Bonmarchand A, Coquerel-Beghin D, Duval-Modeste A B, Le Cloirec J, Duparc F, Auquit-Auckbur I
Rouen University, Rouen Cedex 1, France.
Centre Henri Becquerel, Rouen, France.
Surg Radiol Anat. 2018 Jan;40(1):3-13. doi: 10.1007/s00276-017-1877-0. Epub 2017 May 29.
The cutaneous lymphatic system of the trunk is a complex network, the anatomical knowledge of which remains unclear. The lymphatic system plays a major role in the dissemination of lymphophilic cancers like melanomas. The aim of this study was to improve our knowledge, optimize the care of patients with cutaneous tumors of the trunk, and to use our clinical experience of the topography of pathologic lymph nodes related to cutaneous melanomas and depicted by lymphoscintigraphy.
This prospective study included 90 consecutive patients who had primary resection of cutaneous melanoma of the trunk between June 2011 and January 2015. All patients had lymphatic mapping by lymphoscintigraphy, followed by sentinel lymph node procedure. We compared data of lymphatic imaging (lymphoscintigraphy and SPECT-CT) and surgery. We divided the trunk into 36 regions based on cutaneous anatomical landmarks to determine the topography of the lymphatic system for each tumor.
Our study showed cutaneous lymphatic drainage of melanomas of the trunk in 16 different areas. This drainage could be single or multiple. We observed that drainage could be controlateral in medial regions of the trunk, and lymphatic pathway could be retrograde. This drainage could be bilateral for medial regions and mainly into axillary areas for regions above L1 level. Posterior regions of the trunk had more diversity of drainage areas than anterior regions.
Cutaneous lymphatic drainage of the trunk was not limited to axillary and inguinal areas, showed interindividual variability, and was single or multiple, unilateral or bilateral, and unpredictable.
躯干皮肤淋巴系统是一个复杂的网络，其解剖学知识仍不清楚。淋巴系统在黑色素瘤等亲淋巴性癌症的扩散中起主要作用。本研究的目的是增进我们的了解，优化躯干皮肤肿瘤患者的护理，并利用我们对与皮肤黑色素瘤相关的病理性淋巴结的地形学的临床经验，这些淋巴结通过淋巴闪烁显像描绘。
这项前瞻性研究纳入了2011年6月至2015年1月期间连续90例接受躯干皮肤黑色素瘤初次切除的患者。所有患者均通过淋巴闪烁显像进行淋巴图谱绘制，随后进行前哨淋巴结手术。我们比较了淋巴成像（淋巴闪烁显像和SPECT-CT）和手术的数据。我们根据皮肤解剖标志将躯干分为36个区域，以确定每个肿瘤的淋巴系统地形。
我们的研究显示躯干黑色素瘤的皮肤淋巴引流分布在16个不同区域。这种引流可以是单一的或多个的。我们观察到，在躯干内侧区域引流可以是对侧的，并且淋巴途径可以是逆行的。躯干内侧区域的引流可以是双侧的，而L1水平以上区域的引流主要进入腋窝区域。躯干后部区域的引流区域比前部区域更多样化。
躯干皮肤淋巴引流不限于腋窝和腹股沟区域，存在个体差异，且是单一或多个、单侧或双侧的，并且不可预测。
