Wanebo H J, Harpole D, Teates C D
Cancer. 1985 Mar 15;55(6):1403-13. doi: 10.1002/1097-0142(19850315)55:6<1403::aid-cncr2820550640>3.0.co;2-k.
Frequently the primary lesion of high-risk cutaneous melanoma (level III, greater than or equal to 1.5mm; greater than or equal to 1.0 mm with ulceration) is in an ambiguous lymphatic drainage site on the trunk, pelvic and shoulder girdles, and head and neck area. Lymphoscintigrams were performed by a circumferential intradermal injection of the biopsy site using technetium 99m (99mTc) antimony sulfide colloid in a total dose of 0.2 to 0.6 mCi in a volume of 0.1 to 0.5 ml. Imaging was done with a large-field gamma camera with high-resolution parallel hole collimator. Technetium 99m antimony sulfide colloid is an ideal agent for lymphoscintigrams because of small particle size (3-30 micron), which permits early migration into the interstitial space and lymphatics and rapid pickup by lymph nodes. Although it is a gamma emmitter with high activity, it has a short half-life and does not induce tissue necrosis. It does not localize the site of lymph node metastases, but indicates only the drainage pattern. Images were obtained at 1, 5, 10, 15, 30, and 60 minutes, respectively, and then three times every hour. Surgery was usually performed 24 hours later. The majority of patients had lesions with ambiguous drainage sites: head and neck (4 of 5 patients) and trunk (9 of 13 patients). The drainage by scan was to unpredictive sites in 72%, and resulted in a change of treatment planning by location and extent of ablation with node dissection in 9 of 18 patients. Ambiguous dissection sites included: (1) question of preauricular dissection with parotidectomy versus posterior auricular and cervical dissection for selected scalp lesions; (2) low-neck with or without axillary dissection for upper chest and shoulder lesions; and (3) axillary versus groin dissections for midflank lesions at zone of ambiguity between axilla and groin. It was concluded that preoperative 99mTc antimony sulfide lymphoscintigraphy is a highly useful planning technique in determining the appropriate lymphatic drainage basin for dissection in selected melanoma patients.
高危皮肤黑色素瘤（III级，大于或等于1.5毫米；大于或等于1.0毫米且伴有溃疡）的原发损害常常位于躯干、骨盆和肩胛带以及头颈部区域的不明确淋巴引流部位。通过在活检部位进行圆周皮内注射99m锝（99mTc）硫化锑胶体来进行淋巴闪烁显像，总剂量为0.2至0.6毫居里，体积为0.1至0.5毫升。使用带有高分辨率平行孔准直器的大视野伽马相机进行成像。99m锝硫化锑胶体是淋巴闪烁显像的理想剂，因为其颗粒尺寸小（3 - 30微米），这使得它能够早期迁移到间质间隙和淋巴管，并被淋巴结快速摄取。尽管它是一种具有高活性的伽马发射体，但其半衰期短，不会导致组织坏死。它不能定位淋巴结转移部位，而仅显示引流模式。分别在1、5、10、15、30和60分钟时获取图像，然后每小时获取三次。手术通常在24小时后进行。大多数患者的损害位于不明确的引流部位：头颈部（5例患者中的4例）和躯干（13例患者中的9例）。扫描显示72%的引流至不可预测的部位，并且导致18例患者中有9例根据消融部位和范围以及淋巴结清扫情况改变了治疗计划。不明确的清扫部位包括：（1）对于选定的头皮损害，是行腮腺切除术加耳前清扫还是耳后及颈部清扫的问题；（2）对于上胸部和肩部损害，是行低位颈部清扫加或不加腋窝清扫；以及（3）对于腋窝和腹股沟之间不明确区域的中侧腹损害，是行腋窝清扫还是腹股沟清扫。得出的结论是，术前99mTc硫化锑淋巴闪烁显像在确定选定黑色素瘤患者进行清扫的合适淋巴引流区域方面是一种非常有用的规划技术。
