Bartolomei M, Testori A, Chinol M, Gennari R, De Cicco C, Leonardi L, Zoboli S, Paganelli G
Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy.
Eur J Nucl Med. 1998 Nov;25(11):1489-94. doi: 10.1007/s002590050326.
In stage I cutaneous melanoma, biopsy of the first tumour-draining lymph node (sentinel node, SN) may replace routine elective lymph node dissection (ELND). The patent blue dye (PBD) technique has been shown to be an original method for the localization of the SN, but its sensitivity is sometimes unsatisfactory, depending on the basin where the SN is located. We compared three methods to locate the SN: intraoperative PBD mapping, lymphoscintigraphy (LS) with an aspecific tracer (colloid) and LS with a specific tracer (monoclonal antibody, MoAb). Fifty patients with cutaneous melanoma were enrolled in this study. The day before surgery LS was performed following an intradermal injection of 55 MBq technetium-99m-labelled HSA colloidal particles (25 patients: group A) or 220 MBq of 99mTc-F(ab')2 MoAb 225.28 S (25 patients: group B) around the site of the primary lesion. In group B an equal amount of tracer was injected, as a control, in the contralateral site. Early and delayed images were acquired with a gamma camera and SN(s) marked on the skin. In all 50 patients the PBD technique was also performed immediately before surgery. When a blue node was identified intraoperatively, its radioactivity level was measured with a gamma probe. In the absence of blue coloration, the probe alone was used to detect the SN. Lymphoscintigraphic visualization of SNs was possible in 50/50 patients (100%), a total of 73 SNs (38 in group A and 35 in group B) were found, distributed in 55 basins. Gamma probe detection (GPD) allowed the identification of SNs in 49/50 patients (98%), and 72 SNs in 54 basins were localized. By contrast, using PBD, SNs were stained only in 40/50 patients (50 SNs in 40 basins). A tumour-positive SN was histologically proven in 13 patients (26%). In group B, no increase uptake was observed in the seven positive SNs (6/25 patients) compared with the contralateral uninvolved nodes. In conclusion this study demonstrates that LS combined with GPD is a safe method for detecting SNs and is more sensitive than the PBD technique. The use of MoAb fragments did not show any advantage over the non-specific tracer.
在I期皮肤黑色素瘤中，对首个引流肿瘤的淋巴结（前哨淋巴结，SN）进行活检可替代常规选择性淋巴结清扫术（ELND）。专利蓝染料（PBD）技术已被证明是定位SN的一种原始方法，但其敏感性有时并不令人满意，这取决于SN所在的区域。我们比较了三种定位SN的方法：术中PBD定位、使用非特异性示踪剂（胶体）的淋巴闪烁显像（LS）以及使用特异性示踪剂（单克隆抗体，MoAb）的LS。50例皮肤黑色素瘤患者纳入本研究。手术前一天，在原发灶周围皮内注射55 MBq锝-99m标记的HSA胶体颗粒（25例患者：A组）或220 MBq的99mTc-F(ab')2 MoAb 225.28 S（25例患者：B组）后进行LS。在B组中，作为对照，在对侧部位注射等量的示踪剂。用γ相机采集早期和延迟图像，并在皮肤上标记出SN。所有50例患者在手术前还立即进行了PBD技术。术中发现蓝色淋巴结时，用γ探头测量其放射性水平。在没有蓝色染色的情况下，仅用探头检测SN。50/50例患者（100%）均可通过淋巴闪烁显像观察到SN，共发现73个SN（A组38个，B组35个），分布在55个区域。γ探头检测（GPD）可在49/50例患者（98%）中识别出SN，54个区域定位了72个SN。相比之下，使用PBD时，仅40/50例患者（40个区域中的50个SN）的SN被染色。13例患者（26%）经组织学证实SN有肿瘤转移。在B组中，与对侧未受累淋巴结相比，7个阳性SN（6/25例患者）未观察到摄取增加。总之，本研究表明，LS联合GPD是检测SN的一种安全方法，且比PBD技术更敏感。使用MoAb片段并未显示出比非特异性示踪剂有任何优势。
