Picciotto Franco, Avallone Gianluca, Castellengo Federico, Merli Martina, Caliendo Virginia, Senetta Rebecca, Lesca Adriana, Deandreis Désirée, Fierro Maria Teresa, Quaglino Pietro, Ribero Simone
Section of Surgical Dermatology, AOU Città Della Salute e Della Scienza, 10126 Turin, Italy.
Department of Medical Sciences, Section of Dermatology, University of Turin, 10126 Turin, Italy.
J Clin Med. 2021 Sep 23;10(19):4319. doi: 10.3390/jcm10194319.
Sentinel lymph node biopsy has been demonstrated to be an effective staging procedure since its introduction in 1992. The new American Joint Committee on Cancer (AJCC) classification did not consider the lack of information that would result from the less usage of the complete lymph node dissection as for a diagnostic purpose. Thus, this makes it difficult the correct staging and would leave about 20% of the further positive non-sentinel lymph nodes in the lymph node basin. In this paper, we aim to describe a new surgical technique that, combined with single-photon emission computed tomography-computed tomography (SPECT-CT), allows for better staging of melanoma patients. This is a prospective study that includes 104 patients with cutaneous melanoma. Sentinel lymph node biopsy was offered according to the AJCC guideline. Planar lymphoscintigraphy was performed in association with SPECT-CT, identifying and removing all non-biologically "excluded" lymph nodes, guiding the surgeon's hand in detection and removal of lymph nodes. Even if identification and removal of non-sentinel lymph nodes is unable to increase overall survival, it definitely gives better disease control in the basin. With a "classic" setting, the risk of leaving further lymph nodes out of the sentinel lymph node procedure is around 20%, thus, basically, the surgical sentinel lymph node of first and second lymph nodes would have therapeutic value and complete lymph node dissection classically performed.
自1992年引入以来，前哨淋巴结活检已被证明是一种有效的分期程序。美国癌症联合委员会（AJCC）的新分类没有考虑到由于较少使用完整淋巴结清扫术进行诊断而导致的信息缺失。因此，这使得正确分期变得困难，并会在淋巴结区域留下约20%的后续阳性非前哨淋巴结。在本文中，我们旨在描述一种新的手术技术，该技术与单光子发射计算机断层扫描-计算机断层扫描（SPECT-CT）相结合，能够更好地对黑色素瘤患者进行分期。这是一项前瞻性研究，纳入了104例皮肤黑色素瘤患者。根据AJCC指南进行前哨淋巴结活检。将平面淋巴闪烁显像与SPECT-CT联合进行，识别并切除所有非生物学上“排除”的淋巴结，在检测和切除淋巴结过程中指导外科医生的操作。即使识别和切除非前哨淋巴结无法提高总体生存率，但它肯定能更好地控制区域内的疾病。在“经典”情况下，在前哨淋巴结手术中遗漏更多淋巴结的风险约为20%，因此，基本上，第一和第二淋巴结的手术前哨淋巴结将具有治疗价值，并经典地进行完整淋巴结清扫。
