Cochran Alistair J, Wen Duan-Ren, Huang Rong-Rong, Wang Hei-Jing, Elashoff Robert, Morton Donald L
Department of Pathology and Laboratory Medicine, School of Public Health at UCLA, Los Angeles, CA 90095-1732, USA.
Mod Pathol. 2004 Jul;17(7):747-55. doi: 10.1038/modpathol.3800117.
Lymphatic mapping and sentinel node biopsy are well-established techniques for staging and managing patients with melanoma, breast cancer and other malignancies that spread initially to the regional lymph nodes. Identification of tumor in the sentinel node is the most precise staging technique currently available. The sentinel node is the site of metastatic melanoma in approximately 20% of melanoma patients and if tumor is present in the sentinel node it is customary to perform a complete dissection of the lymph nodes of the affected nodal basin. This may be overtreatment for some patients as tumor is identified in the nonsentinel nodes of only one-third of sentinel node-positive melanoma patients treated by completion lymphadenectomy. If it were possible accurately to identify the minority of patients with tumor in the nonsentinel nodes, the patients most likely to benefit from lymphadenectomy, the remaining patients could be spared a potentially morbid operation that is unlikely to confer clinical advantage. In 90 patients with a melanoma-positive sentinel node, who subsequently had a completion lymphadenectomy, we evaluated and compared the capacity of characteristics of the primary melanoma and of the sentinel node to predict individuals likely to have tumor in nonsentinel nodes. We assessed the Breslow thickness of the primary, the amount of tumor in the sentinel node (relative tumor area) and, as an index of immune modulation of the sentinel node, the density of dendritic leukocytes in the nodal paracortex. The relative area of tumor in the sentinel node and Breslow thickness of the primary melanoma most accurately predicted the presence of tumor in the nonsentinel nodes (P=0.0001 in both cases-Wilcoxon rank sums). The presence of melanoma in the nonsentinel nodes was also predicted by the density of dendritic leukocytes in the paracortex (P=0.008-Wilcoxon rank sums). These three observations assessed alone and in combination predict the presence of tumor in the nonsentinel nodes with high accuracy. The same characteristics also significantly correlated with tumor recurrence (tumor burden, P=0.0001, Breslow, P=0.0001 and dendritic cell density, P=0.0007) and death from melanoma (tumor burden, P=0.0001, Breslow, P=0.0001 and dendritic cell density, P=0.0026).
淋巴绘图和前哨淋巴结活检是用于黑色素瘤、乳腺癌及其他最初转移至区域淋巴结的恶性肿瘤患者分期和治疗的成熟技术。在前哨淋巴结中发现肿瘤是目前可用的最精确的分期技术。在前哨淋巴结中发现转移性黑色素瘤的患者约占黑色素瘤患者的20%，如果前哨淋巴结中存在肿瘤，通常会对受影响的淋巴结区域进行彻底清扫。对于一些患者来说，这可能属于过度治疗，因为在接受根治性淋巴结清扫术的前哨淋巴结阳性黑色素瘤患者中，只有三分之一的患者在非前哨淋巴结中发现肿瘤。如果能够准确识别非前哨淋巴结中有肿瘤的少数患者，即最有可能从淋巴结清扫术中获益的患者，那么其余患者就可以避免进行可能导致病态的手术，而这种手术不太可能带来临床益处。在90例前哨淋巴结黑色素瘤阳性且随后接受根治性淋巴结清扫术的患者中，我们评估并比较了原发性黑色素瘤和前哨淋巴结的特征预测非前哨淋巴结中可能存在肿瘤个体的能力。我们评估了原发性肿瘤的Breslow厚度、前哨淋巴结中的肿瘤量（相对肿瘤面积），并作为前哨淋巴结免疫调节指标，评估了淋巴结副皮质中树突状白细胞的密度。前哨淋巴结中的肿瘤相对面积和原发性黑色素瘤的Breslow厚度最准确地预测了非前哨淋巴结中肿瘤的存在（两种情况的P值均为0.0001-Wilcoxon秩和检验）。副皮质中树突状白细胞的密度也可预测非前哨淋巴结中黑色素瘤的存在（P=0.008-Wilcoxon秩和检验）。单独评估和综合评估这三个观察指标都能高度准确地预测非前哨淋巴结中肿瘤的存在。相同的特征也与肿瘤复发（肿瘤负荷，P=0.0001，Breslow，P=0.0001，树突状细胞密度，P=0.0007）和黑色素瘤死亡（肿瘤负荷，P=0.0001，Breslow，P=0.0001，树突状细胞密度，P=0.0026）显著相关。
