Bostick P, Essner R, Sarantou T, Kelley M, Glass E, Foshag L, Stern S, Morton D
Roy E. Coats Research Laboratories of John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA.
Am J Surg. 1997 Nov;174(5):536-9. doi: 10.1016/S0002-9610(97)00150-5.
We previously reported dye-directed intraoperative lymphatic mapping and selective sentinel lymphadenectomy for primary cutaneous melanomas draining to the neck lymph nodes. In this study we determined whether combining the dye with a radiopharmaceutical agent would enhance our rate of sentinel node detection.
One hundred seventeen patients with primary cutaneous melanomas of the upper chest and head and neck underwent preoperative cutaneous lymphoscintigraphy to confirm lymphatic drainage to neck nodes, followed by intraoperative lymphatic mapping and sentinel lymphadenectomy. In 94 cases, isosulfan blue dye was injected at the primary site; in the remaining 23 cases, a 1:3 mixture of radiopharmaceutical and dye was injected, and a hand-held probe was used to determine the radioactive counts.
Preoperative cutaneous lymphoscintigraphy identified 129 drainage basins; 12 patients (10%) had dual-basin drainage. During intraoperative lymphatic mapping and sentinel lymphadenectomy, 183 sentinel nodes were identified and excised from 120 basins (1.5 nodes/basin). The blue dye alone identified sentinel nodes in 93 of 101 basins (92%). The probe identified sentinel nodes in 28 of 28 basins, only one of which failed to reveal blue-staining sentinel nodes; thus, the probe plus dye identified sentinel nodes in 27 of 28 basins (96%). Histopathologic analysis revealed metastasis in sentinel nodes from 11 patients (12%) who underwent sentinel lymphadenectomy with blue dye alone and in 3 patients (13%) who underwent sentinel lymphadenectomy with dye plus probe. There were no same-basin recurrences over a mean follow-up of 46 months (range 1 to 125).
Selective sentinel lymphadenectomy is a highly accurate method of staging the regional nodes in patients with primary tumors of the head and neck. Although we initially demonstrated the utility of this technique with blue dye alone, our results now suggest that the combination of dye and radiopharmaceutical may be a more sensitive method to detect sentinel nodes.
我们之前报道了染料引导的术中淋巴管造影和选择性前哨淋巴结切除术，用于引流至颈部淋巴结的原发性皮肤黑色素瘤。在本研究中，我们确定将染料与放射性药物联合使用是否会提高我们的前哨淋巴结检测率。
117例上胸部、头颈部原发性皮肤黑色素瘤患者术前行皮肤淋巴闪烁显像以确认淋巴管引流至颈部淋巴结，随后进行术中淋巴管造影和前哨淋巴结切除术。94例患者在原发部位注射异硫蓝染料；其余23例患者注射放射性药物与染料的1:3混合物，并使用手持探头测定放射性计数。
术前皮肤淋巴闪烁显像确定了129个引流区；12例患者（10%）有双引流区。在术中淋巴管造影和前哨淋巴结切除术中，从120个引流区识别并切除了183个前哨淋巴结（每个引流区1.5个淋巴结）。仅蓝色染料在101个引流区中的93个（92%）识别出前哨淋巴结。探头在28个引流区中的28个识别出前哨淋巴结，其中只有1个未显示蓝色染色的前哨淋巴结；因此，探头加染料在28个引流区中的27个（96%）识别出前哨淋巴结。组织病理学分析显示，仅使用蓝色染料进行前哨淋巴结切除术的11例患者（12%）和使用染料加探头进行前哨淋巴结切除术的3例患者（13%）的前哨淋巴结有转移。平均随访46个月（范围1至125个月）期间无同一引流区复发。
选择性前哨淋巴结切除术是对头颈部原发性肿瘤患者区域淋巴结进行分期的一种高度准确的方法。尽管我们最初仅用蓝色染料证明了该技术的实用性，但我们现在的结果表明，染料与放射性药物联合使用可能是检测前哨淋巴结更敏感的方法。
