THE ORDERLY PROGRESSION OF MELANOMA NODAL METASTASES
THE ORDERLY PROGRESSION OF MELANOMA NODAL METASTASES
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DOI：
10.1097/00000658-199412000-00009
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发表时间：
1994-12-01
影响因子：
9
通讯作者：
BALCH, C
中科院分区：
文献类型：
--
作者：
REINTGEN, D;CRUSE, CW;BALCH, C
目的本研究的目的是确定黑色素瘤淋巴结转移的顺序。背景资料摘要大多数实体瘤被认为表现出随机的淋巴结转移模式。跳跃性淋巴结转移的发生率排除了使用第一站淋巴结盆的采样程序来实现适当的病理分期。恶性黑色素瘤可能与其他恶性肿瘤不同，因为皮肤淋巴流更好地定义，可以准确地映射。淋巴结转移的有序进展的概念是从根本上不同的比什么被认为是发生在自然史中的转移，从大多数其他实体malignancy.Methods的研究者进行术前和术中映射的皮肤mathetics从原发性黑色素瘤，试图确定区域盆地中的“前哨"淋巴结。所有患者均患有肿瘤厚度>0.76 mm的原发性黑色素瘤，并被认为是选择性淋巴结清扫术的候选人。前哨淋巴结定义为原发部位引流的盆中的第一个淋巴结。收集前哨淋巴结并单独提交病理学检查，然后进行完整的淋巴结清扫。检验的零假设是恶性黑色素瘤的淋巴结转移是否发生在前哨和非前哨nodes.Results之间的比例相等，42例患者符合标准的协议的基础上，他们的原发性黑色素瘤的预后因素。34例患者的前哨淋巴结组织学阴性，盆内其余淋巴结也为阴性。因此，未记录跳跃转移。8例患者前哨淋巴结阳性，其中7例前哨淋巴结为唯一的病变部位。在这7例患者中，前哨淋巴结转移的频率为92%，而较高的淋巴结无转移性疾病。根据二项分布，比较前哨淋巴结组和非前哨淋巴结组的淋巴结受累情况。在淋巴结转移分布均匀的零假设下，所有7个未配对的观察结果均表明前哨淋巴结受累的概率为0.008。结论皮肤黑色素瘤淋巴结转移不是随机事件。淋巴盆中的前哨淋巴结可以被单独绘制和识别，并且它们已经被证明包含黑色素瘤转移的第一个证据。这一信息可用于彻底改变黑色素瘤护理，以便只有那些有淋巴结转移性疾病证据的患者才能承受完全淋巴结清扫的发病率和费用。由于前哨淋巴结的组织学能准确反映淋巴池其余部分的组织学，因此前哨淋巴结活检获得的信息可作为黑色素瘤的预后因素。这些发现证明了有效的病理分期，没有降低护理标准，并减少发病率与侵略性，合理的手术方法。
Objective The aim of this study was to determine the order of melanoma nodal metastases.Summary Background Data Most solid tumors are thought to demonstrate a random nodal metastatic pattern. The incidence of skip nodal metastases precluded the use of sampling procedures of fi,st station nodal basins to achieve adequate pathological staging. Malignant melanoma may be different from other malignancies in that the cutaneous lymphatic flow is better defined and can be mapped accurately. The concept of an orderly progression of nodal metastases is radically different than what is thought to occur in the natural history of metastases from most other solid malignancies.Methods The investigators performed preoperative and intraoperative mapping of the cutaneous lymphatics from the primary melanoma in an attempt to identify the ''sentinel'' lymph node in the regional basin. All patients had primary melanomas with tumor thicknesses >0.76 mm and were considered candidates for elective lymph node dissection. The sentinel lymph node was defined as the first node in the basin from which the primary site drained. The sentinel lymph node was harvested and submitted separately to pathology, followed by a complete node dissection. The null hypothesis tested was whether nodal metastases from malignant melanoma occurred in equal proportions among sentinel and nonsentinel nodes.Results Forty-two patients met the criteria of the protocol based on prognostic factors of their primary melanoma. Thirty-four patients had histologically negative sentinel nodes, with the rest of the nodes in the basin also being negative. Thus, there were no skip metastases documented. Eight patients had positive sentinel nodes, with seven of the eight having the sentinel node as the only site of disease, In these seven patients, the frequency of sentinel nodal metastases was 92%, whereas none of the higher nodes had documented metastatic disease. Nodal involvement was compared between the sentinel and nonsentinel nodal groups, based on the binomial distribution. Under the null hypothesis of equality in distribution of nodal metastases, the probability that all seven unpaired observations would demonstrate that involvement of the sentinel node is 0.008.Conclusions The data presented demonstrate that nodal metastases from cutaneous melanoma are not random events. The sentinel lymph nodes in the lymphatic basins can be mapped and identified individually, and they have been shown to contain the first evidence of melanoma metastases. This information can be used to revolutionize melanoma care so that only those patients with evidence of nodal metastatic disease are subjected to the morbidity and expense of a complete node dissection. Because sentinel node histology accurately reflects the histology of the remainder of the lymphatic basin, information gained from the sentinel node biopsy can be used as a prognostic factor for melanoma. These findings demonstrate effective pathologic staging, no decrease in standards of care, and a reduction of morbidity with a less aggressive, rational surgical approach.