Duke University, Durham, NC, USA.
Otolaryngol Head Neck Surg. 2011 Sep;145(3):375-82. doi: 10.1177/0194599811408554. Epub 2011 May 3.
This systematic review was conducted to examine the test performance of sentinel node biopsy in head and neck melanoma, including the identification rate and false-negative rate.
PubMed, EMBASE, ASCO, and SSO database searches were conducted to identify studies fulfilling the following inclusion criteria: sentinel node biopsy was performed, lesions were located on the head and neck, and recurrence data for both metastatic and nonmetastatic patients were reported.
Dual-blind data extraction was conducted. Primary outcomes included identification rate and test performance based on completion neck dissection or nodal recurrence.
A total of 3442 patients from 32 studies published between 1990 and 2009 were reviewed. Seventy-eight percent of studies were retrospective and 22% were prospective. Trials varied from 9 to 755 patients (median 55). Mean Breslow depth was 2.53 mm. Median sentinel node biopsy identification rate was 95.2%. More than 1 basin was reported in 33.1% of patients. A median of 2.56 sentinel nodes per patient were excised. Sentinel node biopsy was positive in 15% of patients. Subsequent completion neck dissection was performed in almost all of these patients and revealed additional positive nodes in 13.67%. Median follow-up was 31 months. Across all studies, predictive value positive for nodal recurrence was 13.1% and posttest probability negative was 5%. Median false-negative rate for nodal recurrence was 20.4%.
Sentinel node biopsy of head and neck melanoma is associated with an increased false-negative rate compared with studies of non-head and neck lesions. Positive sentinel node status is highly predictive of recurrence.
本系统评价旨在检查头颈部黑色素瘤前哨淋巴结活检的检测性能，包括识别率和假阴性率。
通过 PubMed、EMBASE、ASCO 和 SSO 数据库检索，以确定符合以下纳入标准的研究：进行了前哨淋巴结活检，病变位于头颈部，并且报告了转移性和非转移性患者的复发数据。
进行了双盲数据提取。主要结局包括基于完成性颈部清扫术或淋巴结复发的识别率和检测性能。
共回顾了 1990 年至 2009 年期间发表的 32 项研究中的 3442 例患者。78%的研究为回顾性，22%为前瞻性。试验范围从 9 例到 755 例患者（中位数 55 例）。平均 Breslow 深度为 2.53mm。前哨淋巴结活检的中位识别率为 95.2%。33.1%的患者报告了超过 1 个淋巴结区。中位数每例患者切除 2.56 个前哨淋巴结。15%的患者前哨淋巴结活检阳性。几乎所有这些患者都进行了后续的完成性颈部清扫术，发现了 13.67%的额外阳性淋巴结。中位随访时间为 31 个月。在所有研究中，淋巴结复发的预测值阳性为 13.1%，试验后概率阴性为 5%。淋巴结复发的中位假阴性率为 20.4%。
与非头颈部病变的研究相比，头颈部黑色素瘤的前哨淋巴结活检假阴性率较高。前哨淋巴结阳性状态高度提示复发。
