Plastic, Reconstructive and Aesthetic Surgery Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Nuclear Medicine Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
J Invest Surg. 2020 Sep;33(8):741-747. doi: 10.1080/08941939.2018.1559898. Epub 2019 Mar 20.
The presence of nodal metastasis is an important prognostic factor for malignant melanoma and causes a 50% decrease in survival. Patients found not to have lymph node metastasis as a result of sentinel lymph node biopsy but develop regional lymph node metastasis in the follow-up period are called false negative sentinel. The hypothesis of this study was that excisional biopsy in patients with large lesions may change the lymphatic pathway and therefore cause false negative results. A total of 40 Sprague-Dawley rats were divided into 4 groups: the control group, Group 1 (10 mm excision), Group 2 (15 mm lesion excision), and Group 3 (20 mm excision). Sentinel lymph nodes were found via imaging with nanocolloidal albumin including 99mTc and indocyanine green (ICG) before the excision and at 3 weeks after the excision. Evaluations were performed to determine whether or not they were the same nodes. The false sentinel node detection rate in Group 3 was significantly higher than in both the control group and Group 1 ( < 0.05). No significant difference was detected between Group 2 and 3 according to false sentinel node detection rate. There were differences between preoperative and postoperative detection of sentinel lymph nodes found by radioactive and ICG methods but no significant difference was detected in the Kappa agreement coefficient. It can be suggested that incisional biopsy is performed on large lesions initially, followed by wide excision combined with SLNB at the second stage. This can help to prevent changes in the lymphatic pathway and therefore to decrease false negativity rates caused by the previous surgery.
前哨淋巴结转移是恶性黑色素瘤的一个重要预后因素，会导致患者 50%的生存率降低。前哨淋巴结活检未发现淋巴结转移，但在随访期间出现区域性淋巴结转移的患者称为假阴性前哨淋巴结。本研究的假设是，对于大病变的患者进行切除性活检可能会改变淋巴途径，从而导致假阴性结果。
总共 40 只 Sprague-Dawley 大鼠被分为 4 组：对照组、第 1 组（10mm 切除）、第 2 组（15mm 病变切除）和第 3 组（20mm 切除）。在切除前和切除后 3 周，使用包括 99mTc 和吲哚菁绿（ICG）的纳米胶体白蛋白进行影像学检查以找到前哨淋巴结。评估它们是否为同一淋巴结。第 3 组的假前哨淋巴结检出率明显高于对照组和第 1 组（<0.05）。第 2 组和第 3 组的假前哨淋巴结检出率无显著差异。放射性和 ICG 方法术前和术后检测前哨淋巴结存在差异，但 Kappa 一致性系数无显著差异。
因此，建议对大病变患者进行初步切口活检，然后进行广泛切除，并在第二阶段进行 SLNB。这有助于防止淋巴途径的改变，从而降低由于先前手术引起的假阴性率。
