吲哚菁绿荧光淋巴显像联合淋巴闪烁显像提高黑色素瘤前哨淋巴结活检的准确性。
Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy Improves the Accuracy of Sentinel Lymph Node Biopsy in Melanoma.
机构信息
From the Department of Plastic Surgery, Cleveland Clinic.
出版信息
Plast Reconstr Surg. 2021 Jul 1;148(1):83e-93e. doi: 10.1097/PRS.0000000000008096.
BACKGROUND
Despite advances in melanoma management, there remains room for improvement in the accuracy of sentinel lymph node biopsy. The authors analyzed a prospective cohort of patients with primary cutaneous melanoma who underwent sentinel lymph node biopsy with lymphoscintigraphy and indocyanine green fluorescence to evaluate the quality and accuracy of this technique.
METHODS
Consecutive primary cutaneous melanoma patients who underwent sentinel lymph node biopsy with radioisotope lymphoscintigraphy and indocyanine green fluorescence from 2012 to 2018 were prospectively enrolled. Analysis was performed of melanoma characteristics, means of identifying sentinel lymph nodes, sentinel lymph node status, and recurrence.
RESULTS
Five hundred ninety-four melanomas and 1827 nodes were analyzed; 1556 nodes (85.2 percent) were identified by radioactivity/fluorescence, 255 (14 percent) by radioactivity only, and 16 (0.9 percent) with indocyanine green only. There were 163 positive sentinel nodes. One hundred forty-seven (90.2 percent) were identified by radioactivity/fluorescence, 13 (8 percent) by radioactivity only, and three (0.6 percent) with fluorescence only. Of the 128 patients with a positive biopsy, eight patients' (6.3 percent) nodes were identified by radioactivity only and four (3.4 percent) with fluorescence only. There were 128 patients with a positive biopsy, 454 with a negative biopsy, and 12 patients who had a negative biopsy with subsequent nodal recurrence. Mean follow-up was 2.8 years.
CONCLUSIONS
In the study of the largest cohort of patients with primary cutaneous melanoma who underwent a sentinel lymph node biopsy with radioisotope lymphoscintigraphy and indocyanine green-based technology, the quality and accuracy of this technique are demonstrated. This has important implications for melanoma patients, as the adoption of this approach with subsequent accurate staging, adjuvant workup, and treatment may improve survival outcomes. .
CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.
背景
尽管黑色素瘤的治疗取得了进展，但在提高前哨淋巴结活检的准确性方面仍有改进的空间。作者分析了一组接受放射性同位素淋巴闪烁显像和吲哚菁绿荧光法前哨淋巴结活检的原发性皮肤黑色素瘤患者的前瞻性队列，以评估该技术的质量和准确性。
方法
前瞻性纳入 2012 年至 2018 年间接受放射性同位素淋巴闪烁显像和吲哚菁绿荧光法前哨淋巴结活检的原发性皮肤黑色素瘤患者。分析黑色素瘤特征、识别前哨淋巴结的方法、前哨淋巴结状态和复发情况。
结果
分析了 594 个黑色素瘤和 1827 个淋巴结；1556 个（85.2%）淋巴结通过放射性/荧光法确定，255 个（14%）仅通过放射性确定，16 个（0.9%）仅通过吲哚菁绿确定。有 163 个前哨淋巴结阳性。147 个（90.2%）通过放射性/荧光法确定，13 个（8%）仅通过放射性确定，3 个（0.6%）仅通过荧光法确定。在 128 例阳性活检患者中，8 例（6.3%）患者的淋巴结仅通过放射性确定，4 例（3.4%）患者的淋巴结仅通过荧光确定。有 128 例患者的活检呈阳性，454 例患者的活检呈阴性，12 例患者的活检呈阴性但随后发生淋巴结复发。平均随访时间为 2.8 年。
结论
在对接受放射性同位素淋巴闪烁显像和吲哚菁绿为基础技术的最大原发性皮肤黑色素瘤患者队列进行的研究中，该技术的质量和准确性得到了证明。这对黑色素瘤患者具有重要意义，因为采用这种方法进行后续准确分期、辅助检查和治疗可能会改善生存结果。
临床问题/证据水平：诊断，II。
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