Fujiwara Masao, Suzuki Takahiro, Takiguchi Tetsuya, Fukamizu Hidekazu, Tokura Yoshiki
Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
J Dermatol. 2016 Feb;43(2):170-4. doi: 10.1111/1346-8138.13033. Epub 2015 Jul 27.
Prediction of nodal metastasis in skin cancer before sentinel lymph node (SLN) biopsies is ideal to avoid unnecessary SLN biopsy performance. Primary truncal skin cancers are characterized by the lymphatic flow that drains from the primary lesion, occasionally to plural nodal basins. The scintigraphic appearance time (SAT), defined as the time between radionuclide injection and first SLN visualization, can potentially predict nodal metastasis, and a short SAT is a predictive parameter for metastasis. We recently introduced a novel method to measure the lymphatic flow rate using dynamic lymphoscintigraphy exhibiting a time-activity curve in the SLN. The time at which the count reaches a plateau in the SLN is termed the scintigraphic saturation time (SST) and can be a good alternative to the SAT. Moreover, the value obtained by division of the distance between the primary lesion and the SLN by the SST was termed the lymphatic transit rate (LTR), which represents the scintigraphic saturation velocity. In the present study, we evaluated LTR as a predictive parameter for nodal metastasis. Data for 22 lymph nodes from 18 patients with primary truncal skin cancers were used. Histopathologically, nodal metastasis was determined in nine nodes of eight patients. Because the mean LTR were 1.84 cm/min in non-metastatic SLN and 2.38 cm/min in metastatic SLN, the LTR was significantly higher in metastatic SLN than in non-metastatic SLN. All SLN with LTR of less than 1.8 cm/min were histopathologically evaluated as non-metastatic. The LTR may be a predictive indicator for nodal metastasis.
在进行前哨淋巴结（SLN）活检之前预测皮肤癌的淋巴结转移，对于避免不必要的SLN活检操作是理想的。原发性躯干皮肤癌的特征是淋巴液从原发灶引流，偶尔会引流至多个淋巴结区域。闪烁显像出现时间（SAT）定义为放射性核素注射与首次SLN显影之间的时间，它有可能预测淋巴结转移，且短SAT是转移的一个预测参数。我们最近引入了一种新方法，使用动态淋巴闪烁显像来测量淋巴流速，该显像在SLN中呈现时间-活性曲线。SLN中计数达到平台期的时间称为闪烁显像饱和时间（SST），它可以很好地替代SAT。此外，用原发灶与SLN之间的距离除以SST得到的值称为淋巴转运速率（LTR），它代表闪烁显像饱和速度。在本研究中，我们评估LTR作为淋巴结转移的预测参数。使用了18例原发性躯干皮肤癌患者的22个淋巴结的数据。组织病理学上，在8例患者的9个淋巴结中确定有淋巴结转移。因为非转移性SLN的平均LTR为1.84 cm/min，转移性SLN的平均LTR为2.38 cm/min，所以转移性SLN的LTR显著高于非转移性SLN。所有LTR小于1.8 cm/min的SLN经组织病理学评估为无转移。LTR可能是淋巴结转移的一个预测指标。
