Lin Doris, Franc Benjamin L, Kashani-Sabet Mohammed, Singer Mark I
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, 2380 Sutter Street, Box 1703, San Francisco, CA 94143-0342, USA.
Head Neck. 2006 Mar;28(3):249-55. doi: 10.1002/hed.20328.
The purpose of this study was to evaluate lymphatic drainage patterns of head and neck cutaneous melanoma observed on preoperative lymphoscintigraphy and sentinel lymph node biopsy (SLNB) and determine discordancy from clinically predicted lymphatic drainage patterns.
We conducted a retrospective chart review of 114 patients with head and neck cutaneous melanomas evaluated with preoperative lymphoscintigraphy and SLNB from January 2001 through July 2004.
At least one sentinel lymph node (SLN) was identified in 97% of cases. On preoperative lymphoscintigraphy, an SLN was identified in an area not clinically predicted in 49 cases (43%). The most common sites of discordancy were in areas not typically dissected in standard neck dissections, such as the postauricular region, or in areas of more distant drainage than described previously, such as the inferior or posterior neck. Their percentages of discordant cases were 51%, 27%, and 22%, respectively. The sites of regional recurrence occurred in two cases not predicted on preoperative lymphoscintigraphy and in two cases of failed SLNB.
On the basis of preoperative lymphoscintigraphy and the results of SLNB, head and neck cutaneous melanomas do have expected lymphatic drainage patterns despite perceived discordancy with previously clinically predicted drainage patterns that are based on standard neck dissection specimens. These "discordant" sites can still harbor melanoma, and all sites predicted on preoperative lymphoscintigraphy still need to be explored. The four cases of recurrences underscore the importance of close follow-up for all patients regardless of the SLNB result.
本研究的目的是评估术前淋巴闪烁显像和前哨淋巴结活检（SLNB）观察到的头颈部皮肤黑色素瘤的淋巴引流模式，并确定与临床预测的淋巴引流模式的不一致性。
我们对2001年1月至2004年7月期间接受术前淋巴闪烁显像和SLNB评估的114例头颈部皮肤黑色素瘤患者进行了回顾性病历审查。
97%的病例中至少发现了一个前哨淋巴结（SLN）。在术前淋巴闪烁显像中，49例（43%）在临床未预测的区域发现了SLN。最常见的不一致部位是标准颈部清扫术中通常未清扫的区域，如耳后区域，或比先前描述的更远端引流的区域，如下颈部或后颈部。它们的不一致病例百分比分别为51%、27%和22%。区域复发部位发生在术前淋巴闪烁显像未预测的2例以及SLNB失败的2例中。
根据术前淋巴闪烁显像和SLNB的结果，尽管与基于标准颈部清扫标本的先前临床预测引流模式存在明显不一致，但头颈部皮肤黑色素瘤确实有预期的淋巴引流模式。这些“不一致”部位仍可能存在黑色素瘤，术前淋巴闪烁显像预测的所有部位仍需进行探查。这4例复发病例强调了无论SLNB结果如何，对所有患者进行密切随访的重要性。
