Goydos J S, Ravikumar T S, Germino F J, Yudd A, Bancila E
Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School and The Cancer Institute of New Jersey, New Brunswick 08901, USA.
J Am Coll Surg. 1998 Aug;187(2):182-8; discussion 188-90. doi: 10.1016/s1072-7515(98)00138-0.
A minimally invasive standard has yet to be developed for sentinel lymphadenectomy, and many patients undergo this procedure in the main operating room under general anesthesia. These patients often have microscopic metastases in sentinel nodes that could be missed by histopathologic examination. Techniques of reverse transcriptase polymerase chain reaction (RT-PCR) could detect these metastases if the nodes could be preserved intraoperatively.
Fifty patients with melanoma > or = mm thick underwent sentinel lymphadenectomy under local anesthesia in an outpatient surgical unit. Sentinel nodes were identified using blue dye and technetium-99 sulfur colloid and a hand-held gamma probe. Each node was sectioned, with half sent for routine histopathologic study and half preserved in liquid nitrogen. We used RT-PCR to detect mRNA for tyrosinase and Melanoma Antigen Recognized by T cells-1 (MART-1).
All patients were able to tolerate sentinel lymph node biopsy under local anesthesia. Sentinel lymph nodes were obtained in 100% of our patients, and usable mRNA was harvested from all but five. Ten patients had positive sentinel node(s) by standard histopathologic examination, and all of these nodes were also positive for MART-1 and tyrosinase. Three patients with negative results by histopathology had positive results by RT-PCR analysis. The average cost of these outpatient operations was 38% less than the same operations performed in the main operating room under general anesthesia.
Sentinel lymphadenectomy under local anesthesia in an outpatient setting and intraoperative lymph node preservation in liquid nitrogen are both feasible. Both tyrosinase and MART-1 are promising markers in the detection of occult melanoma in lymph nodes.
前哨淋巴结切除术的微创标准尚未制定，许多患者在全身麻醉下于主手术室接受该手术。这些患者的前哨淋巴结中常存在微小转移灶，可能会被组织病理学检查遗漏。如果术中能够保存淋巴结，逆转录聚合酶链反应（RT-PCR）技术可检测到这些转移灶。
50例黑色素瘤厚度≥1mm的患者在门诊手术单元接受局部麻醉下的前哨淋巴结切除术。使用蓝色染料、99锝硫胶体和手持式γ探测器识别前哨淋巴结。每个淋巴结均进行切片，一半送去做常规组织病理学研究，另一半保存在液氮中。我们使用RT-PCR检测酪氨酸酶和T细胞识别的黑色素瘤抗原-1（MART-1）的mRNA。
所有患者均能耐受局部麻醉下的前哨淋巴结活检。100%的患者获取到了前哨淋巴结，除5例患者外，其余均收获了可用的mRNA。10例患者的前哨淋巴结经标准组织病理学检查呈阳性，所有这些淋巴结的MART-1和酪氨酸酶也呈阳性。3例组织病理学检查结果为阴性的患者经RT-PCR分析呈阳性。这些门诊手术的平均费用比在全身麻醉下于主手术室进行的相同手术低38%。
在门诊环境下进行局部麻醉下的前哨淋巴结切除术以及术中将淋巴结保存在液氮中都是可行的。酪氨酸酶和MART-1在检测淋巴结隐匿性黑色素瘤方面都是很有前景的标志物。
