前哨淋巴结活检和选择性淋巴结清扫术在上肢鳞状细胞癌中的应用。前哨淋巴结活检在避免高风险上肢鳞状细胞癌中进行不必要的淋巴结清扫方面的效用。

The use of sentinel node biopsy and selective lymphadenectomy in squamous cell carcinoma of the upper limb. Usefulness of sentinel node biopsy to avoid useless lymphadenectomies in high-risk upper limb SCC.

作者信息

Cuccia Giuseppe, Colonna Michele R, Papalia Igor, Manasseri Benedetto, Romeo Marco, d'Alcontres Francesco Stagno

机构信息

Plastic Surgery, Unit of Messina, University Medical School, Messina, Italy.

出版信息

Ann Ital Chir. 2008 Jan-Feb;79(1):67-71.

PMID:18572743

Abstract

BACKGROUND

Squamous cell carcinoma (SCC) is the second most common skin cancer in humans. Because the incidence of metastasis from SCC of the skin is rare, regional lymphadenectomy is generally not recommended for the patients with clinically node-negative disease. However, in patients with an intermediate and high risk of metastasis, evaluation of the lymph nodes to detect the absence of metastatic nodal disease is a difficult task.

PATIENTS AND METHODS

The authors reviewed the pertinent demographic and surgical data in a consecutive series of six patients with squamous cell carcinoma who underwent sentinel lymph node staging. The tumour size was greater than 2 cm (T2) and the patients had clinically non-palpable regional lymph nodes (N0). All nodes were examined using haematoxylin-eosin staining. Sentinel Lymph Node Biopsy (SLNB) and Selective Lymphadenectomy (SL) using preoperative lymphoscintigraphy and intraoperative radiolymphoscintigraphy and vital dye injections was used to identify the sentinel lymph node avoiding complete axillary node dissection.

RESULTS

No false-negative results were observed. At a median follow-up of 10 months (mean 15 months), neither local or regional recurrences in sentinel node-negative basins have been noted.

CONCLUSIONS

Sentinel node biopsy is a minimally invasive staging procedure useful in identifying occult regional lymph node disease in selected patients with squamous cutaneous malignancies of the arm. Furthermore sentinel lymph node histology is possibly the most important negative predictor of early recurrence and survival in patients with American Joint Committee on Cancer stage I and II squamous cell carcinoma. Although sentinel node-negative patients are a prognostically favourable group, this small series of patients demonstrates that further studies to verify these findings and develop formal guidelines are indicated

摘要

背景

鳞状细胞癌（SCC）是人类第二常见的皮肤癌。由于皮肤SCC转移的发生率很低，对于临床淋巴结阴性的患者，一般不建议进行区域淋巴结清扫术。然而，对于有中高转移风险的患者，评估淋巴结以检测有无转移性淋巴结疾病是一项艰巨的任务。

患者与方法

作者回顾了连续6例接受前哨淋巴结分期的鳞状细胞癌患者的相关人口统计学和手术数据。肿瘤大小大于2 cm（T2），患者临床触诊未发现区域淋巴结（N0）。所有淋巴结均采用苏木精-伊红染色检查。使用术前淋巴闪烁显像、术中放射性淋巴闪烁显像和活性染料注射进行前哨淋巴结活检（SLNB）和选择性淋巴结清扫（SL），以识别前哨淋巴结，避免进行完整的腋窝淋巴结清扫。

结果

未观察到假阴性结果。中位随访10个月（平均15个月），前哨淋巴结阴性区域未发现局部或区域复发。

结论

前哨淋巴结活检是一种微创分期方法，有助于识别选定的手臂皮肤鳞状恶性肿瘤患者隐匿的区域淋巴结疾病。此外，前哨淋巴结组织学可能是美国癌症联合委员会I期和II期鳞状细胞癌患者早期复发和生存的最重要阴性预测指标。尽管前哨淋巴结阴性的患者预后良好，但这一小系列患者表明，需要进一步研究以验证这些发现并制定正式指南。