Jaukovic Ljiljana, Rajović Milica, Kandolf Sekulovic Lidija, Radulovic Marija, Stepic Nenad, Mijuskovic Zeljko, Petrov Nenad, Ajdinovic Boris
From the Institute of Nuclear Medicine.
Clinic for Plastic Surgery and Burns.
Ann Plast Surg. 2018 Jul;81(1):80-86. doi: 10.1097/SAP.0000000000001465.
Sentinel lymph node (SLN) biopsy is a widely accepted staging procedure for cutaneous melanoma patients who are at risk of clinically occult nodal metastases. Numerous predictive factors for regional lymph node metastases have been identified; however, few have been found to be reproducibly significant. Also, the role of blue dye in identification was questioned in recent trials. Time to procedure was also found to be predictive of SLN positivity, but this was not confirmed in other studies. In our study, predictive factors for metastatic involvement of SLN were analyzed, together with the role of addition blue dye in imaging on detection rate and false-negative SLN rate. An impact of time interval to procedure on the rate of SLN positivity was also explored.
Data analysis was done in 362 cutaneous melanoma patients who underwent lymphoscintigraphy and SLN biopsy at our institution from 2010 to 2016, with a median follow-up of 29 months (1-98 months). To delineate the relation of each variable (demographical, time to procedure, and clinical and pathological variables, as well as the presence of in-transit nodes, the number of draining basins, and SLN localization on scintigraphy) with positive SLN status, we used univariate logistic regression with odds ratios representing effect size.
Metastatic involvement SLN was found in 67 (18.8%) of 356 patients. Detection rate was similar with or without further intraoperative SLN identification with blue dye (98.8% vs 98.17%, P > 0.05). Time to procedure was not associated with higher SLN positivity rate (P > 0.05). In univariate analysis, Breslow thickness (P < 0.001), primary ulceration lesion (P = 0.001), and lymphovascular invasion (P = 0.006) were strongly correlated with SLN positivity, as well as the site of primary tumor (P = 0.024), tumor-infiltrating lymphocytes (TILs) (P = 0.021), and sex (P = 0.026). In multivariate analysis, Breslow thickness and TILs were found to be significant independent predictors of SLN status (P < 0.05).
Addition of blue dye did not improve SLN detection rate; time to procedure was not found to be associated with higher SLN biopsy positivity rates. Breslow thickness and TILs, as a marker of immune response to tumor, were consistently found to be significant independent predictors of SLN status.
前哨淋巴结（SLN）活检是一种被广泛接受的用于有临床隐匿性淋巴结转移风险的皮肤黑色素瘤患者的分期程序。已经确定了许多区域淋巴结转移的预测因素；然而，很少有因素被发现具有可重复性的显著性。此外，在最近的试验中，蓝色染料在识别中的作用受到质疑。手术时间也被发现可预测SLN阳性，但在其他研究中未得到证实。在我们的研究中，分析了SLN转移累及的预测因素，以及额外蓝色染料在成像中对检出率和假阴性SLN率的作用。还探讨了手术时间间隔对SLN阳性率的影响。
对2010年至2016年在本机构接受淋巴闪烁显像和SLN活检的362例皮肤黑色素瘤患者进行数据分析，中位随访时间为29个月（1 - 98个月）。为了描述每个变量（人口统计学、手术时间、临床和病理变量，以及途中淋巴结的存在、引流区数量和闪烁显像上的SLN定位）与阳性SLN状态之间的关系，我们使用单因素逻辑回归，比值比代表效应大小。
356例患者中有67例（18.8%）发现SLN有转移累及。术中使用或不使用蓝色染料进一步识别SLN，检出率相似（98.8%对98.17%，P > 0.05）。手术时间与较高的SLN阳性率无关（P > 0.05）。在单因素分析中，Breslow厚度（P < 0.001）、原发性溃疡病变（P = 0.001）和淋巴管侵犯（P = 0.006）与SLN阳性密切相关，以及原发肿瘤部位（P = 0.024）、肿瘤浸润淋巴细胞（TILs）（P = 0.021）和性别（P = 0.026）。在多因素分析中，Breslow厚度和TILs被发现是SLN状态的显著独立预测因素（P < 0.05）。
添加蓝色染料并未提高SLN检出率；未发现手术时间与较高的SLN活检阳性率相关。Breslow厚度和TILs作为对肿瘤免疫反应的标志物，一直被发现是SLN状态的显著独立预测因素。
