Lymphatic mapping and sentinel lymphadenectomy after wide local excision of primary melanoma.
Lymphatic mapping and sentinel lymphadenectomy after wide local excision of primary melanoma.
复制标题
原发性黑色素瘤广泛局部切除后的淋巴标测和前哨淋巴结切除术。
DOI：
10.1016/s1072-7515(99)00144-1
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发表时间：
1999
影响因子：
5.2
通讯作者：
Morton,DL
中科院分区：
文献类型：
--
作者：
Kelemen,PR;Essner,R;Foshag,LJ;Morton,DL
背景资料：淋巴映射和前哨淋巴结切除术（LM/SL）通常避免在已经经历了广泛的局部切除术（WLE）的原发性黑色素瘤的患者，因为担心破坏皮肤淋巴管可能会改变淋巴流向前哨淋巴结。我们审查了精心挑选的患者谁经历了LM/SL后WLE，以确定的情况下，可能使这种方法，否则安全和临床accurate.Study设计：从我们的黑色素瘤数据库的8,300例患者，其中1,015经历了LM/SL，我们回顾性地确定了47例患者谁以前经历了WLE。收集患者和肿瘤特征，并与临床文件中的随访数据进行比较。结果：LM/SL前中位WLE手术切缘为2.0 cm，大多数患者有肢体病变。47例患者中有11例（23%）有肿瘤累及的前哨淋巴结，其中8例（73%）有孤立性淋巴结转移。中位随访时间为36个月，3例前哨淋巴结阴性患者发生淋巴结复发。其中2例患者在病理学复查时前哨淋巴结阳性，不认为淋巴标测外科手术失败。第三例患者发生转移和延迟淋巴结复发。另一名患者，谁有一个原发性肿瘤的躯干，开发了一个淋巴结复发盆对面确定的淋巴结造影。该技术的总体错误率为4/36（11%）。这包括2例病理误诊（5.6%），1例淋巴结复发与过境区域转移（2.8%），1例淋巴映射错误（2.8%.Conclusions）：LM/SL可以谨慎地进行在谁经历了以前的WLE的患者，如果原发切除边缘不大于2.0厘米，主要是不是在一个区域的模糊引流。当黑色素瘤切缘较大时，淋巴映射可能不准确，特别是当伤口用旋转皮瓣闭合时，以及当黑色素瘤位于头颈部或躯干区域时。
Background: Lymphatic mapping and sentinel lymphadenectomy (LM/SL) are generally avoided in patients who have already undergone wide local excision (WLE) of a primary melanoma, because of concern that disruption of the cutaneous lymphatics might alter lymphatic flow to the sentinel node. We reviewed carefully chosen patients who had undergone LM/SL after WLE to identify circumstances that might make this approach otherwise safe and clinically accurate.Study Design: From our melanoma database of 8,300 patients, of whom 1,015 had undergone LM/SL, we retrospectively identified 47 patients who had previously undergone WLE. Patient and tumor characteristics were collected and compared with followup data from clinic files.Results: Median WLE surgical margins before LM/SL were 2.0 cm and most patients had extremity lesions. Eleven of the 47 patients (23%) had tumor-involved sentinel nodes, and 8 of these patients (73%) had a solitary nodal metastasis. With a median followup period of 36 months, 3 sentinel node-negative patients developed nodal recurrences. Two of these patients had positive sentinel nodes on pathology re-review and were not considered failures of the lymphatic mapping surgical procedure. The third patient developed in-transit metastases and delayed nodal recurrence. An additional patient, who had a primary tumor on the trunk, developed a nodal recurrence in the basin opposite that identified by lymphoscintigraphy. The overall error rate of the technique was 4 in 36 (11%). This included 2 pathology misdiagnoses (5.6%), 1 nodal recurrence associated with in-transit regional metastases (2.8%), and 1 lymphatic mapping error (2.8%).Conclusions: LM/SL can be cautiously performed in patients who have undergone previous WLE if the primary resection margin was no greater than 2.0 cm and the primary was not in a region of ambiguous drainage. Lymphatic mapping may be inaccurate when melanomas have been resected with large margins, especially if the wound was closed with rotation flaps, and when melanomas are on the head and neck or trunk regions.