Pijpers R, Collet G J, Meijer S, Hoekstra O S
Department of Nuclear Medicine, Free University Hospital, Amsterdam, The Netherlands.
Eur J Nucl Med. 1995 Nov;22(11):1238-41. doi: 10.1007/BF00801606.
In cutaneous melanoma, biopsy of the first tumour-draining lymph node (sentinel node, SN) may replace routine elective lymph node dissection (ELND). Even in experienced hands the original technique using vital dyes fails to localise the SN in 20% of cases. In this study we investigated whether the procedure benefits from lymphoscintigraphy and the use of a gamma probe. In 41 patients technetium-99m-colloidal albumin was injected intracutaneously around the scar of the excised tumour. This was followed by dynamic and late static imaging. The first focal accumulation was assumed to be the SN. In all patients at least one SN was found, in 95% within the first 20 min. By showing multiple or ramifying lymphatic channels, dynamic lymphoscintigraphy differentiated between spill and multiple SNs. In all cases the initial focus retained the highest fraction of radioactivity for at least 18 h. The gamma probe was especially useful in the axilla and neck, where it accurately showed the optimal incision site and facilitated the search for deep-seated nodes. Gamma probe-localised SNs were dye-positive in 93% of cases. The SN contained metastases in 20% of the patients. Only in these patients was ELND performed, which revealed that the SN had been the only metastatic node in four of eight cases. We conclude that dynamic lymphoscintigraphy is essential for SN localisation, that tracer kinetics allow flexible timing of surgery, and that the surgical procedure benefits from use of the gamma probe.
在皮肤黑色素瘤中，对首个引流肿瘤的淋巴结（前哨淋巴结，SN）进行活检可能会取代常规的选择性淋巴结清扫术（ELND）。即便在经验丰富的医生手中，使用活性染料的原始技术仍有20%的病例无法定位前哨淋巴结。在本研究中，我们调查了该手术是否因淋巴闪烁显像和使用γ探测仪而受益。41例患者中，在切除肿瘤的瘢痕周围皮内注射了99m锝胶体白蛋白。随后进行动态和延迟静态显像。首个放射性聚集点被认定为前哨淋巴结。所有患者均至少发现一个前哨淋巴结，95%的患者在前20分钟内发现。通过显示多条或分支状的淋巴通道，动态淋巴闪烁显像区分了溢出和多个前哨淋巴结。所有病例中，初始放射性聚集点至少18小时内保持最高放射性比例。γ探测仪在腋窝和颈部特别有用，它能准确显示最佳切口部位并便于寻找深部淋巴结。γ探测仪定位的前哨淋巴结在93%的病例中呈染料阳性。20%的患者前哨淋巴结有转移。仅对这些患者进行了淋巴结清扫术，结果显示8例中有4例前哨淋巴结是唯一的转移淋巴结。我们得出结论，动态淋巴闪烁显像对前哨淋巴结定位至关重要，示踪剂动力学允许灵活安排手术时间，并且手术操作因使用γ探测仪而受益。
