Chakera Annette Hougaard, Drzewiecki Krzysztof Tadeusz, Eigtved Annika, Juhl Birgitte Ravn
Department of Plastic Surgery and Burn Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen Ø, Denmark.
Melanoma Res. 2004 Dec;14(6):521-6. doi: 10.1097/00008390-200412000-00013.
The aim of this study was to evaluate the sentinel node biopsy (SNB) technique for melanoma using both radiocolloid and blue dye in 241 clinically N0 patients with melanomas >1.0 mm, or thinner lesions exhibiting regression/ulceration. We showed that an increase in injected radioactivity increased both the number of visualized nodes at lymphoscintigraphy and the number of SNs removed surgically. At least one SN was removed in 98% (236) of patients, and all nodes were identified with the probe. Seventy-four per cent of the 194 patients injected with blue dye had stained SNs. In 46% (144) of the lymph node basins, there was a discrepancy between the nodes visualized at lymphoscintigraphy and the nodes removed at surgery. There were 38 unusually located nodes. Only eight of these were removed surgically; none contained metastases. SN metastases were detected in 22% (53) of patients. There were nine haematoxylin and eosin (HE)-negatives, all of which were found by immunohistochemistry. The false negative rate for the SNB procedure was 4% (2/55). The complication rate was 6% after SNB and 29% after complete node dissection. In conclusion, SN status is a strong prognostic factor in melanoma patients, and SNB has made the approach to radical lymphadenectomy more rational.
本研究的目的是评估放射性胶体和蓝色染料联合使用的前哨淋巴结活检（SNB）技术在241例临床N0期、黑色素瘤厚度>1.0 mm或有消退/溃疡表现的较薄病变患者中的应用。我们发现，注射放射性物质剂量的增加会使淋巴闪烁显像中可视化淋巴结的数量以及手术切除的前哨淋巴结数量均增加。98%（236例）的患者至少切除了1个前哨淋巴结，并且所有淋巴结均可用探针识别。注射蓝色染料的194例患者中，74%有前哨淋巴结被染色。在46%（144个）的淋巴结区域，淋巴闪烁显像中可视化的淋巴结与手术切除的淋巴结之间存在差异。有38个淋巴结位置异常。其中仅8个被手术切除；均未发现转移灶。22%（53例）的患者检测到前哨淋巴结转移。有9例苏木精-伊红（HE）染色阴性，所有这些均通过免疫组化发现。前哨淋巴结活检程序的假阴性率为4%（2/55）。前哨淋巴结活检后的并发症发生率为6%，而完全淋巴结清扫后的并发症发生率为29%。总之，前哨淋巴结状态是黑色素瘤患者的一个重要预后因素，并且前哨淋巴结活检使根治性淋巴结清扫的方法更加合理。
