Vidal-Sicart Sergi, Pons Francesca, Fuertes Silvia, Vilalta Antonio, Rull Ramón, Puig Susana, Palou Josep M, Ortega Marisa, Castel Teresa
Department of Nuclear Medicine, Hospital Clínic, University of Barcelona, Spain.
Eur J Nucl Med Mol Imaging. 2004 Jul;31(7):945-9. doi: 10.1007/s00259-004-1485-1. Epub 2004 Mar 3.
The sentinel lymph node (SLN) is the first node in a nodal basin to receive the direct lymphatic flow from a malignant melanoma. However, in some patients, lymphoscintigraphic study reveals the presence of lymphatic nodes in the area between the primary melanoma and the regional basin. These nodes are called "in-transit nodes" or "interval nodes" and, by definition, are also SLNs. The purpose of this study was to determine the incidence and location of in-transit SLNs in patients with malignant melanoma and to assess whether it is really necessary to harvest them. The evaluation involved 600 consecutive malignant melanoma patients. Lymphoscintigraphy was performed on the day before surgery following intradermal injection of 74-111 MBq of (99m)Tc-nanocolloid in four doses around the primary melanoma or the biopsy scar. Dynamic and static images were obtained and revealed SLNs in 599 out of 600 patients. The SLN was intraoperatively identified with the aid of patent blue dye and a hand-held gamma probe. Lymphoscintigraphy showed in-transit SLNs in 59/599 patients (9.8%). During surgery, all these in-transit SLNs were harvested, with those in the popliteal and epitrochlear regions being the most difficult to identify and excise. Metastatic cell deposits were subsequently identified in ten (16.9%) of these in-transit SLNs. In conclusion, lymphoscintigraphy has a key role in the identification of in-transit SLNs. Although the incidence of these nodes is relatively low in malignant melanoma patients, such SLNs present metastatic deposits in a significant percentage of cases and therefore the identification of in-transit SLNs in these patients is really necessary.
前哨淋巴结（SLN）是淋巴结引流区中首个接收来自恶性黑色素瘤直接淋巴引流的淋巴结。然而，在一些患者中，淋巴闪烁造影研究显示在原发性黑色素瘤与区域引流区之间的区域存在淋巴结。这些淋巴结被称为“途中淋巴结”或“区间淋巴结”，根据定义，它们也是前哨淋巴结。本研究的目的是确定恶性黑色素瘤患者途中前哨淋巴结的发生率和位置，并评估是否真的有必要切除它们。该评估纳入了600例连续的恶性黑色素瘤患者。在手术前一天，于原发性黑色素瘤或活检瘢痕周围分四剂皮内注射74 - 111 MBq的（99m）Tc - 纳米胶体后进行淋巴闪烁造影。获取动态和静态图像，600例患者中有599例显示有前哨淋巴结。术中借助专利蓝染料和手持γ探头识别前哨淋巴结。淋巴闪烁造影显示599例患者中有59例（9.8%）存在途中前哨淋巴结。手术期间，所有这些途中前哨淋巴结均被切除，其中腘窝和肘上区域的淋巴结最难识别和切除。随后在这些途中前哨淋巴结中的10例（16.9%）中发现了转移细胞沉积。总之，淋巴闪烁造影在识别途中前哨淋巴结方面起关键作用。尽管这些淋巴结在恶性黑色素瘤患者中的发生率相对较低，但此类前哨淋巴结在相当比例的病例中存在转移沉积，因此在这些患者中识别途中前哨淋巴结确实有必要。
