Sentinel node biopsy in melanoma patients: Dynamic lymphoscintigraphy followed by intraoperative gamma probe and vital dye guidance
Sentinel node biopsy in melanoma patients: Dynamic lymphoscintigraphy followed by intraoperative gamma probe and vital dye guidance
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DOI：
10.1007/s002689900307
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发表时间：
1997-10-01
影响因子：
2.6
通讯作者：
Teule, GJJ
中科院分区：
文献类型：
--
作者：
Pijpers, R;Borgstein, PJ;Teule, GJJ
活检的第一个肿瘤引流淋巴结（前哨淋巴结，SN）必然成为程序的选择，在区域分期的黑色素瘤患者。肿瘤阴性SN实际上排除了淋巴转移，并避免了淋巴结清扫的需要。本研究的目的是将三种已知技术的优点联合收割机，以提高SN活检的成功率。共对135例患者的150个引流区域进行了评价。首先，术前动态和静态淋巴结造影后注射锝99 m胶体白蛋白。在所有患者中，97%的患者在注射示踪剂后20分钟内在淋巴引流区观察到1至3个与SN一致的局灶性积聚。在注射示踪剂后2至24小时，使用手持式伽马探头进行SN的围手术期识别，以估计小切口的最佳部位并指导准备。术前注射活体染料，以便于SN的最终识别和活检。共对216例SN进行了活检。在30个引流区的39个SN中发现了微转移，其中22个SN是唯一的淋巴结。在30个引流区域中的5个中，SN不含蓝色染料，如果没有伽马探头，将不会被发现。到目前为止（随访233-691天），在SN无肿瘤的淋巴引流区没有复发。得出的结论是，通过结合这三种技术，可以在所有患者中检测和切除SN。该程序结合了陡峭的学习曲线和高灵敏度。
Biopsy of the first tumor-draining lymph node (sentinel node, SN) is bound to become the procedure of choice in regional staging of melanoma patients. A tumor-negative SN virtually excludes lymphatic metastases and obviates the need for lymph node dissection. The aim of this study was to combine the advantages of three known techniques to improve the yield of successful SN biopsies. A total of 150 drainage areas in 135 patients was evaluated. First, preoperative dynamic and static lymphoscintigraphy was performed after injection of technetium 99m colloidal albumin. In all patients one to three focal accumulations, concordant with SNs, were seen in the lymphatic drainage areas, in 97% within 20 minutes from injection of the tracer. Peroperative identification of the SN, 2 to 24 hours after injection of the tracer, was done with a handheld gamma probe to estimate the optimal site for the small incision and to guide preparation. Vital dye was injected just preoperatively and served to facilitate the final identification and biopsy of the SN. A total of 216 SNs were biopsied. Micrometastases were found in 39 SNs in 30 drainage areas, and in 22 of the 30 the SN was the only node harboring tumor. In 5 of 30 drainage areas, the SN did not contain blue dye and would not have been found without the gamma probe. Up to now (follow-up 233-691 days) no recurrence has developed in the lymphatic drainage areas where the SN was tumor-free. It was concluded that by combining these three techniques the SN could be detected and excised in all patients. The procedure combines a steep learning curve with high sensitivity.