized.
淋巴绘图技术已经成熟，就该手术的实施方式达成了共识；外科医生表明他们在近100%的患者中能够找到前哨淋巴结；肿瘤状态被证明是最有力的预后因素。然而，最近的研究揭示了一些不利的新信息，对这一趋势的合理性提出了质疑。2001年发表的三项研究共涉及1851名患者，显示假阴性率为16%至25%。另一个令人不安的发现是，三个研究小组报告称，在前哨淋巴结肿瘤阳性的患者中，有13%至19%发生了途中转移。淋巴绘图的最终目的是为前哨淋巴结阳性的患者提供早期治疗措施，如区域淋巴结清扫和辅助全身治疗。然而，目前没有证据表明这种方法能改善区域控制和生存率。只有当前哨淋巴结的肿瘤状态对患者的管理方式有明确的已证实的益处，且不危及区域控制时，前哨淋巴结活检才能成为常规患者管理的一部分。
