Uren Roger F, Thompson John F, Howman-Giles Robert, Chung David K V
Nuclear Medicine and Diagnostic Ultrasound, RPAH Medical Centre, 100 Carillon Avenue, Newtown, NSW 2042, Australia.
Surg Oncol Clin N Am. 2006 Apr;15(2):285-300. doi: 10.1016/j.soc.2005.12.006.
Lymphatic drainage of the skin cannot be predicted based on clinical guidelines developed more than 100 years ago. Approximately 30% of patients experience drainage from the skin to unexpected lymph node sites rather than those specified by these guidelines, and therefore these outdated assumptions should no longer be used to plan surgery. A possible survival benefit has been shown for the early detection and surgical removal of metastatic disease in the draining lymph nodes, and therefore, clinicians must obtain accurate lymphatic mapping for each patient who has intermediate thickness melanoma to plan appropriate surgical therapy. Lymphoscintigraphy can be used to accurately define the precise position of each true sentinel node in every patient, whether these nodes lie in a standard node field or in an unusual location. In this way, lymphoscintigraphy has a direct beneficial impact on the surgical management of patients who have melanoma.
基于100多年前制定的临床指南，无法预测皮肤的淋巴引流情况。约30%的患者皮肤引流至意外的淋巴结部位，而非这些指南所指定的部位，因此，这些过时的假设不应再用于手术规划。已显示早期检测并手术切除引流淋巴结中的转移性疾病可能具有生存益处，因此，临床医生必须为每例中度厚度黑色素瘤患者进行准确的淋巴绘图，以规划适当的手术治疗。淋巴闪烁造影可用于准确确定每位患者每个真正前哨淋巴结的精确位置，无论这些淋巴结位于标准淋巴结区域还是异常位置。通过这种方式，淋巴闪烁造影对黑色素瘤患者的手术管理产生直接有益影响。
