Department of Dermatology, Venereology and Allergology, Georg August University of Göttingen, Robert-Koch-Str 40, 37075, Göttingen, Germany,
Eur J Nucl Med Mol Imaging. 2015 Feb;42(2):231-40. doi: 10.1007/s00259-014-2914-4. Epub 2014 Oct 15.
To retrospectively study the influence of nodal tumour burden on lymphoscintigraphic imaging in 509 consecutive patients with melanomas.
Bidirectional lymphatic drainage, the clear depiction of an afferent lymphatic vessel, time to depiction of the first sentinel lymph node (SLN) and number of depicted and excised nodes were recorded. Nodal tumour load was classified as SLN-negative, SLN micrometastases or macrometastases.
In the overall population, using multivariate regression analysis, a short SLN depiction time was significantly associated with the depiction of a greater number of radioactive nodes, a short distance between the primary tumour site and the nodal basin, younger age and lower nodal tumour burden. The proportion of patients with clear depiction of an afferent lymphatic vessel depended on the nodal tumour load (46% in SLN-negative patients, 57% in SLN positive patients, and 69% in patients with macrometastases; P = 0.009). Macrometastasis was significantly associated with delayed depiction of the first radioactive node and a greater number of depicted hotspots. In patients with clinically nonsuspicious nodes, i.e. the classical target group for SLN biopsy, clear depiction of an afferent vessel was significantly associated with a higher number of SLNs during dynamic acquisition, SLN micrometastasis and a higher overall number of metastatic lymph nodes after SLN biopsy plus completion lymphadenectomy. The excision of more than two SLNs did not increase the metastasis detection rate. In patients with bidirectional or tridirectional lymphatic drainage, the SLN positivity rates for the first, second and third basin were 25.4%, 11.7% and 0.0 %, respectively (P = 0.002).
In patients with clinically nonsuspicious lymph nodes, clear depiction of an afferent lymph vessel may be a sign of micrometastasis. Macrometastasis is associated with prominent afferent vessels, delayed depiction of the first radioactive node and a higher number of depicted hotspots.
回顾性研究 509 例黑色素瘤连续患者淋巴结肿瘤负荷对淋巴闪烁显像的影响。
记录双向淋巴引流、显影的输入淋巴管、首次前哨淋巴结 (SLN) 显影时间和显影及切除的淋巴结数量。淋巴结肿瘤负荷分为 SLN 阴性、SLN 微转移或宏转移。
在总体人群中，采用多元回归分析，SLN 显影时间短与显影放射性淋巴结数量较多、原发肿瘤部位与淋巴结盆之间距离较短、年龄较小、淋巴结肿瘤负荷较低显著相关。输入淋巴管显影清晰的患者比例取决于淋巴结肿瘤负荷（SLN 阴性患者为 46%，SLN 阳性患者为 57%，宏转移患者为 69%；P=0.009）。宏转移与首次放射性节点显影延迟和更多显影热点显著相关。在临床无可疑淋巴结的患者中，即 SLN 活检的经典靶人群，动态采集时 SLN 显影清晰与更多 SLN、SLN 微转移和 SLN 活检加完成淋巴结清扫术后总转移性淋巴结数量较高显著相关。切除两个以上 SLN 并不能提高转移检测率。在双向或三向淋巴引流的患者中，第一、第二和第三淋巴结盆的 SLN 阳性率分别为 25.4%、11.7%和 0.0%（P=0.002）。
在临床无可疑淋巴结的患者中，输入淋巴管显影清晰可能是微转移的标志。宏转移与明显的输入血管、首次放射性节点显影延迟和更多显影热点相关。
