Department of Surgery, University of Washington, Seattle, WA, USA.
World J Surg Oncol. 2011 Jul 19;9:80. doi: 10.1186/1477-7819-9-80.
High-risk cutaneous squamous cell carcinoma (SCC) is associated with an increased risk of metastases. The role of sentinel lymph node (SLN) biopsy in these patients remains unclear. To address this uncertainty, we collected clinical data on six patients with clinical N0 high-risk SCC that underwent SLN biopsy between 1999 and 2006 and performed a literature review of SLN procedures for SCC to study the utility of SLN biopsy. There were no positive SLN identified among six cases and there was one local and one distant recurrence on follow-up. Literature review identified 130 reported cases of SLN biopsy for SCC. The SLN positivity rate was 14.1%, 10.1%, and 18.6%; false negative rate was 15.4%, 0%, and 22.2%; and the negative predictive value was 97.8%, 100%, and 95.2% for all sites, head/neck, and truncal/extremity sites, respectively. SLN biopsy remains an investigational staging tool in clinically node-negative high-risk SCC patients. The higher false negative rate and lower negative predictive value among SCC of the trunk/extremity compared to SCC of the head/neck sites suggests a more cautious approach when treating patients with the former. Given the paucity of long-term follow up, an emphasis is placed upon the need for close surveillance regardless of SLN status.
高危皮肤鳞状细胞癌（SCC）与转移风险增加相关。在这些患者中，前哨淋巴结（SLN）活检的作用仍不清楚。为了解决这一不确定性，我们收集了 1999 年至 2006 年间 6 例临床 N0 高危 SCC 患者的 SLN 活检临床数据，并对 SCC 的 SLN 手术进行了文献复习，以研究 SLN 活检的效用。6 例中均未发现阳性 SLN，随访时有 1 例局部和 1 例远处复发。文献复习共发现 130 例报道的 SCC 行 SLN 活检的病例。SLN 阳性率为 14.1%、10.1%和 18.6%；假阴性率为 15.4%、0%和 22.2%；所有部位、头颈部和躯干/四肢部位的阴性预测值分别为 97.8%、100%和 95.2%。SLN 活检仍然是临床淋巴结阴性高危 SCC 患者的一种研究性分期工具。与头颈部 SCC 相比，躯干/四肢 SCC 的假阴性率更高，阴性预测值更低，这表明在治疗前者时应采取更为谨慎的方法。鉴于缺乏长期随访，强调无论 SLN 状态如何，都需要密切监测。
