Radioguided sentinel lymph node biopsy in patients with malignant cutaneous melanoma: the nuclear medicine contribution
Radioguided sentinel lymph node biopsy in patients with malignant cutaneous melanoma: the nuclear medicine contribution
复制标题
DOI：
10.1002/jso.20027
复制
发表时间：
2004-03-01
影响因子：
2.5
通讯作者：
Strauss, HW
中科院分区：
文献类型：
--
作者：
Mariani, G;Erba, P;Strauss, HW
对于其他实体肿瘤，恶性皮肤黑色素瘤从第一级到第二级，通过淋巴系统以一种合乎逻辑的方式进行引流。因此，遇到的第一个淋巴结(前哨淋巴结)很可能是第一个受到转移影响的，而一个阴性的前哨淋巴结使同一淋巴盆地中的其他淋巴结受到影响的可能性很小。前哨淋巴结活检可以区分没有淋巴结转移的患者，这些患者可以避免淋巴结盆地清扫及其相关的淋巴水肿风险，以及那些有转移受累的患者可能从额外的治疗中受益。考虑到平均只有20%的Breslow厚度在1.5 mm到4 mm之间的黑色素瘤患者在其前哨淋巴结(S)有转移，因此该手术作为一种微创手术具有显著的优势，因此是选择性淋巴清扫手术的候选对象。起源于皮肤黑色素瘤的细胞位于真皮和表皮之间，这一区域引流到网状真皮的内部淋巴管网络，进而进入皮下较大的集合淋巴管。因此，组织间注射放射性胶体用于淋巴显像和随后的放射导向前哨淋巴结活检的最佳方式是通过皮内/皮下注射。根据当地经验和可获得性，不同大小范围的TC-99m标记胶体同样适用于皮肤黑色素瘤患者的放射导向前哨淋巴结活检。对于位于头、颈和躯干中线区域的黑色素瘤，应特别考虑不明确的淋巴引流，这通常需要在肿瘤周围进行实质上的间质注射或手术切除黑色素瘤后留下的疤痕。淋巴核素扫描是前哨淋巴结活检术中必不可少的一部分，因为图像是用来引导外科医生找到结节的位置的(S)。前哨淋巴结计数应显著高于背景计数(术中C至少为10：1)。前哨结节切除后，必须重新检查手术床，以确保所有放射性部位都已确定并移走进行分析。在进行大量手术的机构中，放射导向定位黑色素瘤患者前哨淋巴结的成功率约为98%，结合生命蓝染色技术，成功率接近99%。该手术正在成为皮肤黑色素瘤患者的标准护理，因为它具有很高的预后价值，这使得该手术被纳入最新版本的TNM分期系统。
As for other solid tumors, malignant cutaneous melanoma drains in a logical way through the lymphatic system, from the first to subsequent levels. Therefore, the first lymph node encountered (the sentinel node) will most likely be the first to be affected by metastasis, and a negative sentinel node makes it highly unlikely that other nodes in the same lymphatic basin are affected. Sentinel lymph node biopsy distinguishes patients without nodal metastases, who can avoid nodal basin dissection with its associated risk of lymphedema, and those with metastatic involvement who might benefit from additional therapy. This procedure represents a significant advantage as a minimally invasive procedure, considering that only an average 20% of melanoma patients with Breslow thickness between 1.5 and 4 mm harbour metastasis in their sentinel node(s) and are therefore candidates to elective lymph node dissection procedures. The cells that originate cutaneous melanomas are located between dermis and epidermis, a zone that drains to the inner lymphatic network in the reticular dermis, in turn to larger collecting lymphatics in subcutis. Therefore, the optimal modality of interstitial administration of radiocolloids for lymphoscintigraphy and subsequent radioguided sentinel lymph node biopsy is through intradermal/subdermal injection. Tc-99m-labeled colloids in various size ranges are equally adequate for radioguided sentinel lymph node biopsy in patients with cutaneous melanoma, depending on local experience and availability. For melanomas located in the midline area of the head, neck, and trunk, particular consideration should be given to ambiguous lymphatic drainage, which frequently requires interstitial administration virtually all around the tumor or surgical scar from prior excision of the melanoma. Lymphoscintigraphy is an essential part of radioguided sentinel lymph node biopsy because images are used to direct the surgeon to the sites of the node(s). The sentinel lyrnph node should have a significantly higher count than that of background (at least C, 10: 1 intraoperatively). After removal of the sentinel node, the surgical bed must be reexamined to ensure that all radioactive sites are identified and removed for analysis. The success rate of radioguidance in localizing the sentinel lymph node in melanoma patients is about 98% in institutions where a high number of procedures are performed, approaching 99% when combined with the vital blue dye technique. The procedure is becoming the standard of care for patients with cutaneous melanoma because of its high prognostic value that has led to include the procedure in the most recent version of the TNM staging system.