The Use of Intraoperative Radiolymphoscintigraphy for Sentinel Node Biopsy in Patients with Malignant Melanoma
The Use of Intraoperative Radiolymphoscintigraphy for Sentinel Node Biopsy in Patients with Malignant Melanoma
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术中放射淋巴闪烁扫描在恶性黑色素瘤患者前哨淋巴结活检中的应用
DOI：
10.1111/j.1524-4725.1996.tb00623.x
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发表时间：
1996
影响因子：
2.4
通讯作者：
N. Fenske
中科院分区：
文献类型：
--
作者：
Glass Lf;J. Messina;W. Cruse;K. Wells;D. Rapaport;G. Miliotes;C. Berman;D. Reintgen;N. Fenske
背景技术Morton及其同事（Arch Surg 1992;127：392-9）最近介绍了选择性淋巴结切除术或“前哨淋巴结”活组织检查，以对患有中度和重度恶性黑素瘤的患者进行分期。它已被证明是一种有效的方法，以确定淋巴结盆地的转移风险，而没有一个完整的淋巴结清扫的发病率。大多数活检可以在局部麻醉下进行，切口小，但技术困难偶尔会导致不成功的探索。前哨淋巴结的识别可以通过术中放射淋巴显像来增强，这是Alex和Krag（Surg Oncol 1993;137-43）介绍的一种技术，使用放射性标记的硫胶体和手持式伽马探针。目的采用术中放射淋巴显像结合1%阿海珠林蓝染色对148例厚度大于0.76 mm或Clark级TV黑色素瘤的前哨淋巴结进行定位。分离、收获前哨淋巴结，并使用常规组织病理学和S-100和HMB-45抗体的免疫组织化学进行检查。结果两种方法联合应用，前哨淋巴结定位成功率为97%. 21例（34%）患者有微转移，其中17例随后接受了完全淋巴结清扫术。275个前哨淋巴结中有220个（80%）是放射性或“热”的，而单独使用蓝色染料的275个中有165个（60%）。4例微转移患者的前哨淋巴结γ探针检测呈阳性，而蓝色染料定位技术检测呈阴性。结论我们的研究结果表明，术中使用手持式伽玛探测探头的放射性淋巴显像可提高选择性淋巴结切除术中前哨淋巴结的识别率。这可能会减少使用活性蓝染料技术进行淋巴映射的“不成功探索”的数量，并吸引更多的外科医生，包括皮肤科医生。
background Selective lymphadenectomy or “sentinel node” biopsy Ms been introduced recently by Morton and colleagues (Arch Surg 1992;127:392–9) to stage patients with intermediate and thick malignant melanomas. It has proven to be an effective way to identify nodal basins at risk for metastasis without the morbidity of a complete lymph node dissection. The majority of biopsies can be performed under local anesthesia with small incisions, but technical difficulties occasionally result in unsuccessful explorations. Identification of the sentinel node can be enhanced by a intraoperative radiolymphoscintigraphy, a technique introduced Alex and Krag (Surg Oncol 1993;137–43) tint uses radiolabeled sulfur colloid and a hand‐held gamma probe. objective We used intraoperative radiolymphoscintigraphy in conjunction with 1% lymphazurin blue dye to define the sentinel node(s) in 148 patients with greater than 0.76 mm in thickness or Clark level TV melanomas. Sentinel lymph nodes were isolated, harvested, and examined using conventional histopathology, and immunohistochemistry for S‐100 and HMB‐45 antibodies. results The overall success rate of sentinel lymph node localization was 97% using a combination of the two techniques. Twenty‐one (34%) patients had micrometastasis, and 17 of these subsequently underwent complete lymph node dissection. A total of 220 of 275 (80%) sentinel nodes harvested were radioactive or “hot” compared with 165 of 275 (60%) with the blue dye alone. Four of the patients with micrometastasis had sentinel nodes positive by gamma probe, but negative by blue dye mapping techniques. conclusion Our results suggest that intraoperative radiolymphosintigraphy using a hand‐held gamma detecting probe improves the identification of sentinel lymph nodes during selective lymphadenectomy. This may reduce the number of “unsuccessful explorations” using the vital blue dye technique for lymphatic mapping, and appeal to a greater variety of surgeons, including dermatologic surgeons.
影响因子：
--
作者：
D. Morton;Wenger Dr;J. Wong;J. Economou;L. Cagle;Storm Fk;L. Foshag;A. Cochran
通讯作者：
D. Morton;Wenger Dr;J. Wong;J. Economou;L. Cagle;Storm Fk;L. Foshag;A. Cochran
中等厚度原发性黑色素瘤患者选择性淋巴结清扫术的疗效。
影响因子：
9
作者：
Reintgen,DS;Cox,EB;McCartyJr,KS;Vollmer,RT;Seigler,HF
通讯作者：
Seigler,HF