Sahni D, Robson A, Orchard G, Szydlo R, Evans A V, Russell-Jones R
Skin Tumour Unit, St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UK.
J Clin Pathol. 2005 Jul;58(7):715-21. doi: 10.1136/jcp.2004.020123.
Sentinel node (SN) status is the most important prognostic indicator in patients with cutaneous melanoma without clinically evident metastatic spread, but the procedure is associated with considerable morbidity. The LYVE-1 lymphatic marker offers the possibility of studying lymphangiogenesis and tumour metastasis within the primary excision.
To establish whether lymphatic vessel numbers/distribution within the primary tumour correlated with SN status. To assess whether tumour cells were easily demonstrable within lymphatics and could be used as a surrogate for SN status.
Double immunostaining for LYVE-1 and S100 in cutaneous biopsies from 18 SN+ patients with no lymphatic/vascular involvement on routine histology and 18 SN- patients matched for tumour thickness and ulceration.
Lymphatic vessels were detected in all cases. Vessels within the tumour mass were suggestive of active lymphangiogenesis; those outside were mainly mature vessels with well defined walls. Tumour cells within lymphatics were detected in one of 18 SN- and five of 18 SN+ patients. Lymphatics containing tumour cells were all outside the tumour mass in well formed vessels, suggesting melanoma cell invasion into preformed lymphatics. There was no significant difference in lymphatic counts between SN+ and SN- patients. Although peritumorous lymphatic counts were higher in ulcerated than non-ulcerated melanomas, they did not vary with Breslow thickness.
LYVE-1 staining can reliably demonstrate lymphatic vessel distribution, but lymphatic counts cannot predict melanoma metastatic potential and cannot substitute for SN biopsy. LYVE-1 immunostaining can detect melanoma cells within lymphatics, but is unreliable in predicting melanoma metastasis, failing to detect metastatic spread in more than two thirds of patients with regional node metastasis.
前哨淋巴结（SN）状态是无临床明显转移扩散的皮肤黑色素瘤患者最重要的预后指标，但该手术会带来相当高的发病率。LYVE-1淋巴标志物为在原发切除范围内研究淋巴管生成和肿瘤转移提供了可能。
确定原发肿瘤内淋巴管数量/分布是否与SN状态相关。评估肿瘤细胞在淋巴管内是否易于显示，以及能否用作SN状态的替代指标。
对18例SN阳性且常规组织学检查无淋巴管/血管侵犯的患者以及18例肿瘤厚度和溃疡情况相匹配的SN阴性患者的皮肤活检标本进行LYVE-1和S100双重免疫染色。
所有病例均检测到淋巴管。肿瘤块内的血管提示活跃的淋巴管生成；肿瘤块外的血管主要是壁界定清晰的成熟血管。18例SN阴性患者中有1例、18例SN阳性患者中有5例检测到淋巴管内有肿瘤细胞。含有肿瘤细胞的淋巴管均在肿瘤块外且血管形态良好，提示黑色素瘤细胞侵入了预先形成的淋巴管。SN阳性和SN阴性患者的淋巴管计数无显著差异。虽然溃疡型黑色素瘤的瘤周淋巴管计数高于非溃疡型，但它们并不随Breslow厚度而变化。
LYVE-1染色可可靠地显示淋巴管分布，但淋巴管计数无法预测黑色素瘤的转移潜能，也不能替代SN活检。LYVE-1免疫染色可检测淋巴管内的黑色素瘤细胞，但在预测黑色素瘤转移方面不可靠，超过三分之二有区域淋巴结转移的患者未能检测到转移扩散。
