Pfeiffer Margaret L, Ozgur Omar K, Myers Jeffrey N, Peng Andrew, Ning Jing, Zafereo Mark E, Thakar Sudip, Thuro Bradley, Prieto Victor G, Ross Merrick I, Esmaeli Bita
Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, Texas, USA.
Acta Ophthalmol. 2017 Jun;95(4):e323-e328. doi: 10.1111/aos.13252. Epub 2016 Oct 24.
We sought to update our prior report of findings on sentinel lymph node biopsy (SLNB) and predictors of a positive SLN in patients with conjunctival or eyelid melanoma.
We reviewed the records of all patients with ocular adnexal melanoma who underwent SLNB at one institution during 2000-2015. We determined rates of positive and false-negative findings on SLNB, primary tumour features correlated with positive findings and rate of nodal recurrence (false-negative event) after negative findings.
The study included 51 patients, 31 with conjunctival and 20 with eyelid melanoma. These patients include 30 patients who underwent SLNB during 2000-2008, described in our previous report, and 21 additional patients who underwent SLNB during 2008-2015. There were 30 women and 21 men with median age at SLNB of 62 years (range, 24-83). The nodal basins most commonly sampled were intraparotid (27 patients) and level II (14 patients). Ten patients had positive SLNB findings. Compared to tumours with negative findings, tumours with positive findings had greater median thickness (3.5 mm versus 2.2 mm, p = 0.04), greater median number of mitotic figures (6 versus 2, p = 0.03) and greater incidence of ulceration (80% versus 26%, p = 0.003). Perineural and vascular invasion were not significantly associated with positive findings. There were three false-negative events. Three patients (6%) had temporary marginal mandibular weakness which resolved spontaneously.
SLNB in patients with ocular adnexal melanoma is safe and identifies nodal micrometastasis in approximately 20% of cases. Histologic features associated with a positive SLN included greater tumour thickness, greater number of mitotic figures and ulceration.
我们试图更新之前关于结膜或眼睑黑色素瘤患者前哨淋巴结活检（SLNB）及前哨淋巴结阳性预测因素的研究报告。
我们回顾了2000年至2015年期间在一家机构接受SLNB的所有眼附属器黑色素瘤患者的记录。我们确定了SLNB的阳性和假阴性结果率、与阳性结果相关的原发性肿瘤特征以及阴性结果后的淋巴结复发率（假阴性事件）。
该研究纳入了51例患者，其中31例为结膜黑色素瘤，20例为眼睑黑色素瘤。这些患者包括我们之前报告中描述的2000年至2008年期间接受SLNB的30例患者，以及2008年至2015年期间接受SLNB的另外21例患者。共有30名女性和21名男性，SLNB时的中位年龄为62岁（范围24 - 83岁）。最常取样的淋巴结区域是腮腺内（27例患者）和II级（14例患者）。10例患者SLNB结果为阳性。与阴性结果的肿瘤相比，阳性结果的肿瘤具有更大的中位厚度（3.5毫米对2.2毫米，p = 0.04）、更多的中位有丝分裂象数量（6对2，p = 0.03）和更高的溃疡发生率（80%对26%，p = 0.003）。神经周围和血管侵犯与阳性结果无显著相关性。有3例假阴性事件。3例患者（6%）出现暂时性下颌缘支无力，随后自行缓解。
眼附属器黑色素瘤患者的SLNB是安全的，并且在大约20%的病例中可识别出淋巴结微转移。与前哨淋巴结阳性相关的组织学特征包括更大的肿瘤厚度、更多的有丝分裂象数量和溃疡形成。
