Tc-利妥昔单抗前哨淋巴结测绘与活检，这项有效技术避免了腋窝清扫，并预测了 533 例皮肤黑色素瘤的预后。
Tc-Rituximab sentinel lymph node mapping and biopsy, the effective technique avoids axillary dissection and predicts prognosis in 533 cutaneous melanoma.
机构信息
Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
出版信息
Ann Nucl Med. 2023 Mar;37(3):189-197. doi: 10.1007/s12149-022-01815-8. Epub 2022 Dec 31.
OBJECTIVE
To evaluate the efficiency of a novel lymph node radiotracer Tc-rituximab in sentinel lymph node (SLN) lymphoscintigraphy and SLN biopsy (SLNB), and the influence of SLNB results on the prognosis of cutaneous malignant melanoma (CMM) patients.
METHODS
A retrospective study was performed on 533 patients with CMM who underwent lymphoscintigraphy and SLNB. All patients received a preoperative peritumoral injection of 11.1-18.5 MBq of Tc-rituximab 0.5 to 1 h before lymphoscintigraphy and SLNB.
RESULTS
The detection rate of lymphoscintigraphy and SLNB was both 99.81% (532/533), and the average number of detected SLNs was 2.1 (range 1 to 8) and 2.7 (range 1 to 11) per patient, respectively. 12.1% SLNs and 22.2% patients were found metastatic, with an average of 1.5 (range 1 to 5) metastatic SLNs per patient. The SLN metastatic rates were different in patients with different Breslow thickness, Clark levels, ulceration, mitotic counts, and HMB45 expression (p < 0.05). Ninety patients were proceeded with the regional lymph node dissection (RLND) after SLNB, and the sensitivity, specificity and accuracy of SLNB in metastatic diagnosis is 97.4, 100 and 96.7%, respectively. And SLNs with metastases was an independent prognostic factor for OS and PFS by multivariate prognostic analyses (HR was 5.9 and 4.3, p < 0.001). For patients with metastatic SLNs, the non-SLNs with metastasis and non-SLNs without metastasis in RLND, and observation groups showed different mean PFS as 14.9, 24.8 and 25.5 months (p = 0.018), but no statistically significant difference existed in the OS.
CONCLUSION
The novel radiotracer Tc-rituximab could identify SLNs specifically in SLN lymphoscintigraphy and SLNB in CMM patients, and the pathology obtained from SLNB rather than from RLND better indicated the staging and long-term prognosis.
目的
评估新型淋巴结示踪剂 Tc-利妥昔单抗在哨兵淋巴结（SLN）淋巴闪烁显像和 SLN 活检（SLNB）中的效率，以及 SLNB 结果对皮肤恶性黑色素瘤（CMM）患者预后的影响。
方法
对 533 例接受淋巴闪烁显像和 SLNB 的 CMM 患者进行回顾性研究。所有患者均在 SLN 淋巴闪烁显像和 SLNB 前 1 至 1.5 小时，经皮肿瘤周围注射 11.1-18.5MBq Tc-利妥昔单抗。
结果
淋巴闪烁显像和 SLNB 的检出率均为 99.81%（532/533），每位患者平均检出 SLN 数分别为 2.1（范围 1 至 8）和 2.7（范围 1 至 11）个。12.1%的 SLN 和 22.2%的患者发生转移，每位患者平均转移 SLN 数为 1.5（范围 1 至 5）个。不同 Breslow 厚度、Clark 水平、溃疡、有丝分裂计数和 HMB45 表达的患者 SLN 转移率不同（p<0.05）。90 例患者在 SLNB 后进行了区域淋巴结清扫（RLND），SLNB 在转移诊断中的灵敏度、特异性和准确性分别为 97.4%、100%和 96.7%。多因素预后分析显示，SLN 转移是 OS 和 PFS 的独立预后因素（HR 分别为 5.9 和 4.3，p<0.001）。对于有转移的 SLN 患者，RLND 中的非 SLN 转移、非 SLN 无转移和观察组的中位 PFS 分别为 14.9、24.8 和 25.5 个月（p=0.018），但 OS 无统计学差异。
结论
新型示踪剂 Tc-利妥昔单抗可特异性识别 CMM 患者的 SLN，SLNB 获得的病理结果比 RLND 更能准确分期和预测长期预后。
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