Sentinel lymph node biopsy for cutaneous head and neck melanomas.
Sentinel lymph node biopsy for cutaneous head and neck melanomas.
复制标题
头颈部皮肤黑色素瘤的前哨淋巴结活检。
DOI：
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复制
发表时间：
2002
期刊：
影响因子：
--
通讯作者：
D. Kraus
中科院分区：
文献类型：
--
作者：
S. Patel;D. Coit;A. Shaha;M. Brady;J. Boyle;Bhuvanesh Singh;J. Shah;D. Kraus
客观化
目的报告皮肤头颈部黑色素瘤前哨淋巴结活检(SLNB)的结果。
设计
连续系列随访中位数为20个月。
设置
三级癌症护理中心。
病人
56例临床结节阴性的CMHN患者，中位Breslow厚度2.6 mm(范围0.2-20.0 mm)。
干预措施
术前4h内行99m硫代胶体淋巴显像(PLSG)，术中手持式伽玛探头定位(IHGP)。48例术中注射1%异硫丹蓝(IBD)。对转移性SLN行即刻结节清扫，术中冰冻切片分析，监测阴性SLN。
主要结果衡量标准
SLN识别率、SLN和非SLN阳性、同盆复发、疾病特异性和无复发生存率。
结果
联合应用IHGP和IBD可将SLN的确诊率从IHGP的93%和单纯IBD的73%提高到96%。冰冻切片分析有4例SLN阳性。在48例患者中，47例SLNB阴性可准确预测区域淋巴结控制，而5例区域淋巴疾病患者中有1例漏诊。SLNB失败的4例患者全部存活，无复发。两年Kaplan-Meier病特异性存活率和无复发存活率分别为91%和88%。SLN阴性患者的两年特定疾病存活率为93%，SLN阳性患者为50%(P=.20)。
结论
PLSG联合IHGP和IBD可提高SLNB的成功率。虽然SLNB是CMHN引流淋巴盆地状态的可靠指标，但SLN阴性的患者必须进行更长时间的观察，以了解该手术的真正意义。
OBJECTIVE
To report the results of sentinel lymph node biopsy (SLNB) for cutaneous head and neck melanomas (CMHNs).
DESIGN
Consecutive series followed for a median of 20 months.
SETTING
Tertiary cancer care center.
PATIENTS
Fifty-six individuals with clinically node-negative CMHN, median Breslow thickness, 2.6 mm (range, 0.2-20.0 mm).
INTERVENTIONS
Preoperative technetium 99m sulfur colloid lymphoscintigraphy (PLSG) followed within 4 hours by intraoperative handheld gamma probe localization (IHGP). Intraoperative injection of 1% isosulfan blue dye (IBD) was used in 48 patients. Immediate completion nodal dissection was performed for metastatic SLNs on intraoperative frozen section analysis and monitoring for negative SLNs.
MAIN OUTCOME MEASURES
Rate of SLN identification, SLN and non-SLN positivity, same-basin recurrence, and disease-specific and recurrence-free survival.
RESULTS
Combination of IHGP and IBD improved SLN identification to 96% from 93% for IHGP and 73% for IBD alone. Four patients had a positive SLN on frozen section analysis. A negative SLNB correctly predicted regional nodal control in 47 of 48 patients but missed 1 of 5 patients who had regional lymphatic disease. All 4 patients who failed SLNB remain alive and free of recurrent disease. Two-year Kaplan-Meier disease-specific and relapse-free survival was 91% and 88%, respectively. Two-year disease-specific survival was 93% for SLN-negative patients and 50% for SLN-positive patients (P=.20).
CONCLUSIONS
Combining PLSG with IHGP and IBD improves the success rate of SLNB. Although SLNB is a reliable indicator of the status of the draining lymphatic basins in CMHN, patients with negative SLNs must be observed for longer periods to understand the true implications of the procedure.
原发性黑色素瘤广泛局部切除后的淋巴标测和前哨淋巴结切除术。
影响因子：
5.2
作者：
Kelemen,PR;Essner,R;Foshag,LJ;Morton,DL
通讯作者：
Morton,DL
皮肤黑色素瘤患者中三种淋巴闪烁显像剂的动力学。
DOI：
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发表时间：
1998
期刊：
Journal of nuclear medicine : official publication, Society of Nuclear Medicine
影响因子：
--
作者：
Glass,EC;Essner,R;Morton,DL
通讯作者：
Morton,DL