Caracò C, Marone U, Celentano E, Botti G, Mozzillo N
National Cancer Institute, Via M. Semmola, 80131, Naples, Italy.
Ann Surg Oncol. 2007 Sep;14(9):2662-7. doi: 10.1245/s10434-007-9433-5. Epub 2007 Jun 28.
Sentinel lymph node biopsy is widely accepted as standard care in melanoma despite lack of pertinent randomized trials results. A possible pitfall of this procedure is the inaccurate identification of the sentinel lymph node leading to biopsy and analysis of a nonsentinel node. Such a technical failure may yield a different prognosis. The purpose of this study is to analyze the incidence of false negativity and its impact on clinical outcome and to try to understand its causes.
The Melanoma Data Base at National Cancer Institute of Naples was analyzed comparing results between false-negative and tumor-positive sentinel node patients focusing on overall survival and prognostic factors influencing the clinical outcome.
One hundred fifty-one cases were diagnosed to be tumor-positive after sentinel lymph node biopsy and were subjected to complete lymph node dissection. Thirty-four (18.4%)patients with tumor-negative sentinel node subsequently developed lymph node metastases in the basin site of the sentinel procedure. With a median follow-up of 42.8 months the 5-year overall survival was 48.4% and 66.3% for false-negative and tumor-positive group respectively with significant statistical differences (P < .03).
The sensitivity of sentinel lymph node biopsy was 81.6%, and a regional nodal basin recurrence after negative-sentinel node biopsy means a worse prognosis, compared with patients submitted to complete lymph node dissection after a positive sentinel biopsy. The evidence of higher number of tumor-positive nodes after delayed lymphadenectomy in false-negative group compared with tumor-positive sentinel node cases, confirmed the importance of an early staging of lymph nodal involvement. Further data will better clarify the role of prognostic factors to identify cases with a more aggressive biological behavior of the disease.
尽管缺乏相关随机试验结果，但前哨淋巴结活检已被广泛接受为黑色素瘤的标准治疗方法。该手术的一个潜在缺陷是前哨淋巴结识别不准确，导致对非前哨淋巴结进行活检和分析。这种技术失误可能会产生不同的预后。本研究的目的是分析假阴性的发生率及其对临床结局的影响，并试图了解其原因。
对那不勒斯国家癌症研究所的黑色素瘤数据库进行分析，比较假阴性和前哨淋巴结肿瘤阳性患者的结果，重点关注总生存期和影响临床结局的预后因素。
151例患者在前哨淋巴结活检后被诊断为肿瘤阳性，并接受了完整的淋巴结清扫术。34例（18.4%）前哨淋巴结肿瘤阴性的患者随后在进行前哨淋巴结活检的区域发生了淋巴结转移。中位随访42.8个月，假阴性组和肿瘤阳性组的5年总生存率分别为48.4%和66.3%，差异有统计学意义（P < 0.03）。
前哨淋巴结活检的敏感性为81.6%，前哨淋巴结活检阴性后的区域淋巴结复发意味着预后较差，与前哨淋巴结活检阳性后接受完整淋巴结清扫术的患者相比。与前哨淋巴结肿瘤阳性病例相比，假阴性组延迟淋巴结切除术后肿瘤阳性淋巴结数量更多的证据，证实了早期分期淋巴结受累的重要性。进一步的数据将更好地阐明预后因素在识别具有更具侵袭性生物学行为疾病病例中的作用。
