The application of sentinel node radiolocalization to solid tumors of the head and neck: A 10-year experience
The application of sentinel node radiolocalization to solid tumors of the head and neck: A 10-year experience
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DOI：
10.1097/00005537-200401000-00002
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发表时间：
2004-01-01
期刊：
影响因子：
2.6
通讯作者：
Alex, JC
中科院分区：
文献类型：
--
作者：
Alex, JC
目标/假设。本研究的目的是在猫模型中开发一种易于掌握、准确、微创的前哨淋巴结放射定位活检（SNRLB）技术;将其与蓝色染料标测技术进行比较;并测试前哨淋巴结放射定位活检在三种头颈部肿瘤类型中的适用性：NO恶性黑色素瘤、NO默克尔细胞癌和NO鳞状细胞癌。研究设计：在猫模型和三种头颈肿瘤类型中进行了前瞻性连续系列研究：无恶性黑色素瘤（43例患者）、无默克尔细胞癌（8例患者）和无鳞状细胞癌（20例患者）。方法.前哨淋巴结放射定位活检技术进行了分析，在8只猫，并与蓝色染料映射。前哨淋巴结γ发射的模式进行了记录。通过放射定位活检确定蓝色染料和前哨淋巴结的定位成功率。在人体研究中，所有患者均以类似方式进行前哨淋巴结放射定位活检。在手术当天早晨，每例患者均进行了前哨淋巴结放射定位活检，采用皮内或瘤周注射锝。Tc 99 m硫胶体。前哨淋巴结定位在皮肤表面使用手持式伽玛探测器。伽马计数测量结果如下。1)切口前体内的“热点”点/节点，2）解剖过程中体内的热点/节点，3）离体热点/节点，4）热点/节点去除后的淋巴床，以及5）手术室中的背景。确定了第一个引流淋巴结，并对该淋巴结进行了活检。单独提交放射性前哨淋巴结进行常规组织病理学评价。对黑色素瘤和默克尔细胞癌患者进行术前淋巴结造影。在头颈部鳞状细胞癌患者中，研究了前哨淋巴结和剩余淋巴盆之间的关系，所有患者均接受了完整的颈部清扫术。报告了每种头颈部肿瘤类型的前哨淋巴结放射定位活检的准确性、微转移率、假阴性率和长期复发率。在黑色素瘤研究中，比较了前哨淋巴结放射定位活检、蓝染料标测和淋巴结造影术的前哨淋巴结定位成功率。在默克尔细胞癌研究中，评价了前哨淋巴结放射定位活检和淋巴结造影的定位率。在头颈部鳞状细胞癌研究中，确定了前哨淋巴结放射定位活检的定位率和前哨淋巴结相对于剩余淋巴床的预测价值。所有结果进行统计学分析。结果：在研究的不同头颈部肿瘤类型中，前哨淋巴结放射定位活检的成功率接近95%。前哨淋巴结放射定位活检在识别前哨淋巴结方面比蓝染料标测或淋巴结造影术更成功，尽管这三种技术是互补的。没有前哨淋巴结阴性患者发生区域淋巴结复发的情况。在头部和颈部鳞状细胞癌的研究中，没有一个情况下，前哨淋巴结是阴性的，其余的淋巴结切除术标本是positive.Conclusion：在头部和颈部肿瘤，通过淋巴管传播，它似乎前哨淋巴结放射定位活检可以进行一个高成功率。该技术具有较低的假阴性率，并且可以通过小切口进行。在头颈部鳞状细胞癌中，前哨淋巴结的组织学表现似乎反映了患者的区域淋巴结状态。
Objectives/Hypothesis. The goals of the research study were to develop an easily mastered, accurate, minimally invasive technique of sentinel node radiolocalization with biopsy (SNRLB) in the feline model; to compare it with blue-dye mapping techniques; and to test the applicability of sentinel node radiolocalization biopsy in three head and neck tumor types: NO malignant melanoma, NO Merkel cell carcinoma, and NO squamous cell carcinoma. Study Design: Prospective consecutive series studies were performed in the feline model and in three head and neck tumor types: NO malignant melanoma (43 patients), NO Merkel cell carcinoma (8 patients), and NO squamous cell carcinoma (20 patients). Methods. The technique of sentinel node radiolocalization with biopsy was analyzed in eight felines and compared with blue-dye mapping. Patterns of sentinel node gamma emissions were recorded. Localization success rates were determined for blue dye and sentinel node with radiolocalization biopsy. In the human studies, all patients had sentinel node radiolocalization biopsy performed in a similar manner. On the morning of surgery, each patient had sentinel node radiolocalization biopsy of the sentinel lymph node performed using an intradermal or peritumoral injection of technetium. Tc 99m sulfur colloid. Sentinel nodes were localized on the skin surface using a handheld gamma detector. Gamma count measurements were obtained for the following. 1) the "hot" spot/node in vivo before incision, 2) the hot spot/node in vivo during dissection, 3) the hot spot/node ex vivo, 4) the lymphatic bed after hot spot/node removal, and 5) the background in the operating room. The first draining lymph node(s) was identified, and biopsy of the node was performed. The radioactive sentinel lymph node(s) was submitted separately for routine histopathological evaluation. Preoperative lymphoscintigrams were performed in patients with melanoma and patients with Merkel cell carcinoma. In patients with head and neck squamous cell carcinoma, the relationship between the sentinel node and the remaining lymphatic basin was studied and all patients received complete neck dissections. The accuracy of sentinel node radiolocalization with biopsy, the micrometastatic rate, the false-negative rate, and long-term recurrence rates were reported for each of the head and neck tumor types. In the melanoma study, the success of sentinel node localization was compared for sentinel node radiolocalization biopsy, blue-dye mapping, and lymphoscintigraphy. In the Merkel cell carcinoma study, localization rates were evaluated for sentinel node radiolocalization biopsy and lymphoscintigraphy. In the head and neck squamous cell carcinoma study, the localization rate of sentinel node radiolocalization biopsy and the predictive value of the sentinel node relative to the remaining lymphatic bed were determined. All results were analyzed statistically. Results: Across the different head and neck tumor types studied, sentinel node radiolocalization biopsy had a success rate approaching 95%. Sentinel node radiolocalization biopsy was more successful than blue-dye mapping or lymphoscintigraphy at identifying the sentinel node, although all three techniques were complementary. There was no instance of a sentinel node-negative patient developing regional lymphatic recurrence. In the head and neck squamous cell carcinoma study, there was no instance in which the sentinel node was negative and the remaining lymphadenectomy specimen was positive.Conclusion: In head and neck tumors that spread via the lymphatics, it appears that sentinel node radiolocalization biopsy can be performed with a high success rate. This technique has a low false-negative rate and can be performed through a small incision. In head and neck squamous cell carcinoma, the histological appearance of the sentinel node does appear to reflect the regional nodal status of the patient.