Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
J Surg Oncol. 2022 Dec;126(7):1272-1278. doi: 10.1002/jso.27022. Epub 2022 Jul 23.
Lymphatic drainage from subcostal nodes, along the costal groove, have not previously been characterized as sites for melanoma drainage and metastasis. This study reports a series of patients with subcostal nodes draining primary melanomas, with characterization of the sites of primary melanomas that drain to these nodes.
Patients who presented to our institution between 2005 and 2020 with documented cutaneous melanoma and sentinel lymph node biopsy of a subcostal node (sentinel = S), or metastases to subcostal nodes later in clinical management (recurrent = R) were included. Patient demographics, melanoma pathology, nodal features, imaging information, surgical approaches, and outcomes data were collected.
Six patients had subcostal sentinel nodes (SNs). Primary sites included the posterior trunk and lateral chest wall. Subcostal nodes were found under ribs 10-12. Subcostal SNs had at least one dimension measuring 3 mm or less. There were no surgical complications related to removing the subcostal SN.
Melanoma can metastasize to subcostal lymph nodes and be found at the time of SN biopsy or identified at recurrence. These small nodes are fed by lymphatic channels that run in the neurovascular bundle under the ribs. When lymphatic mapping identifies a subcostal SN, it should be excised.
肋间淋巴结沿肋间沟引流，以前并未被描述为黑色素瘤引流和转移的部位。本研究报告了一系列肋间淋巴结引流原发性黑色素瘤的患者，并对引流至这些淋巴结的原发性黑色素瘤的部位进行了特征描述。
本研究纳入了 2005 年至 2020 年期间在我院就诊并记录有皮肤黑色素瘤病史，且行肋间哨位淋巴结活检（哨位淋巴结=S）或在临床管理中发现肋间淋巴结转移（复发性=R）的患者。收集了患者的人口统计学资料、黑色素瘤病理、淋巴结特征、影像学信息、手术方法和结局数据。
6 例患者有肋间哨位淋巴结（SN）。原发性肿瘤部位包括后躯干和侧胸壁。肋间淋巴结位于第 10-12 肋骨下方。肋间 SN 的至少一个维度为 3mm 或更小。切除肋间 SN 无相关手术并发症。
黑色素瘤可转移至肋间淋巴结，可在 SN 活检时发现，也可在复发时发现。这些小淋巴结由肋间神经血管束下的淋巴管供应。当淋巴示踪术确定肋间 SN 时，应将其切除。
