Fahy Aodhnait S, Grotz Travis E, Keeney Gary L, Glasgow Amy E, Habermann Elizabeth B, Erickson Lori, Hieken Tina J, Jakub James W
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
J Surg Oncol. 2016 Dec;114(7):879-883. doi: 10.1002/jso.24430. Epub 2016 Sep 16.
The purpose of this study was to evaluate the accuracy of frozen section (FS) analysis of sentinel lymph nodes (SLN) in melanoma.
Five hundred seventy-one patients underwent FS analysis of SLN between 1/2000 and12/2010. Surgical and pathological characteristics, recurrence, and survival were analyzed. Comparisons were made using χ and Fisher's exact t-test.
One hundred thirty-three (23%) patients were SLN positive of which 63 (47.4%) were identified on FS. 16/70 SLN metastases not identified on FS (23%) were seen only on immunohistochemistry. FS analysis detected 84% of SLN metastasis >2 mm. SLN FS false negative rate was 53%, positive predictive value 100%, negative predictive value 88%, and overall accuracy 89%. Among patients with a FS positive SLN, 17/63 (27%) had additional positive nodes on CLND, versus 1 of 70 (1.4%) with a positive SLN identified only on permanent section pathology (P < 0.0001). The nodal recurrence rate following a negative SLN biopsy was 5%.
FS analysis for SLNs spared approximately half of patients a second operation. Patients with a positive SLN detected on FS were more likely to have further nodal involvement. In our experience intraoperative pathologic analysis of melanoma SLNs does not impair our ability to detect SLN metastasis or lead to a high rate of false positive results or nodal recurrences. J. Surg. Oncol. 2016;114:879-883. © 2016 2016 Wiley Periodicals, Inc.
本研究旨在评估黑色素瘤前哨淋巴结（SLN）冰冻切片（FS）分析的准确性。
2000年1月至2010年12月期间，571例患者接受了SLN的FS分析。分析了手术和病理特征、复发情况及生存率。采用χ检验和Fisher精确t检验进行比较。
133例（23%）患者SLN阳性，其中63例（47.4%）在FS检查中被发现。FS检查未发现的70例SLN转移灶中有16例（23%）仅在免疫组化检查中被发现。FS分析检测出84%的SLN转移灶直径>2mm。SLN的FS假阴性率为53%，阳性预测值为100%，阴性预测值为88%，总体准确率为89%。在FS检查SLN阳性的患者中，17/63（27%）在完成淋巴结清扫术（CLND）时发现有其他阳性淋巴结，而在常规病理切片检查中仅发现1例（1.4%）SLN阳性的患者有阳性淋巴结（P<0.0001）。SLN活检阴性后的淋巴结复发率为5%。
对SLN进行FS分析使约一半患者避免了二次手术。FS检查发现SLN阳性的患者更有可能有进一步的淋巴结受累。根据我们的经验，黑色素瘤SLN的术中病理分析不会损害我们检测SLN转移的能力，也不会导致高假阳性率或淋巴结复发率。《外科肿瘤学杂志》2016年；114:879 - 883。©2016年约翰威立国际出版公司
