Wainstein Alberto Ja, Drummond-Lage Ana P, Kansaon Milhem Jm, Bretas Gustavo O, Almeida Rodrigo F, Gloria Ana Lf, Figueiredo Ana Rp
Faculty of Medical Sciences of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil ; Oncad Surgical Oncology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Faculty of Medical Sciences of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Clin Ophthalmol. 2014 Dec 16;9:1-6. doi: 10.2147/OPTH.S71226. eCollection 2015.
The purpose of this report is to examine the viability and safety of preoperative lymphoscintigraphy and radio guided sentinel lymph node (SLN) biopsy for conjunctival melanoma, and to identify the best technique to perform this procedure.
Three patients diagnosed with malignant melanoma of the conjunctiva underwent lymphoscintigraphy and SLN biopsy using a dual technique comprising isosulfan blue dye and technetium Tc 99m sulfur colloid. Each patient was anesthetized and the conjunctival melanoma was excised. SLNs were localized by a gamma probe, identified according to radioactivity and sentinel blue printing, and dissected, along with drainage of the associated lymphatic basins. The SLNs were evaluated by a pathologist using hematoxylin-eosin staining following serial sectioning and immunohistochemistry using a triple melanoma cocktail (S-100, Melan-A, and HMB-45 antigens).
Two SLNs were stained in the jugular chain during preoperative lymphoscintigraphy in the first patient, two SLNs were identified in the preauricular and submandibular areas in the second patient, and two SLNs were identified in the submandibular and parotid areas in the third patient. All lymph nodes identified by lymphoscintigraphy were dissected and identified at surgery with 100% accuracy in all three patients. All SLNs were histologically and immunohistochemically negative. Patients had good cosmetic and functional results, and maintained their visual acuity and ocular motility.
Patients with conjunctival melanoma can undergo preoperative lymphoscintigraphy and SLN biopsy safely using radioactive technetium and isosulfan blue dye.
本报告旨在探讨术前淋巴闪烁显像及放射性引导前哨淋巴结（SLN）活检用于结膜黑色素瘤的可行性及安全性，并确定实施该手术的最佳技术。
3例被诊断为结膜恶性黑色素瘤的患者接受了淋巴闪烁显像及SLN活检，采用异硫蓝染料和锝Tc 99m硫胶体的双重技术。每位患者均接受麻醉，然后切除结膜黑色素瘤。通过γ探测器定位SLN，根据放射性及前哨蓝染进行识别，并连同相关淋巴引流区一并切除。病理学家对SLN进行评估，先进行连续切片苏木精-伊红染色，然后使用三联黑色素瘤抗体鸡尾酒（S-100、Melan-A和HMB-45抗原）进行免疫组化检测。
第1例患者术前淋巴闪烁显像时，颈链中有2个SLN被染色；第2例患者在耳前和下颌下区域发现2个SLN；第3例患者在下颌下和腮腺区域发现2个SLN。所有经淋巴闪烁显像识别的淋巴结均被切除，并在手术中准确识别，3例患者的识别准确率均为100%。所有SLN在组织学和免疫组化检查中均为阴性。患者的美容和功能效果良好，视力和眼球运动得以保留。
结膜黑色素瘤患者使用放射性锝和异硫蓝染料可安全地进行术前淋巴闪烁显像及SLN活检。
