Kayton Mark L, Delgado Ruby, Busam Klaus, Cody Hiram S, Athanasian Edward A, Coit Daniel, La Quaglia Michael P
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Cancer. 2008 May 1;112(9):2052-9. doi: 10.1002/cncr.23403.
Few data exist regarding techniques, indications, and outcomes for sentinel lymph node biopsy in pediatric patients with sarcomas and carcinomas.
A retrospective 10-year review was conducted, with Institutional Review Board waiver, of the pathology, lymphoscintigraphy, and clinical records for all pediatric patients selected to undergo sentinel lymph node biopsy at a major cancer center.
Thirty-one sentinel lymph node biopsies were performed in 30 pediatric patients (median age, 12 years; range, 2-21 years). With the administration of technetium 99m sulfur colloid, sentinel lymph nodes were identified preoperatively in 30 of 31 cases, and intraoperatively in the remaining case. Radiotracer alone was used in 13 of 31 cases but was supplemented with isosulfan blue dye in the remaining 18 cases. There were no complications. Positive sentinel lymph nodes occurred in 1 of 9 patients with rhabdomyosarcoma and in 2 of 5 patients with breast cancer, and in both of these diseases the sentinel lymph node results helped guide treatment decisions. No other patients had positive sentinel lymph nodes, and among those with nonrhabdomyosarcoma soft-tissue sarcomas there were no lymph node basin recurrences despite a lack of lymph node basin irradiation or formal lymph node dissection. The median follow-up was 48 months (range, 0-111 months).
Sentinel lymph node biopsy for pediatric soft-tissue tumors can be performed safely, and the results can alter treatment decisions both for children with rhabdomyosarcoma and adolescents with breast cancer. In patients with nonrhabdomyosarcoma soft-tissue sarcoma, we observed no positive sentinel lymph nodes and no lymph node basin recurrences; these data should prompt the prospective study of sentinel lymph node biopsy as a modality that might help guide the administration or withholding of regional therapy among pediatric patients with nonrhabdomyosarcoma soft-tissue sarcoma.
关于小儿肉瘤和癌患者前哨淋巴结活检的技术、适应证及结果的数据较少。
在一家大型癌症中心，对所有选择接受前哨淋巴结活检的小儿患者的病理、淋巴闪烁显像及临床记录进行了一项为期10年的回顾性研究，该研究获机构审查委员会豁免。
30例小儿患者（中位年龄12岁；范围2 - 21岁）接受了31次前哨淋巴结活检。给予99m锝硫胶体后，31例中有30例在术前确定了前哨淋巴结，其余1例在术中确定。31例中13例仅使用放射性示踪剂，其余18例补充了异硫蓝染料。无并发症发生。9例横纹肌肉瘤患者中有1例前哨淋巴结阳性，5例乳腺癌患者中有2例前哨淋巴结阳性，在这两种疾病中，前哨淋巴结结果均有助于指导治疗决策。其他患者前哨淋巴结均为阴性，在非横纹肌肉瘤软组织肉瘤患者中，尽管未进行淋巴结区域照射或正规淋巴结清扫，但无淋巴结区域复发。中位随访时间为48个月（范围0 - 111个月）。
小儿软组织肿瘤的前哨淋巴结活检可安全进行，其结果可改变横纹肌肉瘤患儿和乳腺癌青少年患者的治疗决策。在非横纹肌肉瘤软组织肉瘤患者中，我们未观察到前哨淋巴结阳性及淋巴结区域复发；这些数据应促使对前哨淋巴结活检进行前瞻性研究，作为一种可能有助于指导小儿非横纹肌肉瘤软组织肉瘤患者区域治疗的应用或不应用的方法。
