Martinez Steve R, Mori Takuji, Hoon Dave S B
Department of Molecular Oncology, John Wayne Cancer Institute at St. John's Health Center, 2200 Santa Monica Boulevard, Santa Monica, CA 90404, USA.
Surg Oncol Clin N Am. 2006 Apr;15(2):331-40. doi: 10.1016/j.soc.2005.12.012.
The presence of lymph node metastasis is the best predictor of disease progression and overall survival in patients who have melanoma. Lymphatic mapping and selective lymphadenectomy allows directed pathologic analysis of the node or nodes most likely to have metastatic disease. To diagnose metastatic disease in SLNs reliably requires a coordinated effort by nuclear medicine physicians, surgeons, and pathologists. Errors may occur if quality assurance is not emphasized at any point during the process. This, along with the presence of occult metastatic disease, may lead to disease recurrence and progression, even when SLN histologically are free of disease. Molecular up-staging of occult malignant disease has the potential to provide important information to facilitate the diagnosis, surveillance, and treatment of cancer. The detection of occult tumor cells in SLNs and blood provides a powerful tool for assessing early regional and systemic disease spread in patients who have AJCC stage II and III-not only melanoma but also other solid tumors. The use of varying panels of markers from different laboratories has hampered the interpretation of data and made it difficult to unravel the merits of molecular up staging. Molecular approaches have made a major impact on the field of infectious disease and should one day be of equal usefulness in the diagnosis of cancer.
淋巴结转移的存在是黑色素瘤患者疾病进展和总体生存的最佳预测指标。淋巴绘图和选择性淋巴结切除术可对最有可能发生转移性疾病的一个或多个淋巴结进行定向病理分析。要可靠地诊断前哨淋巴结中的转移性疾病，需要核医学医师、外科医生和病理学家共同努力。如果在该过程中的任何环节不强调质量保证，就可能会出现错误。即便前哨淋巴结组织学检查未发现病变，这一点连同隐匿性转移性疾病的存在，都可能导致疾病复发和进展。隐匿性恶性疾病的分子分期有可能提供重要信息，以促进癌症的诊断、监测和治疗。在前哨淋巴结和血液中检测隐匿性肿瘤细胞，为评估美国癌症联合委员会（AJCC）II期和III期患者的早期区域和全身疾病扩散——不仅是黑色素瘤，还有其他实体瘤——提供了一个有力工具。不同实验室使用不同的标志物组合，妨碍了数据解读，难以阐明分子分期的优势。分子方法对传染病领域产生了重大影响，总有一天在癌症诊断中也会同样有用。
