Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
The Angeles Clinic and Research Institute, Santa Monica, CA, USA.
Ann Surg Oncol. 2018 Feb;25(2):356-377. doi: 10.1245/s10434-017-6267-7. Epub 2017 Dec 13.
To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma.
An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma.
Nine new observational studies, two systematic reviews and an updated randomized controlled trial (RCT) of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included.
Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (non-ulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or <0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of >1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors, and details of the reference patient populations are included within the guideline.
更新美国临床肿瘤学会（ASCO）-外科肿瘤学会（SSO）关于黑色素瘤前哨淋巴结（SLN）活检的指南。
成立了一个 ASCO-SSO 小组，并对 SLN 活检和阳性前哨淋巴结后行淋巴结清扫术（CLND）的文献进行了系统回顾。
纳入了 9 项新的观察性研究、2 项 SLN 活检的系统评价和更新的随机对照试验（RCT），以及 2 项阳性 SLN 活检后行 CLND 的随机对照试验。
不建议对 T1a 期（非溃疡病变<0.8mm 的 Breslow 厚度）薄型黑色素瘤患者常规进行 SLN 活检。如果与患者进行了充分的讨论，了解了该操作的潜在益处和风险，那么对于 T1b 期（0.8-1.0mm Breslow 厚度或<0.8mm Breslow 厚度伴溃疡）薄型黑色素瘤患者，可考虑进行 SLN 活检。对于中厚度黑色素瘤（T2 或 T3；Breslow 厚度>1.0-4.0mm）患者，建议进行 SLN 活检。对于 T4 期（Breslow 厚度>4.0mm）的厚型黑色素瘤患者，如果讨论了潜在的益处和风险，可以考虑进行 SLN 活检。在前哨淋巴结活检阳性的情况下，对于低危微转移疾病的患者，可以选择 CLND 或密切观察，同时要充分考虑临床病理因素。对于高危患者，只有在与患者充分讨论了避免 CLND 的潜在风险和益处后，才可考虑密切观察。指南中包括了概述相关临床病理因素的重要限定性陈述以及参考患者人群的详细信息。
