Roshan Amit, Pasha Terouz, Kounidas Georgios, Murphy Suzanne, Aloj Luigi, Buscombe John, Patel Animesh, Durrani Amer
Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Cancer Research UK Cambridge Institute, University of Cambridge, Robinsons Way, Cambridge, CB2 0RE, UK.
Ann Nucl Med. 2025 Jan;39(1):77-85. doi: 10.1007/s12149-024-01980-y. Epub 2024 Sep 16.
Sentinel Lymph Node Biopsy (SLNB) is an important management tool for early-stage melanoma. Different radiopharmaceuticals are used internationally to localise the sentinel node using lymphoscintigraphy (LSG) before surgery. Recent reports have suggested that a delayed interval between LSG and SLNB using Tc-labelled nanocolloid tracer has an adverse survival impact, but not with Tc-labelled antimony sulphide colloid. This study aims to analyse survival outcome in a prospective cohort of melanoma patients undergoing same day or next day SLNB after LSG using Tc-labelled nanocolloid.
Outcome data were reviewed for patients undergoing SLNB, stratified by time interval between LSG and SLNB at a single UK academic centre. Kaplan-Meier survival analysis was used to assess overall survival (OS), melanoma-specific survival (MSS) and progression-free survival (PFS). Cox multivariable regression analysis identified independent risk factors.
925 patients had LSG using the Tc-nanocolloid tracer between 2009 and 2019, with a median follow-up of 6.36 years. No difference was seen on univariate analysis in OS, MSS, PFS, or nodal recurrence between patients undergoing same day or next day SLNB (Log-rank P = 0.437, 0.293, 0.587, 0.342 respectively). In addition, nodal recurrence as first site or anytime site of recurrence in SLNB negative patients was similar between the groups (Log-rank P = 0.093 and 0.457 respectively). Stratified analysis of time did not demonstrate an outcome difference (MSS Log-rank P = 0.938). Cox multivariable regression did not show time interval to independently influence OS, MSS or PFS.
We do not find a significant effect on long-term outcomes when SLNB is performed the day after LSG with Tc-labelled nanocolloid tracer. We infer that tracer migration is not clinically significant within 24 h of injection based on long term clinical outcome data.
前哨淋巴结活检（SLNB）是早期黑色素瘤的一项重要治疗手段。在国际上，手术前使用不同的放射性药物通过淋巴闪烁显像（LSG）来定位前哨淋巴结。近期报告表明，使用锝标记的纳米胶体示踪剂进行LSG与SLNB之间的间隔时间延长对生存有不利影响，但使用锝标记的硫化锑胶体则不然。本研究旨在分析在使用锝标记的纳米胶体进行LSG后当日或次日接受SLNB的黑色素瘤患者前瞻性队列中的生存结局。
回顾了在英国一个学术中心接受SLNB患者的结局数据，按LSG与SLNB之间的时间间隔进行分层。采用Kaplan-Meier生存分析评估总生存期（OS）、黑色素瘤特异性生存期（MSS）和无进展生存期（PFS）。Cox多变量回归分析确定独立危险因素。
2009年至2019年间，925例患者使用锝纳米胶体示踪剂进行了LSG，中位随访时间为6.36年。在接受当日或次日SLNB的患者中，单因素分析显示OS、MSS、PFS或淋巴结复发无差异（对数秩检验P分别为0.437、0.293、0.587、0.342）。此外，SLNB阴性患者中作为复发的首发部位或任何时间部位的淋巴结复发在两组间相似（对数秩检验P分别为0.093和0.457）。时间分层分析未显示结局有差异（MSS对数秩检验P = 0.938）。Cox多变量回归未显示时间间隔对OS、MSS或PFS有独立影响。
当使用锝标记的纳米胶体示踪剂在LSG后次日进行SLNB时，我们未发现对长期结局有显著影响。基于长期临床结局数据，我们推断示踪剂在注射后24小时内的迁移在临床上无显著意义。
