THE IMPACT OF DYNAMIC LYMPHOSCINTIGRAPHY AND GAMMA-PROBE GUIDANCE ON SENTINEL NODE BIOPSY IN MELANOMA
THE IMPACT OF DYNAMIC LYMPHOSCINTIGRAPHY AND GAMMA-PROBE GUIDANCE ON SENTINEL NODE BIOPSY IN MELANOMA
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DOI：
10.1007/bf00801606
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发表时间：
1995-11-01
期刊：
影响因子：
--
通讯作者：
HOEKSTRA, OS
中科院分区：
文献类型：
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作者：
PIJPERS, R;COLLET, GJ;HOEKSTRA, OS
在皮肤黑色素瘤，活检的第一个肿瘤引流淋巴结（前哨淋巴结，SN）可以取代常规选择性淋巴结清扫术（ELND）。即使在有经验的人手中，使用活体染料的原始技术在20%的情况下也无法定位SN。在这项研究中，我们调查了淋巴结造影术和伽马探针的使用是否有益于该过程。在41名患者中，在切除肿瘤的疤痕周围皮内注射了99 m锝-胶体白蛋白。随后是动态和晚期静态成像，第一个病灶积聚被认为是SN。在所有患者中，至少有一个SN被发现，在95%的第一个20分钟内。通过显示多个或分支的淋巴管，动态淋巴管造影区分溢出和多个SN。在所有情况下，初始病灶保留最高放射性分数至少18 h。伽玛探头在腋窝和颈部特别有用，它可以准确显示最佳切口部位，并有助于寻找深层淋巴结。γ探针定位的SN在93%的病例中呈染色阳性。20%的患者SN含有转移，仅在这些患者中进行ELND，这表明SN是8例病例中唯一的转移性淋巴结。我们的结论是，动态淋巴结造影术是必不可少的SN定位，示踪剂动力学允许灵活的手术时间，手术过程中受益于使用伽马探头。
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.