Division of Melanoma and Soft Tissue Sarcoma, European Institute of Oncology, European Institute of Oncology, Milan, Italy.
Melanoma Res. 2010 Apr;20(2):133-7. doi: 10.1097/CMR.0b013e3283324e40.
The original procedure of intraoperative lymphatic mapping by using vital blue dye initially described by Morton and colleagues in 1992 was implemented in subsequent years by the introduction of preoperative lymphoscintigraphy (LS) and intraoperative gamma detection probe to allow a better identification of sentinel nodes (SNs). However, it is common, in practice, to detect more than one radioactive node with the gamma detection probe. Whether these additional lymph nodes represent true SNs is not yet clear. The aims of this study are: to investigate the role of pelvic sentinel node biopsy in recurrent pelvic disease in those patients with negative inguinal SN, having one or more deep hot spots identified by preoperative LS (follow-up group). One hundred and four stage I/II melanoma patients with primary tumor of the lower limb and lower trunk were enrolled in a restrospective study at the European Institute of Oncology, Milan, Italy, between 2000 and 2007. All patients presented hot spots both in superficial (groin) and deep (iliac-obturator) areas during dynamic LS. The study population consisted of 35 men and 69 women with a median age of 57 years at the time of diagnosis. The median follow-up period was 49 months (SD 22.4; range, 10-98 months). Of the 104 patients, 83 had a negative SN (80%). All sentinel-lymph-node-positive patients underwent superficial and deep inguinal dissection. Two patients (2.4%; 95% confidence interval: 1.5-8.8%) with negative SNs had pelvic recurrence. Among patients who underwent ilioinguinal dissection, three (14%; 95% confidence interval: 4-35%) had positive pelvic lymph nodes. After a 60-month follow-up, 79% of patients were alive and 66% were disease free. In SN-negative patients, disease-free survival was 69% and in SN-positive patients 53%. No significant difference was found by SN status (log-rank P values 0.15). Even if the sample size of our study cannot bring to conclusive results, and further studies are needed, it might be possible that harvesting pelvic SN in those patients with pelvic hot spots at LS could modify the natural history of melanoma patients in terms of pelvic recurrence and disease free survival. We recommend to improve our knowledge in the role of pelvic sentinel node in the natural history of melanoma.
最初由 Morton 及其同事于 1992 年描述的术中淋巴定位的原始程序，通过引入术前淋巴闪烁显像术（LS）和术中伽马探测探头得以在后续年份中得以实施，以更好地识别前哨淋巴结（SNs）。然而，在实践中，用伽马探测探头通常会检测到一个以上的放射性淋巴结。这些额外的淋巴结是否代表真正的 SNs尚不清楚。本研究的目的是：研究在 LS 术前发现一个或多个深部热点的腹股沟 SN 阴性患者中，盆腔 SN 活检在复发性盆腔疾病中的作用（随访组）。意大利米兰欧洲肿瘤研究所于 2000 年至 2007 年期间对 104 例 I/II 期黑色素瘤患者进行了回顾性研究，这些患者的下肢和下躯干原发性肿瘤，LS 动态检查显示腹股沟（腹股沟）和深部（髂耻闭孔）区域均有热点。研究人群包括 35 名男性和 69 名女性，诊断时的中位年龄为 57 岁。中位随访期为 49 个月（SD 22.4；范围，10-98 个月）。104 例患者中，83 例 SN 阴性（80%）。所有 SN 阳性患者均行腹股沟浅深淋巴结清扫术。2 例（2.4%；95%置信区间：1.5-8.8%） SN 阴性患者出现盆腔复发。在接受髂腹股沟淋巴结清扫术的患者中，3 例（14%；95%置信区间：4-35%）患者盆腔淋巴结阳性。60 个月随访后，79%的患者存活，66%无疾病。SN 阴性患者无病生存率为 69%，SN 阳性患者为 53%。SN 状态无显著差异（log-rank P 值 0.15）。尽管我们的研究样本量无法得出结论性结果，需要进一步研究，但在 LS 出现盆腔热点的患者中采集盆腔 SN 可能会改变黑色素瘤患者的自然病程，降低盆腔复发和无病生存率。我们建议提高对盆腔 SN 在黑色素瘤自然病程中作用的认识。
