Matter Maurice, Nicod Lalonde Marie, Allaoua Mohamed, Boubaker Ariane, Liénard Danielle, Gugerli Oliver, Cerottini Jean-Philippe, Bouzourene Hanifa, Bischof Delaloye Angelika, Lejeune Ferdinand
Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
J Nucl Med. 2007 Oct;48(10):1607-13. doi: 10.2967/jnumed.107.041707. Epub 2007 Sep 14.
In sentinel node (SN) biopsy, an interval SN is defined as a lymph node or group of lymph nodes located between the primary melanoma and an anatomically well-defined lymph node group directly draining the skin. As shown in previous reports, these interval SNs seem to be at the same metastatic risk as are SNs in the usual, classic areas. This study aimed to review the incidence, lymphatic anatomy, and metastatic risk of interval SNs.
SN biopsy was performed at a tertiary center by a single surgical team on a cohort of 402 consecutive patients with primary melanoma. The triple technique of localization was used-that is, lymphoscintigraphy, blue dye, and gamma-probe. Otolaryngologic melanoma and mucosal melanoma were excluded from this analysis. SNs were examined by serial sectioning and immunohistochemistry. All patients with metastatic SNs were recommended to undergo a radical selective lymph node dissection.
The primary locations of the melanomas included the trunk (188), an upper limb (67), or a lower limb (147). Overall, 97 (24.1%) of the 402 SNs were metastatic. Interval SNs were observed in 18 patients, in all but 2 of whom classic SNs were also found. The location of the primary was truncal in 11 (61%) of the 18, upper limb in 5, and lower limb in 2. One patient with a dorsal melanoma had drainage exclusively in a cervicoscapular area that was shown on removal to contain not lymph node tissue but only a blue lymph channel without tumor cells. Apart from the interval SN, 13 patients had 1 classic SN area and 3 patients 2 classic SN areas. Of the 18 patients, 2 had at least 1 metastatic interval SN and 2 had a classic SN that was metastatic; overall, 4 (22.2%) of 18 patients were node-positive.
We found that 2 of 18 interval SNs were metastatic: This study showed that preoperative lymphoscintigraphy must review all known lymphatic areas in order to exclude an interval SN.
在前哨淋巴结（SN）活检中，间隔前哨淋巴结被定义为位于原发性黑色素瘤与直接引流皮肤的解剖学上明确的淋巴结组之间的一个或一组淋巴结。如先前报告所示，这些间隔前哨淋巴结似乎与通常经典区域的前哨淋巴结具有相同的转移风险。本研究旨在回顾间隔前哨淋巴结的发生率、淋巴解剖结构和转移风险。
在一家三级中心，由一个手术团队对402例连续的原发性黑色素瘤患者进行SN活检。采用了三重定位技术，即淋巴闪烁显像、蓝色染料和γ探测仪。本分析排除了耳鼻喉黑色素瘤和黏膜黑色素瘤。通过连续切片和免疫组织化学检查前哨淋巴结。所有前哨淋巴结转移的患者均被建议进行根治性选择性淋巴结清扫。
黑色素瘤的主要部位包括躯干（188例）、上肢（67例）或下肢（147例）。总体而言，402个前哨淋巴结中有97个（24.1%）发生转移。在18例患者中观察到间隔前哨淋巴结，除2例患者外，其余患者均同时发现了经典前哨淋巴结。18例患者中，11例（61%）的原发部位在躯干，5例在上肢，2例在下肢。1例背部黑色素瘤患者的引流仅在颈肩胛区域，切除后显示该区域不含淋巴结组织，仅含有一条无肿瘤细胞的蓝色淋巴通道。除间隔前哨淋巴结外，13例患者有1个经典前哨淋巴结区域，3例患者有2个经典前哨淋巴结区域。18例患者中，2例至少有1个转移的间隔前哨淋巴结，2例有转移的经典前哨淋巴结；总体而言，18例患者中有4例（22.2%）淋巴结阳性。
我们发现18个间隔前哨淋巴结中有2个发生转移：本研究表明，术前淋巴闪烁显像必须检查所有已知的淋巴区域，以排除间隔前哨淋巴结。
