Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine & The Winship Cancer Institute, Atlanta, GA, USA.
Ann Surg Oncol. 2011 Nov;18(12):3309-15. doi: 10.1245/s10434-011-1750-z. Epub 2011 May 4.
True frequency of synchronous pelvic metastases with positive inguinal sentinel lymph node (SLN) biopsy is unknown. Role of pelvic dissection in the SLN era is unclear.
From 1994 to 2004, 1 surgeon routinely performed nonselective, complete inguinopelvic lymphadenectomy after positive inguinal SLN biopsy. All cases were identified from a prospectively maintained database. Clinicopathologic features associated with pelvic disease were assessed.
A total of 40 patients with positive inguinal SLN underwent, without additional selection, 42 complete inguinopelvic lymphadenectomies. Median age was 46.5 years (range 25-79 years); 79% had lower extremity primaries. Median Breslow depth was 2.3 mm (range 1.0-10.0 mm), Clark's IV/V 98%, ulceration 26%. Frequency of synchronous pelvic disease upon completion lymphadenectomy was 5 of 42 (11.9%). Patients with and without pelvic disease were similar in age, sex, Breslow depth, Clark's level, ulceration, and mitoses. All 5 cases with pelvic metastases had extremity primaries (4 distal, 1 proximal). Of the 5, 3 (60%) had ≥3 total involved inguinal nodes, compared with only 1 (2.7%) of the 37 cases without pelvic disease (P=.003). Ratio of positive to total number inguinal nodes retrieved was >0.20 in 80% of cases with pelvic disease and 8.6% of cases without (P=.002). Upon lymphoscintigraphy review, secondary pelvic drainage was present in 80% of cases with pelvic disease compared with 56% of cases without pelvic disease, though the trend was statistically insignificant (P=.63).
In this cohort of unselected, SLN-positive patients with complete inguinopelvic lymphadenectomy, frequency of synchronous pelvic disease was 11.9%. Patients with ≥3 total involved inguinal nodes or inguinal node ratio >0.20 appear more likely to harbor pelvic disease.
腹股沟前哨淋巴结（SLN）活检阳性时同时发生盆腔转移的真实频率尚不清楚。在 SLN 时代，盆腔清扫术的作用尚不清楚。
1994 年至 2004 年，1 位外科医生常规对腹股沟 SLN 活检阳性后进行非选择性、完全的腹股沟-盆腔淋巴结清扫术。所有病例均来自前瞻性维护的数据库。评估与盆腔疾病相关的临床病理特征。
40 例腹股沟 SLN 阳性的患者在无其他选择的情况下接受了 42 例完全的腹股沟-盆腔淋巴结清扫术。中位年龄为 46.5 岁（范围 25-79 岁）；79%的患者下肢有原发性肿瘤。中位 Breslow 深度为 2.3mm（范围 1.0-10.0mm），Clark 分级 IV/V 级 98%，溃疡 26%。完成淋巴结清扫术后，盆腔疾病的同步发生率为 5/42（11.9%）。有和没有盆腔疾病的患者在年龄、性别、Breslow 深度、Clark 分级、溃疡和有丝分裂方面相似。所有 5 例盆腔转移患者均有肢体原发性肿瘤（4 例远端，1 例近端）。在这 5 例患者中，有 3 例（60%）有≥3 个总受累的腹股沟淋巴结，而在无盆腔疾病的 37 例患者中只有 1 例（2.7%）（P=.003）。有盆腔疾病的病例中，阳性淋巴结与总淋巴结检出数的比值>0.20 的比例为 80%，而无盆腔疾病的病例中这一比例为 8.6%（P=.002）。通过淋巴闪烁显像复查，有盆腔疾病的病例中，继发性盆腔引流占 80%，而无盆腔疾病的病例中占 56%，但这一趋势无统计学意义（P=.63）。
在本队列中，对未经选择的 SLN 阳性患者进行完全的腹股沟-盆腔淋巴结清扫术，同时发生盆腔疾病的频率为 11.9%。有≥3 个总受累的腹股沟淋巴结或淋巴结比值>0.20 的患者更有可能存在盆腔疾病。
