Lee Ji Hyun, Kim Hyun Su, Yoon Young Cheol, Kim Min Je, Cha Min Jae, Kim Jung-Han
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Ultrasonography. 2020 Oct;39(4):376-383. doi: 10.14366/usg.20013. Epub 2020 Mar 18.
Excision of metastatic lesions is an important treatment strategy in patients with malignant melanoma, both at the initial diagnosis and upon recurrence. Since nonpalpable lesions cannot be easily visualized in the surgical field, we evaluated the effectiveness of ultrasound (US)-guided tattooing using a charcoal suspension for the localization of nonpalpable metastatic lesions of malignant melanoma.
Between November 2009 and June 2019, we retrospectively reviewed 65 nonpalpable lesions in 29 patients with malignant melanoma who underwent preoperative US-guided tattooing using a charcoal suspension for histologically confirmed or suspected metastases. The characteristics of the tattooed lesions were analyzed. The effectiveness of the procedure was evaluated based on the detection rate in the surgical field and the presence or absence of residua on postoperative follow-up US. Procedure-related complications were also analyzed.
Of 65 lesions, 33 (50.8%) were histologically confirmed as metastases before the tattooing procedure, while the other 32 were suspected of being metastases based on imaging studies. The mean lesion size was 9.8 mm (range, 1.3 to 24.4 mm). The final pathology revealed metastases in 59 lesions (90.8%), including lymph node (n=51), muscle (n=5), and in-transit (n=3) metastases. Sixty-one lesions (93.8%) were successfully detected intraoperatively and removed without residua on follow-up US. Four residual lesions were removed after repeated localization (n=2) or by intraoperative US (n=2). No relevant complications were noted.
Preoperative US-guided tattooing localization can safely and effectively delineate nonpalpable metastatic melanoma lesions to aid in successful surgical excision.
对于恶性黑色素瘤患者，无论是在初始诊断还是复发时，切除转移灶都是重要的治疗策略。由于不可触及的病灶在手术视野中不易可视化，我们评估了使用木炭混悬液的超声（US）引导下纹身术对恶性黑色素瘤不可触及转移灶的定位效果。
2009年11月至2019年6月，我们回顾性分析了29例恶性黑色素瘤患者的65个不可触及病灶，这些患者接受了术前US引导下使用木炭混悬液进行纹身术，以明确组织学确诊或疑似转移灶。分析纹身病灶的特征。根据手术视野中的检出率以及术后随访超声检查中是否存在残留来评估该操作的有效性。还分析了与操作相关的并发症。
65个病灶中，33个（50.8%）在纹身术前经组织学确诊为转移灶，另外32个根据影像学检查怀疑为转移灶。病灶平均大小为9.8mm（范围1.3至24.4mm）。最终病理显示59个病灶（90.8%）为转移灶，包括淋巴结转移（n = 51）、肌肉转移（n = 5）和途中转移（n = 3）。61个病灶（93.8%）在术中成功检出并切除，术后随访超声检查无残留。4个残留病灶在重复定位（n = 2）或术中超声引导下（n = 2）后被切除。未发现相关并发症。
术前US引导下纹身定位可安全有效地勾勒出不可触及的转移性黑色素瘤病灶，有助于成功进行手术切除。
