Department of Otolaryngology, Division of Head and Neck Surgery, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
Head Neck. 2010 Dec;32(12):1686-92. doi: 10.1002/hed.21390.
Current therapy for intermediate thickness melanoma involves wide local excision with sentinel lymph node biopsy (SLNB). SLNB provides important prognostic information and immediate regional lymphadenectomy for a positive sentinel lymph node (SLN) may improve survival and identifies patients who are candidates for adjuvant therapy and/or clinical trials. The head and neck site is unique because of its complex lymphatic drainage pattern to multiple nodal basins and because of the risk of site-specific morbidity associated with regional lymphadenectomy when compared to other body sites. The goal of this study is to report the results of SLNB for head and neck cutaneous melanoma in locating the sentinel node and to report on the prognostic implications of SLNB for this cohort of patients.
A prospectively entered melanoma database was used to review consecutive patients with head and neck cutaneous melanoma undergoing SLNB at Memorial Sloan-Kettering Cancer Center between 1996 and 2007. The database, along with a retrospective chart review, was used to evaluate the success of SLNB at locating an SLN and the success rate of frozen section and permanent section analysis at diagnosing metastatic disease. Recurrence at all sites including the nodal basin and status at last follow-up was recorded. Characteristics of the patients' primary melanoma were included. Descriptive statistics along with univariate and multivariate survival analysis were performed.
Between 1996 and 2007, 234 patients with a diagnosis of head and neck cutaneous melanoma underwent SLNB and had at least 1 month of follow-up. At least 1 SLN was identified in 218 of these patients (93%) by lymphoscintigraphy. In 16 patients, no SLN was found. These patients had a much shorter time to recurrence (4.75 months) than either the SLN-positive group (10.7 months) or the SLN-negative group (26.0 months). They had a disease-specific survival (DSS) in between the SLN-positive and SLN-negative group. Of the patients in whom an SLN was identified, 28 patients (12%) had at least 1 positive SLN. Of these, the SLNs of 14 patients (50%) were identified on frozen section; 14 (50%) could only be identified after further sectioning or immunohistochemical analysis postoperatively. Among 190 patients with a negative SLNB, 12 patients had recurrences in the nodal basin. This resulted in a sensitivity of 70%, a negative predictive value of 94%, and a false-negative rate of 30%. The 3-year disease-free survival for SLN-negative and SLN-positive patients was 84% (p < .031) and 58% (p < .102), respectively. The 3-year melanoma-specific survival was 98% (p < .012) and 75% (p < .201), respectively.
The SLN status is an important predictor of survival. The technique, performed in the head and neck is complex and associated with a high false-negative rate.
目前，治疗中厚度黑色素瘤需要广泛的局部切除和前哨淋巴结活检（SLNB）。SLNB 提供了重要的预后信息，对于阳性前哨淋巴结（SLN），立即进行局部淋巴结切除术可以改善生存，并确定适合辅助治疗和/或临床试验的患者。头颈部的情况是独特的，因为其复杂的淋巴引流模式涉及多个淋巴结盆，并且与其他身体部位相比，局部淋巴结切除术与特定部位的发病率相关。本研究的目的是报告头颈部皮肤黑色素瘤 SLNB 定位前哨淋巴结的结果，并报告该队列患者的 SLNB 预后意义。
使用前瞻性入组的黑色素瘤数据库，回顾性分析 1996 年至 2007 年期间在 Memorial Sloan-Kettering 癌症中心接受头颈部皮肤黑色素瘤 SLNB 的连续患者。该数据库与回顾性图表审查一起，用于评估 SLNB 定位 SLN 的成功率以及冷冻切片和常规切片分析诊断转移性疾病的成功率。记录所有部位（包括淋巴结盆）的复发情况和最后一次随访时的状态。纳入患者原发性黑色素瘤的特征。进行描述性统计以及单变量和多变量生存分析。
1996 年至 2007 年间，234 例头颈部皮肤黑色素瘤患者接受了 SLNB 并至少随访 1 个月。通过淋巴闪烁显像术，218 例患者（93%）至少发现了 1 个 SLN。在 16 例患者中未发现 SLN。这些患者的复发时间（4.75 个月）明显短于 SLN 阳性组（10.7 个月）或 SLN 阴性组（26.0 个月）。他们的疾病特异性生存率（DSS）介于 SLN 阳性组和 SLN 阴性组之间。在发现 SLN 的患者中，28 例（12%）至少有 1 个阳性 SLN。其中，14 例患者（50%）的 SLN 可通过冷冻切片确定；14 例患者（50%）只能在术后进一步切片或免疫组织化学分析后确定。在 190 例 SLN 阴性的患者中，12 例患者在淋巴结盆中复发。这导致了 70%的敏感性、94%的阴性预测值和 30%的假阴性率。SLN 阴性和 SLN 阳性患者的 3 年无病生存率分别为 84%（p <.031）和 58%（p <.102）。3 年黑色素瘤特异性生存率分别为 98%（p <.012）和 75%（p <.201）。
SLN 状态是生存的重要预测因素。在头颈部进行的该技术复杂，且假阴性率高。
