Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
Histopathology. 2011 Aug;59(2):318-26. doi: 10.1111/j.1365-2559.2011.03931.x.
Most melanoma patients with a positive sentinel node (SN) undergo completion lymph node dissection and frequently experience associated morbidity. However, only 10-30% of SN-positive patients have further lymph node metastases. The aim of the present study was to predict the absence of non-SN metastases in a multicentre study of patients with a positive SN based on primary melanoma features and SN tumour load.
Of 70 SN positive patients, 18 had non-SN metastases. Penetrative depth of metastatic cells into the SN and SN tumour load was assessed by morphometry. None of the 14 patients (20%) with a Breslow thickness <2.0 mm and an SN tumour load <0.2 mm2 had non-SN metastases. Similarly, none of the 15 patients (21%) with a Breslow thickness <2.0 mm and SN penetrative depth <600 μm had non-SN metastases. Lastly, none of the 14 patients (20%) with a Breslow thickness <2.0 mm and a diameter of the largest SN deposit <500 μm had non-SN metastases.
A combination of limited Breslow thickness and low SN tumour load predicts absence of non-SN metastases in melanoma patients with a positive SN with high accuracy. We propose that this subgroup may be spared completion lymph node dissection.
大多数有阳性前哨淋巴结（SN）的黑色素瘤患者接受完成淋巴结清扫术，并经常经历相关的发病率。然而，只有 10-30%的 SN 阳性患者有进一步的淋巴结转移。本研究的目的是基于原发性黑色素瘤特征和 SN 肿瘤负荷，在一项阳性 SN 患者的多中心研究中预测非 SN 转移的缺失。
在 70 例 SN 阳性患者中，18 例有非 SN 转移。通过形态计量学评估转移性细胞在 SN 中的穿透深度和 SN 肿瘤负荷。在 Breslow 厚度<2.0mm 和 SN 肿瘤负荷<0.2mm2 的 14 例患者中（20%），均无非 SN 转移。同样，在 Breslow 厚度<2.0mm 和 SN 穿透深度<600μm 的 15 例患者中（21%），均无非 SN 转移。最后，在 Breslow 厚度<2.0mm 和最大 SN 沉积物直径<500μm 的 14 例患者中（20%），均无非 SN 转移。
有限的 Breslow 厚度和低 SN 肿瘤负荷的组合可以准确预测 SN 阳性黑色素瘤患者中不存在非 SN 转移。我们建议，这一亚组可能可以免于完成淋巴结清扫术。
