Department of Dermatology, Venerology and Allergology, University of Essen-Duisburg, Essen, Germany.
J Eur Acad Dermatol Venereol. 2012 Jan;26(1):79-85. doi: 10.1111/j.1468-3083.2011.04013.x. Epub 2011 Mar 14.
Sentinel lymph node excision (SLNE) for the detection of regional nodal metastases and staging of malignant melanoma has resulted in some controversies in international discussions as it is a surgical intervention with potential morbidity.
The present retrospective study seeks to clarify the reliability of preoperative ultrasonography (US) in direct comparison to the result of SLNE and seeks to identify potential advantages of preoperative ultrasound if performed in conjunction with lymphoscintigraphy in detecting malignant melanoma metastases in sentinel lymph node (SLN).
We retrospectively analysed data from 221 patients with primary malignant melanoma with a Breslow index of ≥ 1.0 mm.
Of the 221 patients, 77.4% (n = 171) had a negative SLN. In 50 patients (22.6%), the histopathological investigation of 71 excised lymph nodes resulted in a positive SLN. The US examination demonstrated a sensitivity of 13.6%, a specificity of 96.9%, a positive predictive value of 97.2% and a negative predictive value of 12.6%. SLNE alone shows a sensitivity of 94%, a specificity of 98.6%, a positive predictive value of 100% and a negative predictive value of 98.3%. Preoperative US in conjunction with dynamic lymphoscintigraphy, followed by SLNE, demonstrated a detecting ratio of 100% (n = 28) for micrometastases and 98.6% (n = 42/43) for macrometastases.
In conclusion, this study confirms that preoperative US alone cannot replace the vital information obtained during dynamic lymphoscintigraphy. But preoperative US is an important component of the staging procedure in melanoma patients and has clear advantages when performed in conjunction with dynamic lymphoscintigraphy. Therefore, we recommend preoperative US before every SLNE.
前哨淋巴结切除（SLNE）用于检测区域淋巴结转移和分期恶性黑素瘤，在国际讨论中引起了一些争议，因为它是一种有潜在发病率的手术干预。
本回顾性研究旨在明确术前超声（US）与 SLNE 结果的直接比较的可靠性，并试图确定如果与淋巴闪烁显像联合使用，术前超声在检测前哨淋巴结（SLN）中恶性黑素瘤转移方面的潜在优势。
我们回顾性分析了 221 例原发性恶性黑素瘤患者的数据，这些患者的 Breslow 指数≥1.0mm。
在 221 例患者中，77.4%（n=171）的 SLN 为阴性。在 50 例患者（22.6%）中，71 个切除淋巴结的组织病理学检查结果为阳性 SLN。US 检查的敏感性为 13.6%，特异性为 96.9%，阳性预测值为 97.2%，阴性预测值为 12.6%。单独进行 SLNE 的敏感性为 94%，特异性为 98.6%，阳性预测值为 100%，阴性预测值为 98.3%。术前 US 结合动态淋巴闪烁显像，继之以 SLNE，显示对微转移的检出率为 100%（n=28），对大转移的检出率为 98.6%（n=42/43）。
综上所述，本研究证实术前 US 单独不能替代动态淋巴闪烁显像获得的重要信息。但是术前 US 是黑素瘤患者分期过程的重要组成部分，与动态淋巴闪烁显像联合使用具有明显优势。因此，我们建议在每次 SLNE 前进行术前 US。
