Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, Toulouse, France.
Department of Surgical Oncology, Cancer University Institute of Toulouse Oncopole, Toulouse Cedex 09, France.
Int J Dermatol. 2018 Apr;57(4):410-416. doi: 10.1111/ijd.13936. Epub 2018 Feb 12.
Needle biopsy is a rapid, reliable, and reproducible procedure for histological confirmation of metastatic melanoma localization. Nonetheless, this procedure presents a theoretical risk of a mechanical weakening of the lymph node capsule with perinodal tumor seeding. The objective of the study was to evaluate the incidence of extracapsular extension after needle biopsy in comparison with surgical adenectomy in patients suspected of metastatic lymph node of melanoma.
We conducted a retrospective study of 1056 patients who underwent lymphadenectomy for melanoma between 2000 and 2016 in our unit. Sixty-nine patients were clinically and/or radiologically suspected of metastatic lymph node of melanoma. Patients were divided according to external lymph node biopsy or surgical adenectomy before lymphadenectomy. The primary endpoint was the histopathological identification of extracapsular extension in analyzed lymph nodes.
The two populations were comparable except for the mitotic index, which was more frequently > 1/mm in the group with surgical adenectomy (P = 0.005). The proportion of extracapsular extension was significantly greater in the needle biopsy group (28/37) than in patients who underwent surgical adenectomy (14/32) (P = 0.0067; OR = 4 [95% CI: 1.4-11]).
Our results suggest an increased risk of extracapsular extension after external lymph node biopsy in cases of suspicion of metastatic lymph node of melanoma. Thus, this encourages us to prefer surgical adenectomy in patients with suspected adenopathy accessible surgically. In other cases, needle biopsy should be carried out under radiological guidance using devices limiting tumor seeding.
对于转移性黑色素瘤的定位，细针活检是一种快速、可靠且可重复的组织学确认方法。尽管如此，该操作仍存在理论上的风险，即淋巴结包膜可能会因周围肿瘤种植而机械性减弱。本研究的目的是评估与外科腺切除术相比，在怀疑转移性黑色素瘤淋巴结的患者中，细针活检后发生囊外扩展的发生率。
我们对 2000 年至 2016 年间在我科行淋巴结切除术的 1056 例黑色素瘤患者进行了回顾性研究。69 例患者在临床上和/或影像学上怀疑有转移性黑色素瘤淋巴结。根据淋巴结切除术之前是否进行外部淋巴结活检或外科腺切除术将患者进行分组。主要终点是分析淋巴结中囊外扩展的组织病理学识别。
两组人群除有丝分裂指数外，其他方面均具有可比性，外科腺切除术组的有丝分裂指数更频繁>1/mm（P = 0.005）。在细针活检组（28/37）中，囊外扩展的比例明显高于行外科腺切除术组（14/32）（P = 0.0067；OR = 4 [95%CI：1.4-11]）。
我们的结果表明，在怀疑有转移性黑色素瘤淋巴结的情况下，外部淋巴结活检后囊外扩展的风险增加。因此，我们鼓励在可手术治疗的可疑淋巴结患者中优先进行外科腺切除术。在其他情况下，应在放射引导下使用限制肿瘤种植的设备进行细针活检。
