Tamiolakis D, Venizelos J, Jivanakis T, Antoniou C, Economou C, Tsiminikakis N, Georgiou G, Alexiadis G, Costopoulou A
Department of Cytology, Regional Hospital of Chania, Crete, Greece.
Minerva Med. 2008 Feb;99(1):15-21.
Sentinel lymph node (SLN) biopsy has revolutionized lymph node staging in patients with malignant melanoma. Intraoperative evaluation is a new addition to the SLN procedure that allows for a one-step regional lymph node dissection to be performed when the SLN biopsy findings are positive. The discriminatory immunostaining pattern with the S-100 and HMB45 monoclonal antibodies allows intraoperative immunocytochemical evaluation of imprint smears of SLNs for melanoma metastases.
One hundred twenty eight SLNs from a cohort of 52 patient-cases that had been identified using sulfur colloid as a radioactive tracer and isosulfan blue were bisected for rapid Diff-Quick stained touch preparations. Intraopera-tive evaluation of sentinel node status by imprint cytology was correlated with the histopathological results of permanent sections. Tumor-negative nodes in routine paraffin sections were further investigated with the employment of the S-100 and HMB45 antibodies.
Thirty-six of all SLNs harbored metastases in paraffin sections, from which 32 were identified by imprint cytology (sensitivity 88.8%). Three SLNs were positive by imprint cytology and negative by histopathology of paraffin sections. Comparison of the results of the touch preparations with the final histopathology (hematoxylin-eosin and S-100/ HMB45 stains) demonstrated a sensitivity of 83.3% and a negative predictive value of 92.5%. The specificity and positive predictive value were 100% respectively.
Touch imprint cytology is potentially useful for intraoperative evaluation of SLNs in malignant melanoma patients. Results can be improved if the surface sampled is appropriately enlarged and a rapid immunohistochemical S-100/HMB45 stain on the imprints is utilized.
前哨淋巴结（SLN）活检彻底改变了恶性黑色素瘤患者的淋巴结分期。术中评估是SLN程序的一项新内容，当SLN活检结果为阳性时，可进行一步区域性淋巴结清扫。S-100和HMB45单克隆抗体的鉴别免疫染色模式可对SLN的印片进行术中免疫细胞化学评估，以检测黑色素瘤转移灶。
对52例患者使用硫胶体作为放射性示踪剂和异硫蓝确定的128个SLN进行对半切开，制作快速Diff-Quick染色的触片。通过印片细胞学对前哨淋巴结状态进行术中评估，并与永久切片的组织病理学结果进行关联。对常规石蜡切片中肿瘤阴性的淋巴结进一步使用S-100和HMB45抗体进行研究。
所有SLN中，36个在石蜡切片中存在转移灶，其中32个通过印片细胞学检测到（敏感性88.8%）。3个SLN印片细胞学呈阳性，石蜡切片组织病理学呈阴性。将触片结果与最终组织病理学（苏木精-伊红和S-100/HMB45染色）结果进行比较，敏感性为83.3%，阴性预测值为92.5%。特异性和阳性预测值分别为100%。
触片印片细胞学对恶性黑色素瘤患者的SLN术中评估可能有用。如果适当扩大取样表面并对印片进行快速免疫组化S-100/HMB45染色，结果可能会得到改善。
